Thoracolumbar Spine III- LBP Flashcards
With LBP, it is ____-_______ and has an unidentified ________ source
non-specific; nociceptive
Which area is the smallest amount of related pathology?
thoracic
With LBP, it is the leading cause of …
worldwide _______
________ limitation and _____ absence
disability
activity
work
What percentage of people will experience LBP in their life?
80%
LBP is common in
Biological ______
Older or younger?
_______ educational status
________ physical work demands
women
older (half > 65 yrs.)
lower
higher
Imaging with MRI:
_______ of asymptomatic individuals had “abnormal” findings
1/3
What are some examples of abnormal findings on imaging with MRI?
IDD
Age-related disc changes
N. compression
Facet Hypertrophy
With Imaging w/ MRI:
______ of symptomatic individuals had an abnormality
1/2
With imaging with CT and MRI:
_____ of asymptomatic 30-80 yr. old individuals had disc changes
1/3
With imaging w/ CT and MRI:
Normal asymptomatic age-related changes MUCH ____ symptomatic structural changes
A. <
B. >
B.
Imaging changes significantly increase with ____
age
Who should get imaging with LBP?
> ____ years of age with a
hx of _____
_______ paresthesias
_______ and ______ dysfunction
Specific _______ deficits
Progressive/_______symptoms
NO improvement after ____ weeks of Rx
50; cancer
saddle
bowel; bladder
neurological
disabling
6
Imaging _____ ______ improve outcomes and guidelines; consistently recommended against routine imaging
does NOT
With LBP nearly all cases have an _________ _________ source
unidentified; nociceptive
With PT Rx, there is a SUBSTANTIAL gap between ______ and ________
evidence; practice
With PT Rx, there is ___________ of unsupported and ineffective Rx
overutilization
What are some examples of unsupported and ineffective Rx?
______ avoidance behaviors promoted with _______ interventions like modalities AND even some manual therapies
Leads to _____ costs
Contributes to greater _______ addiction
Greater imaging and _______ exposure
MORE likely to have ______ procedures, side effects and missed work
Fear; PASSIVE
higher
opioid
radiation
invasive
With PT Rx and prevention, it is:
_______ research
______ promoted preventions lack evidence
Exercise is ________ effective in adults
Inadequate
MOST
Largely
With PT Rx and prevention involving children, it is:
________ furniture effective
_______ is NOT evaluated
Ergonomic; Exercise
With PT Rx and early PT:
Only ___% developed persistent LBP
Significant reductions in lost ____ time
________ by numerous studies
2
work
Supported
With LBP involving education and advice: it is the _____ line of Rx with moderate to strong evidence
First
With LBP, PT Rx is AGAINST what two things?
Bed rest
In-depth explanations
With LBP, PT Rx is FOR what?
Spinal _______ and _______ strength
Overall ________ prognosis
Active P! ________ mechanisms that decrease fear catastrophizing
Stay _______ with early resumption of ADLs
__________ contributors and basics of nociplastic P!
Emphasis on _______ with back protetion techniques
structural; anatomical
favorable
coping
active
Biopsychosocial
function
Dry needling with LBP has what kind of evidence and benefit?
weak; short-term
Modalities with LBP is generally ________ and ____ recommended
ineffective; NOT
Modalities with LBP have what results?
short-term at best
With LBP, soft tissue mobilization/massage have what kind of evidence and benefit?
moderate; short-term
With PT Rx, what overcoming barriers are BEST to practice?
_________ consultation time and follow up
Better ______ to return to work
Reward _______ and NOT volume with reimbursement
________ service announcements
_________ provider knowledge of evidence and guidelines for use in clinical reasoning and decision making
Increase
incentives
quality
Public
Increased
LBP Rx Classifications:
There is ______ evidence with acute LBP
moderate
LBP Rx Classifications:
There is ______ evidence with chronic LBP
weaker
What are the 4 subgroups of LBP Rx Classifications?
Mechanical Traction
Directional Preference
Mobilization/Manipulation
Stabilization
With mechanical traction, there is NO ________ with static tx
benefit
Intermittent tx for LBP with LE P! :
It is typically ______ and _______ LBP with LE P! that doesn’t centralize
acute; subacute
With acute and subacute LBP with LE P! that doesn’t centralize, it needs _______ support
preliminary
A pt. with LBP may need to be in a ______ position if they are…
____-____ years old
Paresthesia’s in last 24 hrs. distal to the _____
Owestry questionnaire score of > ____
+ _______ compression, crossed ______, and or centralization
prone
18; 60
knee
30
spinal n; SLR;
You should NOT use mechanical traction with _______ LBP along with ____ p!
persistent; LE
With mechanical traction:
There is moderate evidence AGAINST all types of tx used alone in patients with :
_____, _______,and _________ LBP
____-______ LBP
_______ symptom patterns
acute; subacute; persistent
non-radicular
varying
Important to Review
____ _____ is a position/motion that alleviates symptoms
directional preference
What repeated motion MOST commonly centralizes LE symptoms to LBP?
extension/hyperextension
________ is the abolition of distal and or/ spinal P! in a distal proximal direction in response to repetitive motion(s) or sustained position(s)
centralization
_________ ________ can help choose positions and motions to avoid symptomsand promote exercise and activity
directional preference
With mobilizations/ manipulation for LBP, there is strong patient preference/belief in ____ _____ effectiveness
short term
With mobilizations/ manipulation for LBP, there is strong evidence for ______ and ___-____ mobilizations
thrust; non-thrust
Manipulation is MOST effective for sub-groups with _____ and ____-______ LBP
acute; sub-acute
Mobilizations have a added benefit when used with ________
exercise
With mobilization/mnanipulation, there is strong evidence to improve ______ mobility with subacute and persistent LBP
hip
With mobilizations/manipulations, there is _______ to _______ evidence to improve LBP and disability with back related LE P!
moderate; strong
Mobilizations/manipulations:
______ quality evidence for a small effect
Manipulation effect larger than _________
_______ effect when combined with exercise
_____-______ effect is NOT well established
Moderate
mobilization
Greater
Long-term
Stabilization for ______ LBP is safe and effective to do early
acute
With stabilization for acute LBP, supervision is typically _________ unless it’s NOT progressing or risk factors for persistent LBP exist
uneccesary
Stabilization is the first line Rx for ____-____ and _______ LBP
sub-acute; persistent
The MOST effective treatments for sub-acute and persistent LBP
- ______ activation/coordination and _________
- _______ therapy, _______, and yoga
- mental health benefits with ______ and _______ training
motor;stabilization
aquatic; pilates
resistance; aerobic
With sub-acute and persistent LBP, this should be graded activity and _______ (MET)
individualized
______ muscle activation is effective for _____-____LBP and functions in isoation or with other ____-____
local
non-specific
ther ex
Local muscle activation with LBP helps to improve _______ control and created ______ muscle activation
trunk; earlier
With LBP, there was strong evidence for progressive ______ exercise for any intensity of aerobic activity
endurance
With LBP there is moderate evidence of short-term benefit with chronic LBP with LE ________ mobilizations
neural
William’s flexion exercises/ protocol
Theory: deforming the spine by forcing ourselves to _____
Goal: reduce ______
Exercises: involved _____ pelvic tilt and trunk and _____ flexion
What kind of evidence? ______
stand
lordosis
posterior
hip
weak
With LBP PT Rx, _______ had NO difference in P! function vs. NO intervention at all with persistent LBP
A. Exercise
B. Mobilizations
C. Stretching
C. Stretching
What kind of therapy is the FIRST line of Rx with LBP?
cogntive therapy
______ ______ _______ helps patients understand and manage all biopsychosocial elements contributing to their symptoms
Cognitive Behavioral Therapy
Cognitive behavioral therapy helps to understand things such as:
_______ pain
Innaccurate beliefs on ______ damage
unhelpful _______ behaviors
______ and ______ stress (related to symptoms)
Acivity and ______ avoidance
______ dysfunction
Nociplastic
tissue
lifestyle
mental; emotional
social
sleep
Cognitive Functional Therapy is like behavior therapy plus addressing the _______ of movement
QUALITY
With cognitive functional therapy, there is _____ and ______ improvements with persistent LBP at less than half the cost of usual care
large; sustained
The 3 components of cognitive functional therapy:
- Making sense of P! from a _______ perspective
- Graded return to ______
such as
- _______
- ________
- _______ - _______ behavioral changes
biopsychosocial
activity (ADL) (MET) (p! control ad confidence to move)
lifestyle
__________ _______ ______ is less effective than combining manual therapy and stabilization exercises
A. Cognitive Behavioral Therapy
B. Cognitive Functional Therapy
B.
With LBP prognosis:
There are rapid improvements within ______ month
MOST improve substantially in ____ weeks
1; 6
The typical patient with LBP:
Persistent LBP- _____% report P! at _____ and ______ months
There will be a ____-_____% reoccurrence, 33% have within one year
________ evidence that post- DC HEP prevented reoccurrences
66; 3; 12
24; 65
moderate
With LBP prognosis: depression, anxiety, catastrophizing, and lack of self efficacy increases risk for _______
disability
With LBP prognosis: Fear avoidance behaviors MORE influential than the ______ itself
pain
________ education and income contributes to persistent LBP
LOW
With LBP prognosis: there is higher _____ intensity and ______ painful areas that contribute to disability
pain; multiple
With LBP and MD Rx (medications):
Many with ______ and uncertain influence and NOT recommended
Recommended ONLY with an ________ response to exercise and cognitive behavioral therapy
Any utilization should be limited and very ________ with the lowest effective dose
insufficient
inadequate
selective
With LBP and MD Rx: there are invasive procedures that play a ______ role
limited
What kind of injections are NOT recommended for non-specific LBP?
epidural and facet joint
Epidural injections for LBP are only recommended if:
There is ______ pain
no benefit within _____ weeks
radicular
4
With LBP, epidiral injections:
Don’t reduce the risk of _______
Create rare but _______ side effects
surgery
serious
