Treatment Based LBP Classification Flashcards
What are the 3 clinical findings that indicate the “red zone” of treatment in the 1st level of the classification?
(1) “Red Flags”
(2) Medical comorbidities precluding rehabilitation
(3) Leg pain with progressive neurologic deficits
What are the 3 clinical findings that indicate the “yellow zone” of treatment in the 1st level of the classification?
(1) Medium-to-high psychosocial risk status
(2) low psychosocial risk status with predominantly leg pain
(3) minor or controlled medical comorbidities
What are the 3 clinical findings that indicate the “green zone” of treatment in the 1st level of the classification?
(1) Low psychosocial risk status
(2) Predominantly axial LBP
(3) Minor or controlled medical comorbidities
What are the signs & symptoms indicating need for medical referral?
What are the “red flags” that refer pain FROM the lower back that may resemble mechanical LBP? (8)
pathologic fracture, sacral stress fracture, acute spondylolisthesis, cancer, infections, cauda equina syndrome, ankylosing spondylitis, and central sensitization disorders
What are the “red flags” that refer pain TO the lower back that will not reproduce symptoms with mechanical provocation? (5)
aneurysm, vascular claudication, kidney stone, genital pathologies, and gastrointestinal pathology
What are some medical comorbidities that may be associated with mechanical LBP? (4)
anxiety/depression, depression, fear of movement, and pain catastrophizing
What are the major components of a treatment based classification exam? (4)
history, observation of posture in standing and sitting, pelvic symmetry/asymmetry in standing and sitting, and examination of trunk movements from standing
What are the neurological exam components of the treatment based classification? (4)
LE sensory testing, LE muscle strength assessment, LE reflex testing, and nerve root tension tests (SLR and femoral nerve)
When status improves with a single movement in any direction, what 3 potential syndromes fit pattern?
extension, flexion, or lateral shift syndromes
When status worsens with movements in any direction, what group should you classify the patient into?
group into classification traction syndrome
What characteristics do patients have that are most likely to benefit from traction?
- Leg symptoms (radiculopathy)
- Signs of nerve root compression (e.g., motor loss)
- Peripheralization with extension (16-point difference in Oswestry at 6 weeks)
- Positive crossed straight leg raise (19-point difference in Oswestry at 6 weeks)
If status quo with movement, what group should they be classified into?
group into classification mobilization syndrome (based off movement they have restriction into)
What are the criteria and what makes the patient “positive” for benefitting from lumbar manipulation?
Criteria (5):
- Current episode < 16 days
- Symptoms proximal to knee
- FABQ work subscale < 19•1 or more hypomobile segments
- Hip internal rotation ROM > 35o
- If patient positive on rule (i.e. had 3/5 criteria) and receives manipulation, then probability of successful outcome at 1 week is 92%
What data from the history indicated the patient should be classified into immobilization syndrome?
- Frequent recurrences & minimal perturbation
- Previous Hx of alternating sides of lateral shift
- Frequent manipulation with short-term relief
- Trauma
- PregnancyPositive change with use of back braces
