Maitland Approach Flashcards
Low Back Pain
At least 80% OF PEOPLE HAVE LOW BACK PAIN AT LEAST ONCE IN LIFE
- -50% ARE RECURRENT
- -70% WILL GET BETTER ON OWN IN 4 WEEKS
- -80% BY 6 WEEKS
ISSUES WITH TREATMENT OFTHE SPINE
• Patho-anatomical model does not work as well as
it does in peripheral joints
• Diagnosis cannot always designate an exact
pathology with particular signs and symptoms
• Pts with similar imaging and signs and symptoms
do not respond to similar treatments the same way
• Diagnostic labels do not provide insight into the
severity, irritability, nature and stage of the
disorder
Patho-biomechanical Approach
- Utilizes biomechanical concepts for assessment of abnormalities
- Treatments utilize arthrokinematic principles, based on identifies target tissue
- May rely on a pathology or diagnostic label prior to treatment
Pain Sensitive Spinal Structures
Superficial Annulus of the disc • Posterior Longitudinal Ligament • Anterior Longitudinal Ligament • Anterior Portion of the Dura Mater • Caspsule of Zygapopyseal joints • Interspinous Ligament • Supraspinous Ligament • Nerve Root Sleeve, If Irritated • Fat • Arteries • Periosteum • Muscles
Patient Response-based Approach
• Less concerned with specific pathologies
• Instead, focus on:
– Pain/Concordant sign
–Range of motion
– Improving function
• Treatment techniques are based on movements
that either decrease pain or increase range of
motion
Blended Model
• Uses a mixture of both methods
– Use biomechanical theories to initiate treatment and
vary treatment based on patient response
– Biomechanical assessment with patient response based
treatment
– Patient response based assessment with biomechanical
based treatments
– Completely blended assessment and treatment
• Bottom line, patient response to intervention is
paramount.
Comparable Sign
Must be comparable to the patient’s primary symptoms
Abnormal in terms of range, resistance and or spasm
Should be anatomically appropriate structurally to the chief complaint
Should reproduce the patient’s symptoms or produce abnormal pain when unable to reproduce their symptoms
Able to reproduce in consistently
Nature of the Condition
The nature of the condition should alter how the assessment is performed
Severity
Irritability
Stage
Severity
how the impairment has affected the patient
annoyance—disability
Stage
Acute, subacute, chronic
Worse, better, the same
Irritability
What or how much activity increases the symptoms?
Once aggravated, how intense are the symptoms and how long do they last?
What is required to return symptoms to baseline?
The Irritable Disorder
- Characterized by
- constant pain or severe intermitten pain
- easily provoked
- Long time to settle - Certain stages
- whiplash, acute trauma
- nerve root irritation - Rest plays an important role, however appropriate movement can be helpful
Pain Dominant
Area=diffuse Night Pain=may be worse history=recent onset nature=disability kind=often burning, aching, sharp frequency= constant/variable effects of activity=aggravated by mild intensity=>5/10(8/10) Duration=slow to stop or reduce Range=often afraid to move Pain=resting , early and mid range Spasm= usually present Repeated movements= aggravates, unless preferred direction
Stiffness Dominant
Area=often localized night pain=usually mild/moderate history=chronic (acute exacerbation) nature=nuisance/annoyance Kind=limited, restricted frequency=intermittent effects of activity=aggravated by vigorous Intensity=<5/10 Duration=short duration Range=limited Pain=often at end range Spasm=Seldom Present Repeated movements= often increases range
Pain Dominant Treatment
Grades ofmovement IandII= Painbefore R1 IntentofExam & Treatment=Reduceand eliminatepain Barriers= Short ofbarriers Focusofassessment=Painbehavior Preferredmovement= Mostfree Suggested Mechanism=Likelyinflammatory Adjectivesusedbypt.=Pain, burning,throbbing, ache,stabbing
