Treating LBP Flashcards
AVOID
paracetamol bed rest electrotherapy traction lumbar supports acupuncture general back exercises general health/lifestyle coaching surgery
INCLUDE
medication - NSAIDs reassurance and advice - activity, goal setting education - biopsychosocial explanation of pain - pain education massage and manipulative therapy in the short term exercise program - patient specific, various types
Principles of Treatment
understand that it is safe to move
feel that it is safe to move
experience that it is safe to move
reinforce safety
Understand that it is safe to move
educate about pain
help them understand their problem
understand the impact of beliefs, perceptions and action on pain experience
understand that ongoing pain is the product of an overprotective system
move away from pathoanatomical explanation
importance of movement
Feel that it is safe to move
develop internal safety cues
develop awareness, connectedness and ownership of the body
perceive safety messages as being trustworthy
modulate tissue sensitivity via heat, massage
improve overall health
Experience it is safe to move
active and passive exposure to movement movement coaching and experimentation to solve movement problems precision focused graded activation explore movement landscape goal orientated increase general physical activity
Reinforce safety
progressively load the system
foster antifragility of the back
build trust and confidence in the body
enhance musculoskeletal capacitY - GET STRONGER
Acute Irritable LBP - Psychological
provide them with clear explanation of their problem
- emphasise low chance of having a serious medical condition
- emphasise likelihood of a favourable outcome
- emphasise function over structure
- emphasise strength and robustness of the spine
- provide biopsychosocial view of the problem
- pain as protection
provide them with treatment plan
- that is explicitly active and encourages self management
- discourages expressive caution and protection
- emphasises the importance of moving and loading
- addresses non somatic factors
- encourages helpful behaviours and coping strategies
Acute Irritable LBP - General Function
discourage bed rest
encourage general activity within tolerance
encourage gentle and graded increase in activity levels
advice on how to temporarily reduce mechanical load
postural and ergonomic advice appropriate for their level of sensitivity
Acute Irritable LBP - Tissue sensitivity
need to settle the pain
- time contingent medications GP
- heat
- taping to unload
- massage and low grade joint manipulation
Acute Irritable LBP - local function
Correct any deformity in movement
- exercises to maintain correction
- manual therapy maybe
Practise movement into directional preference
- exercise to decrease and centralise pain
- manual therapy maybe
Strategies to minimise peripheralising movements
- tape
- task moficiation
- education on load management
Improve local muscle performance
FIND IT - independent movement into the non-provocative direction
CONTROL IT - promote control under the provocative load
Acute Irritable LBP - remote function
Improve mechanics above and below
- promote movement into provocative directions
- improve capacity of muscles to work independently into the provocative direction
Impaired Mobility - psychological
provide them with clear explanation of their problem
- emphasise low chance of having a serious medical condition
- emphasise likelihood of a favourable outcome
- emphasise function over structure
- emphasise strength and robustness of the spine
- provide biopsychosocial view of the problem
- pain as protection
provide them with treatment plan
- that is explicitly active and encourages self management
- discourages expressive caution and protection
- emphasises the importance of moving and loading
- addresses non somatic factors
- encourages helpful behaviours and coping strategies
Impaired Mobility - general function
advice on load management
discourage excessive sedentary behaviour
prescribe a progressive and general exercise program
sporting technique management/manual handling advice
sleep hygiene if indicated
lifestyle counselling if indicated
management of relevant comorbidities
Impaired Mobility - tissue sensitivity
need to settle the pain
- time contingent medications GP
- heat
- taping to unload
- massage and low grade joint manipulation
Impaired Mobility - local function
promote movement into provocative direction
- manual therapy
- home exercises and stretches
improve local muscle performance
FIND IT - independent movement into the provocative direction
CONTROL IT
- high load control exercise under non-provocative load
- improve capacity of the muscles that produce provocative movement
- precise control not really part of the problem
LOAD IT
- loading program under the non-provocative direction
- integrate remote stuff
Impaired Mobility - remote function
improve mechanics above and below
- promote movement into non - provocative direction
- improve capacity of muscles to work independently into the non-provocative direction
Tight Control - psychological
provide them with clear explanation of their problem
- emphasise low chance of having a serious medical condition
- emphasise likelihood of a favourable outcome
- emphasise function over structure
- emphasise strength and robustness of the spine
- provide biopsychosocial view of the problem
- pain as protection
provide them with treatment plan
- that is explicitly active and encourages self management
- discourages expressive caution and protection
- emphasises the importance of moving and loading
- addresses non somatic factors
- encourages helpful behaviours and coping strategies
Tight Control - general function
advice on load management
discourage excessive sedentary behaviour
prescribe a progressive and general exercise program
sporting technique management/manual handling advice
sleep hygiene if indicated
lifestyle counselling if indicated
management of relevant comorbidities
Tight control - tissue sensitivity
need to settle the pain
- time contingent medications GP
- heat
- taping to unload
- massage and low grade joint manipulation
Tight Control - local function
promote movement into provocative direction
- progressive exposure into flexion
- begin in non-threatening positions
- train to minimise protective behaviours
- train normal breathing pattern
Promote non-sagittal movement
- associated with flexion
- manual therapy
- home exercises and stretches
Improve local muscle performance FIND IT - independent movement into flexion - relevant non-sagittal movement CONTROL - promote control under provocative load - flexion control LOAD IT - flexion based loading program
Tight Control - Remote function
improve mechanics above and below
- no real movement imperative
- improve capacity of muscles to work independently
- independent thoracic movement, improve leg drive so that the back does less
Loose Control - psychological
provide them with clear explanation of their problem
- emphasise low chance of having a serious medical condition
- emphasise likelihood of a favourable outcome
- emphasise function over structure
- emphasise strength and robustness of the spine
- provide biopsychosocial view of the problem
- pain as protection
provide them with treatment plan
- that is explicitly active and encourages self management
- discourages expressive caution and protection
- emphasises the importance of moving and loading
- addresses non somatic factors
- encourages helpful behaviours and coping strategies
Loose Control - general function
advice on load management
discourage excessive sedentary behaviour
prescribe a progressive and general exercise program
sporting technique management/manual handling advice
sleep hygiene if indicated
lifestyle counselling if indicated
management of relevant comorbidities
Loose Control - tissue sensitivity
need to settle the pain
- time contingent medications GP
- heat
- taping to unload
- massage and low grade joint manipulation
Loose Control - local function
promote movement into the non-provocative direction
- manual therapy
- home exercises and stretches
improve local muscle performance
FIND IT - independent movement into the non-provocative direction
CONTROL IT - promote control under a provocative load
LOAD IT - loading program under provocative direction
- integrates with remote stuff
Loose Control - remote function
improve mechanics above and below
- promote movement into provocative direction
- improve capacity of muscles to work independently into provocative direction
