Lumbopelvic Spine: Treatment based classification (intro) - Lecture 2 Flashcards
How many weeks does most back pain progress occur?
first 6 weeks then slows
Most pts w/ back pain will be pain free in ____
6-8 weeks
KNOW: Its more serious is pack pain is down the leg (takes longer to rehab because that back pain has been peripheralized –> we have to start by centralizing it)
KNOW: Worsening of neurologic symptoms are always a red flag
If the pt has high disability, volatile symptoms (easily preturbed) and high to moderate pain. Would they get symptom modulation, movement control, or functional optimization
symptom modulation
*Directional preference
* Manipulation/mobilization
* traction
* active rest
if a pt has moderate disability, stable symptoms (I know how to calm down symptoms and make them angery) and moderate to low pain. Would they get symptom modulation, movement control, or functional optimization
Movement control
* Sensorimotor EX
* Stabilization EX
* Flexibility EX
if a pt has low distability, controlled symptoms, and low to absent pain. Would they get symptom modulation, movement control, or functional optimization
functional optimization
* Strength and conditioning EX
* Work- or sport specific tasks
* Aerobic EX
* General fitness EX
How do you get a pt from symptom modulation to movement control?
Mobility
While were in pain control we start working towards mobility to get into movement control
How do you get a pt from movement contorl into functional optimization?
endurance Ex
- to get to strengthn and conditioning these muscles have to be able to work and produce under stress under time - so endurance style EX allow us to transition into strength and conditioning
- NOTE: This makes sense - normally we want to go into endurance style EX because we go into true strength exercises
NOTE: A pt can be discharged at any point (might just need pain contorl and then leave)
KNOW: Normaly patients whose spinal movement is hundered primarily by significant pain and symptomatic features = symptom modulation
* Goals are typically to control symptomes and do lumbar movements along with it (this is the mobility that will get us into movement control)
* Typically treated w/ manual therapy, directional preference EX, traction or brief immobilization
* Active rest only for those with hyper-acuity of pain onset (first 24 hours with high pain during small movements)
If pt is irritable and inflammed what do you do?
Active rest
If pt peripheralizes w/ extension and flexion or has a SLR test positive what should you do?
Traction
If the pt centralizes w/ flexion or extension what would you do?
Prescribe specific EX that centralizes symptoms
If the pt stops to centralize and have has no symptoms distal to the knee what do you do?
Prescribe manipulation
Directional preference = centralize w/ flexion or extension (depends on the pathology)
What do stenosis style pt’s normally centralize w/ (think radiculopathy)
Flexion (Flexion makes their symptoms become more centralized)
* Flexion is their directional preference
What do disc pts normally centralize w/
Extension
* extension is their directional preference because it makes symptoms more centralized
What normally causes facet pain?
Maximal closing down
* So for a facet pathology the would centralize pain w/ flexion (because it opens it up and symptoms get better)
Symptoms less than _ days do great w/ lumbar manipulation?
16
* as long as they dont have numbness and tingling down their leg
KNOW: Movement control pts:
* Pts whose spnal movement is hindered more by dysfunctional joint and soft tissue compliance and neuromuscular control
* * Goal = to improve joint and soft tissue compliance; integrate with appropriate neuromuscular control to improve quality of movement
* Patient’s status tends to be stable. Low baseline level of pain - increases w/ certain daily activities but returns to baseline w/ activity cessation (stopping)
* Movement typically fully, nut may see aberrant movements (like a little catch or painful arc / might have a gour sign)
* May be impaired flexibility, muscle activiation, and motor control
Why do loose pts (tons of flexibility) typically have adverse neural dynamics?
Because all their joints and tendins can stretch but not the nerves
KNOW: bad motor contorl = just feels weird to move things. Head feels like a bowling ball
* prescrive motor contorl EX
Functional optimization:
* pts whose movement is hindered by muscle deconditioning and fatigue
* Realtively asymptomatic
* Can perform ADLs but needs to return to higher level activities
* Goal = improve lumbar spine capability to withstand higher levels of physical performance
* more focus towards work / sport - specific tasks
* HIgher level aerobic EX
general fitness EX
