Treatment Rules Flashcards
Acute severe irritable Rx
Local and remote
Move it
Find it
Control it
Local:
- correct any deformity
Move it - into directional preference
Find it - into directional preference
Control it - provocative direction (improve capacity of muscles to prevent provocative movement)
NO LOAD
Remote:
Move it - provocative direction without provocatively loading the lumbar spine
Improve capacity to work independently into provocative direction
Loose control
Local and remote Move it Find it Control it Load it
Local: Move it - non-provocative direction Find it - non-provocative direction Control it - provocative (improve capacity of muscles to prevent provocative movement) Load it - provocative
Remote:
Move it - provocative direction, without provocatively loading the spine
Improve the capacity to work independently into provocative direction
Tight control
Local and remote Move it Find it Control it Load it
Local: Move it - provocative direction (flexion always) - progressive exposure to flexion - begin in non-threatening positions - minimize protective behaviours - normal breathing pattern
Find it - flexion
Control it - provocative load: flexion control then allow the back to flex with focus
Load it - flexion load (target fear and apprehension)
Remote:
Move it - no clear movement: promote thoracic rotation and side bending if indicated
Improve the capacity to work independently
- independent thoracic movement
- improve leg drive so back does less -> control flexion and produce ext.
Impaired mobility
Local and remote Move it Find it Control it Load it
Local: Move it - provocative direction Find it - provocative direction Control it - high load control under non-provocative load Load it - non-provocative load
Remote:
Move it - non-provocative direction
Improve capacity to work independently into non-provocative direction
Radicular pain only
Local and remote
Move it
Muscle performance
Local:
Move it - IVF opening + directly mobilise nerve
Muscle performance - assess and manage what you find
sliding compromised = extension control programme
excessive tension from poor flexion = flexion control programme
Remote:
Move it - IVF closing directions above and below, without provocatively loading the L-spine
Improve capacity to work independently into these directions
Improve sliding remotely by opening space around nerve
Unload tension remotely - get out of thoracic flexion
Radicular pain with radiculopathy
Local and remote Move it Find it Control it Load it
Local:
Move it - IVF opening, without loading nerve adversely or worsening disc pathology
Find it - IVF opening: primarily slide glide, then flexion
Control it - IVF closing
Load it - IVF closing: loading program under extension side bending load
Remote:
Move it - IVF closing directions above and below, without provocatively loading the L spine
Improve capacity to work independently into these directions
Improve sliding remotely by opening space around nerve
Unload tension remotely - get out of thx flexion
Key psychological points to address when EXPLAINING the PROBLEM to the patient (8)
• Emphasises the low chance of a serious medical condition
• Emphasises the high likelihood of a favourable outcome
• Describes the problem in non-threatening reversible terms
o An emphasises on function over structure
• Disavows patho-anatomical models of pain
• Emphasise the strength and robustness of the spine
• Provides a sensible and plausible rationale for reactivation
• Provides a holistic biopsychosocial view of their problem
• Enriches their understanding of ‘how pain works’
Key psychological factors to address in the treatment plan.
Create and clear and comprehensive rx plan that…
- Decreases fear and offers hope
- Is explicitly active and encourages self-management
- Discourages excessive caution and protection
- Emphasises the importance of moving and loading
- Addresses non-somatic factors
- Encourages helpful behaviours and coping strategies
ASI - General function key points to address (5)
Discourage bed rest
Encourage general activity within tolerance
Encourage gentle and graded increase in activity levels
Advice re strategies to temporarily reduce mechanical load
Postural and ergonomic advice appropriate for level of severity
General function key points to address for loose/tight control, impaired mobility, and neurogenic pain types (7)
Prescribe a Dx appropriate progressive general exercise programme
Advice on load management if indicated
Discourage excessive sedentary behaviour
Sporting technique modification and manual task training
Sleep hygiene if indicated
Lifestyle counselling if indicated
Management of relevant comorbidities within scope of practice
Key additional psychological points to address in the treatment plan for neurogenic pain with radiculopathy (3)
- Acknowledge structural contribution – emphasise function
- Emphasise the capacity of the body to resorb disc prolapse
- Deemphasise the patho-anatomical contribution and the importance of focusing on what is reversible
