Lumbopelvic Spine: Treatment based classification (intro) - Lecture 2

Question 1

How many weeks does most back pain progress occur?

Answer 1

first 6 weeks then slows

Question 2

Most pts w/ back pain will be pain free in ____

Answer 2

6-8 weeks

Question 3

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)

Question 4

KNOW: Worsening of neurologic symptoms are always a red flag

Question 5

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

Answer 5

symptom modulation
*Directional preference
* Manipulation/mobilization
* traction
* active rest

Question 6

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

Answer 6

Movement control
* Sensorimotor EX
* Stabilization EX
* Flexibility EX

Question 7

if a pt has low distability, controlled symptoms, and low to absent pain. Would they get symptom modulation, movement control, or functional optimization

Answer 7

functional optimization
* Strength and conditioning EX
* Work- or sport specific tasks
* Aerobic EX
* General fitness EX

Question 8

How do you get a pt from symptom modulation to movement control?

Answer 8

Mobility

While were in pain control we start working towards mobility to get into movement control

Question 9

How do you get a pt from movement contorl into functional optimization?

Answer 9

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

Question 10

NOTE: A pt can be discharged at any point (might just need pain contorl and then leave)

Question 11

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)

Question 12

If pt is irritable and inflammed what do you do?

Answer 12

Active rest

Question 13

If pt peripheralizes w/ extension and flexion or has a SLR test positive what should you do?

Answer 13

Traction

Question 14

If the pt centralizes w/ flexion or extension what would you do?

Answer 14

Prescribe specific EX that centralizes symptoms

Question 15

If the pt stops to centralize and have has no symptoms distal to the knee what do you do?

Answer 15

Prescribe manipulation

Question 16

Directional preference = centralize w/ flexion or extension (depends on the pathology)

Question 17

What do stenosis style pt’s normally centralize w/ (think radiculopathy)

Answer 17

Flexion (Flexion makes their symptoms become more centralized)
* Flexion is their directional preference

Question 18

What do disc pts normally centralize w/

Answer 18

Extension
* extension is their directional preference because it makes symptoms more centralized

Question 19

What normally causes facet pain?

Answer 19

Maximal closing down
* So for a facet pathology the would centralize pain w/ flexion (because it opens it up and symptoms get better)

Question 20

Symptoms less than _ days do great w/ lumbar manipulation?

Answer 20

16
* as long as they dont have numbness and tingling down their leg

Question 22

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

Question 23

Why do loose pts (tons of flexibility) typically have adverse neural dynamics?

Answer 23

Because all their joints and tendins can stretch but not the nerves

Question 24

KNOW: bad motor contorl = just feels weird to move things. Head feels like a bowling ball
* prescrive motor contorl EX

Question 25

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