Spine Refrences

Question 1

What are the 5 key treatments for NSLBP (with references)?

Answer 1

1. Activity modification/advice to remain active (NICE… 2020; Foster et al, 2018)
2. Patient Education (NICE… 2020; Foster et al, 2018).
3. Superficial Heat (Foster et al, 2018) - Acute only
4. Exercise Therapy (NICE…2020) - Persistent in particular
5. CBT Reffereal (Foster, 2018) - Persistent in particular

Question 2

What are the key recommendations of the NICE Guidelines for NSLBP & Sciatica (with critical appraisal)?

Answer 2

• Stratify patient care based on case severity assessed by the START BACK risk assessment tool.
• Provide people with advice and information, tailored to their needs and capabilities, to help them self-manage their low back pain with or without sciatica, at all steps of the treatment pathway. Include: information on the nature of low back pain and sciatica and encouragement to continue with normal activities.
• Consider a group exercise programme (biomechanical, aerobic, mind–body or a combination of approaches) within the NHS for people with a specific episode or flare-up of low back pain with or without sciatica.
• Take people’s specific needs, preferences and capabilities into account when choosing the type of exercise.
• Promote and facilitate return to work or normal activities of daily living for people with low back pain with or without sciatica.

Question 3

What were the 4 key findings and 3 recommendations of Cook et al (2018) regarding red flag screening for lower back pain (with critical appraisal)

Answer 3

RF screening for LBP is ineffective because:
1. Red flag symptoms neither rule out nor identify serious pathology.
2. Variability in definitions for red flag symptoms greatly limits research and clinical progress in this area.
3. LBP guidelines do not help
4. Clinicians do not actually screen for red flags; they manage LBP conditions they see

Cook Recommends:
1. Watchful waiting
2. Enhancement of value-based care
3. Linking red flag symptomology not with diagnostic testing but directly with health status

Question 4

What are the first-line and second-line treatments for ACUTE lower back pain recommended by Foster et al (2018)?

Answer 4

First Line
* Advice to remain active
* Education

Second Line
* Superficial heat
* Spinal Maipulation
* Massage
* Accupunture

Question 5

Myotomes

Answer 5

L1/2 = hip flexion
L3 = knee extension
L4 = dorsiflexion
L5 = big toe extension
S1 = plantarflexion
S2 = knee flexion

Question 6

Dermatomes

Question 7

SLT