Lumbopelvic Spine Intervention: Mobility Deficits - Lecture 3

Question 1

Where do pts w/ back pain w/ mobility deficits not have pain passed

Answer 1

Normally back pain does not go passed the knee

Question 2

What kind of back pain is back pain w/ mobility deficits?

Answer 2

Dull achy type back pain

Question 3

Does back pain w/ mobility deficits follow a dermatomal pattern?

Answer 3

No

Question 4

KNOW: Back pain w/ mobility deficits can come w/ or w/o leg pain and DOES NOT travel passed the knees

Question 5

Back pain w/ mobility deficits does or does not affect lumbar spine mobility?

Answer 5

Does affect it

Question 6

KNOW: We would do mobility testing w/ back pain w/ mobility deficits

we would also do PIVM testing (physiological movement)

typically yeild hypo mobility

Question 7

What is the tissue like in the area for back pain w/ mobility deficits?

Answer 7

Very gaurded

Think your back: its back pain w/ mobility issues (moving hurts) and the muscles in that area are all very tense and guarded

The muscles are tight because they’re trying to protect that area
* the erector spinae along the pts back might feel very rigid (not much plyobility)

Question 8

For back pain w/ mobility deficits - think weekend warrior that just twist their back and doesnt want to move it and their muscles have become very tense and guarded

Question 9

These are facet reffered pain

NOTE: these reffereals are never down passed the knee

Fall under back pain w/ mobility deficits

Question 10

How to know if muscle refferal isnt coming from a facet?

Answer 10

Push on it

You would also do myotome / dermatome / babinski / clonus / DTRs to make sure its not a radicular issue

Question 11

dont memorize

Question 12

KNOW: the QL is on all the time because its a stabilizer muscle. So it often refferes pain

Referes to iliac rest / greater trochanter
* So differential diagnosis are things like greater troachnteric pain syndrome
* Push on greater trochanter and see if it brings on pain (wont because its being refered from QL which you arent pushing on)
* Palpating around that QL will bring on that comprabile pain if its whats bringing on the issues

Question 13

Glute med / glute min / QL / piriformis are common muscle pain generatoes (dont memorze those specificially) just knwo musclar reffered pain can be causing that back pain

Question 14

Mobility deficits: LBP - SYMPTOM MODULATION PHASE (controlling symptoms phase) - symptoms are vollatile and not under control

• Thurst / non thurst manipulation to reduce pain and distability (then they can exercise)
• Find a position that centralizes (their directional preference)
• Gentle mobility/self mobilization EX
• Education (tell them not to avoid extension, just reduce the amount of extension we do until symptoms are more stable)
• Heat / cold / ultrasound / dry needling / cupping etc. - modalities used to reduce pain (don’t let them get stuck on this to much –> we don’t want them to get hooked on it)

Question 15

What two things do we need present for thrust manipulation in the lumbar spine?

Answer 15

Duration of symptoms < 16 days

No symptoms distal to the knee

(should also not have any red flags)

Question 16

KNOW: Mobility / self mobilization EX are a great follow up to mobilization / manipulation of the spine
* do exercises in the motion you just gained
* If your interventions were to improve extension do extension based exercises in the new mobility you just gained

Question 17

How do we get pts w/ LBH w/ mobility deficits from symptoms mobulation to movement control

Answer 17

mobility exercise

Question 18

Treating LBP w/ mobility deficits under symptom modulation:
* Disibility =
* Symtom staus =
* Pain =
* What 4 treatments do we do for them?

Answer 18

Disability = high
Symptom status = volatile
Pain = high to moderate (likely to change)

1) Directional preference exercises (put that pain back where it came from)

2) mobilization / manipulation (if they fit guidelines [<16 days / no symptoms passed the knee] for manipulation)

3) Traction (and several other modalities to treat pain)

4) Active rest

5) mobilization / self mobilization exercises (repeated movements to gain that extra mobilization they just got from the manipulation)

NOTE: we do mobility EX to get them from symptom modulation –> movement control

Question 19

The LBP pt has now progressed into the movement control phase
* distability =
* Symptom status =
* Pain =
* Treatment

Answer 19

Distability = moderate
Symptom status = stable
Pain = moderate to low

1) Sensiomotor EX
2) Stabilization EX
3) Flexibility EX
4) Education
5) More aggressive mobility / self-mobilization EX
6) Stretching EX
7) Spinal mobilization / manipulation
8) Manual therapy for surrouunding soft tissue

Question 20

Global stability

Answer 20

Muscles can meet activation, acquistion, and assimilation needs of lumbar spine movement

Question 21

Functional Optimization for mobility deficits w/ LBP:
* Distability
* Symptom status
* Pain
* Treatment 4)

Answer 21

Distability = low
Symptom status = controlled
Pain = low to absent

1) Strengthn and condition EX
2) Work- or sport specific tasks
3) Aerobic EX
4) general fitness EX

NOTE: at this point were not longer flexion based or extension based –> were at the end of their treatment

Use pt specific goals here and work on them