Thoracolumbar Spine III- LBP Flashcards by Siva Pye

With LBP, it is ____-_______ and has an unidentified ________ source

non-specific; nociceptive

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Which area is the smallest amount of related pathology?

thoracic

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With LBP, it is the leading cause of …

worldwide _______
________ limitation and _____ absence

disability

activity

work

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What percentage of people will experience LBP in their life?

80%

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LBP is common in

Biological ______

Older or younger?

_______ educational status

________ physical work demands

women

older (half > 65 yrs.)

lower

higher

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Imaging with MRI:

_______ of asymptomatic individuals had “abnormal” findings

1/3

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What are some examples of abnormal findings on imaging with MRI?

IDD

Age-related disc changes

N. compression

Facet Hypertrophy

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With Imaging w/ MRI:

______ of symptomatic individuals had an abnormality

1/2

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With imaging with CT and MRI:

_____ of asymptomatic 30-80 yr. old individuals had disc changes

1/3

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With imaging w/ CT and MRI:

Normal asymptomatic age-related changes MUCH ____ symptomatic structural changes

A. <
B. >

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Imaging changes significantly increase with ____

age

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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

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Imaging _____ ______ improve outcomes and guidelines; consistently recommended against routine imaging

does NOT

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With LBP nearly all cases have an _________ _________ source

unidentified; nociceptive

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With PT Rx, there is a SUBSTANTIAL gap between ______ and ________

evidence; practice

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With PT Rx, there is ___________ of unsupported and ineffective Rx

overutilization

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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

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With PT Rx and prevention, it is:

_______ research

______ promoted preventions lack evidence

Exercise is ________ effective in adults

Inadequate

MOST

Largely

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With PT Rx and prevention involving children, it is:

________ furniture effective

_______ is NOT evaluated

Ergonomic; Exercise

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With PT Rx and early PT:

Only ___% developed persistent LBP

Significant reductions in lost ____ time

________ by numerous studies

work

Supported

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With LBP involving education and advice: it is the _____ line of Rx with moderate to strong evidence

First

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With LBP, PT Rx is AGAINST what two things?

Bed rest

In-depth explanations

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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

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Dry needling with LBP has what kind of evidence and benefit?

weak; short-term

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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 1. ______ activation/coordination and _________ 2. _______ therapy, _______, and yoga 3. 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: 1. Making sense of P! from a _______ perspective 2. Graded return to ______ such as - _______ - ________ - _______ 3. _______ 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

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