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DPT 751 - Musculoskeletal III > Lumbopelvic Treatment Based classification System > Flashcards

Lumbopelvic Treatment Based classification System Flashcards

1
Q

What is the Lumbar Treatment Based Classification System?

A
  • A system that helps clinicians determine subtypes of low back pain and guides treatment decisions.
  • Reset the system, specific directional exercises, reload (functional optimization), and motor control (retraining)
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2
Q

Why is low back pain considered complex?

A

Due to its multifactorial nature, including physical, psychological, and social components.

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3
Q

What are sub-classification systems for low back pain?

A

Models that help clinicians simplify and treat complex low back pain presentations by categorizing them into specific subtypes.

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4
Q

How do sub-classification systems help in treatment?

A

They guide treatment decisions by categorizing low back pain into specific subtypes, leading to more targeted and effective interventions.

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5
Q

What is the significance of directional preference in treatment?

A

It helps identify movements that reduce pain and improve symptoms, guiding the focus of treatment.
-END RANGE IS KEY
-AVOID PAINFUL MOVEMENTS

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6
Q

What are the main treatment approaches in this system?

A
  • Symptom modulation,
  • Movement control,
  • Functional optimization
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7
Q

What are the key red flags to consider in low back pain?

A

Severe trauma, fever, recent bacterial infection, saddle anesthesia, severe or progressive neurological complaints, recent onset bladder dysfunction, unexplained weight loss, history of cancer, IV drug abuse, pain worse with recumbency, and no relief with change of position/rest.

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8
Q

Why is screening for pain neuro-science education (PNE) important?

A

It helps identify patients who need education about pain mechanisms before traditional treatment can be effective.

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9
Q

How to determine if a patient is appropriate for physical therapy?

A

By ruling out medical comorbidities and ensuring the patient has mechanical low back pain that can be addressed with physical therapy.

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10
Q

What are the characteristics of patients requiring unique rehab management because the presentation is complicated?

A

-Patients with PNE
-LBP is complicated with presence of leg pain
-you have ruled out comorbidities so PT is appropriate

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11
Q

What are the characteristics of straightforward therapy patients?

A

Patients with minimal complications who can tolerate more aggressive therapy.

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12
Q

What is the first step in evaluating a patient with low back pain?

A

Screening for red flags and determining the appropriateness of physical therapy.

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13
Q

What is the goal of symptom modulation in low back pain treatment?

A

To decrease the patient’s pain and modulate their symptoms to facilitate further rehabilitation.

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14
Q

How does manipulation help in symptom modulation?

A

By providing immediate pain relief and improving mobility through manual therapy techniques.

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15
Q

What are the indications for using traction in low back pain?

A

Traction is indicated for patients who do not centralize their pain with other treatments.

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16
Q

What are the predictor variables for successful manipulation?

A

i) Patients fitting the clinical prediction rule for manipulation, having pain with extension or unilateral rotation/sidebending, or positive SI joint cluster tests.

CPR:

  • Pain does not travel below the knee
  • onset </= 16 days ago
  • lumbar hypomobility
  • Either hip has > 35 degree of internal rotation
  • FABQ - work subscale score of < 19 or positive belief manipulation will help
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17
Q

What are the typical symptoms of patients in the symptom modulation category?

A

Disabilit: High
Symptom Status: Volatile
Pain: High to Moderate

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18
Q

How does active rest support symptom modulation?

A

By avoiding activities that aggravate symptoms while staying active in other non-painful ways.

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19
Q

What is directional preference in low back pain treatment?

A

The phenomenon where certain movements reduce pain and improve symptoms, guiding treatment focus.

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20
Q

How does McKenzie technique apply directional preference?

A

By identifying and using movements that decrease, abolish, or centralize symptoms to guide treatment. Repeated movement exercises in directional preference.

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21
Q

What are the predictor variables for extension exercises?

A

Symptoms distal to the buttock, symptoms centralize with lumbar extension, symptoms peripheralize with lumbar flexion, and directional preference for extension.

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22
Q

What are the predictor variables for flexion exercises?

A

Older age (> 50 years), directional preference for flexion, and imaging evidence of lumbar spinal stenosis.

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23
Q

How to identify and treat lateral shift in low back pain?

A

By recognizing acute postural deviations and using specific exercises to correct the shift and alleviate pressure on the nerve root.
The lateral shift is named by the direction in which the upper torso is displaced.

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24
Q

What are the benefits of specific exercises for directional preference?

A

They help in reducing pain, improving function, and centralizing symptoms by focusing on movements that provide relief.

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25
Q

What are motor control deficits in low back pain?

A

Impaired ability to control and coordinate movements due to poor motor control, leading to pain and dysfunction.

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26
Q

What are the 3 R’s of motor learning?

A
  • Reset,
  • Reinforce,
  • Reload
27
Q

How to assess and treat too loose or too tight conditions?

A

By evaluating flexibility and muscle tone, and using appropriate strengthening or stretching techniques to restore balance.

28
Q

What are the predictor variables for successful lumbar stabilization?

A
  • SLR > 91°,
  • Age < 40 years,
  • Aberrant motion present with forward bending,
  • (+) Positive prone instability test.
29
Q

What are aberrant motions and how do they affect low back pain?

A

Unusual movements such as painful arcs, instability catches, and thigh climbing, indicating instability and poor motor control.

30
Q

What are the steps in motor control reeducation?

A

Teaching patients to move differently, reducing muscle overactivation, increasing movement variability, and using biofeedback.

31
Q

What is persistent pain and how does it relate to low back pain?

A

Chronic pain lasting for an extended period, often with a complex interplay of physical and psychological factors.

32
Q

Why is PNE important in treating chronic low back pain?

A

It educates patients about pain mechanisms, helping them understand and manage their pain better.

33
Q

What are common life issues that complicate back pain?

A

Factors like stress, poor coping strategies, bad job or relationships, history of abuse or trauma, and high fear.

34
Q

How to approach treatment for patients with high PNE?

A

Providing pain neuro-science education, addressing underlying life issues, and incorporating motor control strategies.

35
Q

What are the goals of PNE in low back pain treatment?

A

To reduce fear, promote aerobic exercise, and reassure patients to improve their overall pain management.

36
Q

How does motor control strategy help in managing chronic pain?

A

By improving movement patterns, reducing overactivation, and enhancing overall function and stability.

37
Q

What are the different types of lumbar mobilizations?

A

Techniques such as side-lying lumbar rotation mobilization, prone mechanical traction, and supine mechanical traction.

38
Q

How to perform a side-lying lumbar rotation manipulation?

A

Position the patient in side-lying, use specific hand placements to apply a high-velocity low amplitude thrust at the lumbar segment.

39
Q

What are the benefits of prone mechanical traction?

A

It helps in relieving nerve root compression and reducing radicular symptoms.

40
Q

How to perform supine mechanical traction for low back pain?

A

Position the patient supine with hips and knees flexed at 90°, apply intermittent traction for 30 second hold and 10 second relaxation phase for a total of 15 minutes

41
Q

What are the contraindications for lumbar manipulation?

A

Conditions like hypermobility, poor integrity of ligamentous or bony structures, unstable fractures, bone tumors, infectious diseases, acute pain, acute radiculopathy, serious vascular problems, and recent surgical fusions, RA, acute soft tissue injuries, fusions

42
Q

What are the clinical findings for movement control phase of a patients treatment?

A
  • disability is moderate
  • symptom status is stable
  • pain is moderate to low
43
Q

What are the clinical findings for functional optimization phase of a patients treatment?

A
  • disability is low
  • symptom status is controlled
  • pain is low to absent
44
Q

What does FABQ stand for?

A
  • Fear Avoidance Beliefs Questionnaire
45
Q

What are some typical patients who fit into the symptom modulation category?

A
  • “I recently hurt my back and prior to that I was OK”
  • “I am stiff in my back and the pain is often unilateral”
  • “the pain can spread from my back to buttock and even into my thigh, but it doesn’t go below the knee”
  • “I do not fit the PNE criteria”
46
Q

What is advice for patients post manipulation?

A
  • stay active but maybe not walking since they were painful with extension
  • stationary bike
  • flexion based exercises more commonly help the patient
  • rotational/facet exercises also good for patient
47
Q

what are the predictor variables for prone mechanical traction?

A
  • peripheralization with repeated lumbar extension
  • positive crossed SLR.
48
Q

What are the predictor variables for supine mechanical traction?

A
  • FABQ-work subscale < 21
  • NO neurological deficits
  • > 30 years old
  • non-manual work job status
49
Q

what screams radicular pain?

A
  • Intense, radiating, severe, sharp, darting, and lancinating, and well localized
  • can be accompanied by motor losses, sensory deficits, or pain in a dermatome distribution
50
Q

During test movement/ repeated movement testing when should you immediately abandon the test?

A

if there is peripheralization

51
Q

What is centralization?

A
  • When movement or a position results in abolishment of pain that is more distally to a location more proximal
  • the patient must have LE pain
52
Q

Abolished centralization?

A
  • the most distal pain was abolished and pain recorded more proximal
53
Q

reductive centralization?

A
  • pain recorded at same distal location but with reduced intensity
54
Q

unstable centralization?

A
  • pain was reduced or abolished after repeated movement testing but then after standing for 1 minute the pain intensity level returned
55
Q

What education do you give an extension responder? (flexion hurts)

A
  • avoid bending
  • dosage: 10 press ups per hour
  • no sitting for longer than 20 minutes
  • use lumber roll and/or taping
56
Q

Who are we using the supine counternutation mobilization/ manipulation technique on?

A
  • flexion restrictions
  • spoondylolisthesis
57
Q

How is a too tight patient going to present (movement impairment)?

A
  • painful loss of movement in at least one direction
  • high levels of muscle guarding and co-contraction
  • excessive “stability”
  • fear of moving, hyper-vigilance, anxiety
  • continued peripheral nociceptor sensitization
  • mal-adaptive
58
Q

How is a too loose patient going to present (control impairment)?

A
  • impairment in the control of the painful segment in direction of pain
  • loss of functional control in neutral zone
  • repetitive strain, excessive loading
  • painful arc or pain in variety of directions
  • movement and postures adopted worsen symptoms
  • decreased proprioceptive awareness
  • fear of movement, anxiety
  • peripherally and/or centrally mediated pain
  • mal-adaptive
59
Q

What are the predictor variables for non-successful lumbar stabilization?

A
  • FABQ-physical activity < 8
  • aberrant movement absent
  • no hyper mobility during PA spring testing
  • negative prone stability test
60
Q

P-A spring test and spinal torsion test will help you determine what?

A
  • whether the patient is too loose or too tight
61
Q

stability/ progressive loading

A
  • improve the overall ability of the system to withstand forces
  • hip stabilizers
  • deep core musculature
  • glute strengthening
62
Q

functional exercise position progressions

A
  1. supported supine or prone
  2. suspending quadruped
  3. stacked tall or half kneeling
  4. standing (lunge, split stance, or normal)
63
Q

how are we determining which category the patient best fits in the guide for treatment?

A
  • resent onset or longstanding
  • high acute pain or more chronic pain
  • low fear or high fear
  • does on movement cause pain vs another movement cause pain
  • symptoms above the knee vs below the knee vs cross STLR
  • long standing symptoms, high levels of trauma, h/o multiple abdominal surgeries or back surgeries

DPT 751 - Musculoskeletal III (9 decks)

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