Unit 1 Resource Roadmap Flashcards
Ch. 3 Pg. 100
What is Temporal Summation?
A clinical Measure of Central Sensitization in which “a high frequency of action potentials in the pre-synaptic neuron elicits post-synaptic potentials that overlap and summate with each other.”
Temporal Summation occurs when an individual reports what?
- Reports an increase of perception of pain from repetitive painful stimuli (e.g., thermal pain, electrical stimulation, or gentle prick with a toothpick) that are applied at the same intensity at a low frequency (e.g., < 3 seconds), and individuals with central censitization report increased intensity of pain with the repeated noxious stimuli
What has Temporal Summation been used as?
Its been used as a proxy measure of central sensitization for studies investigating the mechanisms of spinal manipulation in both healthy subjects and those experiencing chronic pain
Does Spinal Manipulation cause a regional hypoalgesic mechanism?
Yes, there is priliminary evidence that spinal manipulation causes regional hypoalgesic mechanism by inhibition of a temporal summation effect in the dorsal horn of the spinal cord (peripheral pathway). Therefore it has an immediate effect on pain modulation via both central and peripheral pathways.
Hypoalgesic is decreased sensitivity to painful stimuli
Ch. 4, Pg. 172-173
What is Excessive Force Closure associated with?
Its associated with excessive, abnormal, and sustained loading of sensitized pelvic structures by excessive activation of the local and global lumbopelvic muscle systems
Ch. 4, Pg. 172-173
Patients with Excessive Force Closure present with what?
- (+) SIJ provocation test
- Localized pain of the SIJ and surrounding ligamentous and myofascial tissues
- (-) Active Straight Leg Raise (ASLR) {they have no feeling of heaviness}
- Pelvic compression belts and manual pelvic compression tends to make Sx worse
Ch. 4, Pg. 172-173
When observing a patient with Excessive Force Closure, how may you see them?
The patients commonly hold habitual erect lordotic lumbopelvic postures associated with high levels of co-contraction across various muscles, such as the abdominal wall, pelvic floor, piriformis, and local spinal muscles
Ch. 4, Pg. 172-173
Patients with Excessive Force Closure often have had extensive physical therapy, what are they typically preoccupied with concern with?
They are typically concered with “pelvic alignment” and beliefs of being “unstable” or “displaced”. Often these patients have been engaged in intensive stabilizations exercise programes and are commonly anxious and under high levels of stress
Ch. 4, Pg. 172-173
What is the Management of Excessive Force Clossure?
Reducing force closure across the pelvic structures with targeted,
- Relaxation strategies
- Breathing control
- Muscle inhibitory techniques
- Enhancement of passive/relaxed spinal postures
- Pacing strategies
- Focus on cardiovascular exercise
Chronic Low Back Pain (CLBP)
What is Chronic Low Back Pain commonly described as?
What type of pain can CLBP include?
Commonly described as LBP or low back-related lower extremity pain with symptom duration of more than 3 months
CLBP may include Generalized pain not consistent with other impairment-based classification criteria and may be assocaited with the presence of depression, fear-avoidance beliefs, and pain catastrophizing
Chronic Low Back Pain (CLBP)
If a patient has Chronic LBP and they have an absence of depression, anxiety, excessive fear-avoidance beliefs and pain catastrophizing behaviors, an impairment-based approach can be used. What will this include?
- Mobilizations/Manipulations
- Soft Tissue Mobilizations
- Mobility and Motor control exercises
Chronic Low Back Pain (CLBP)
If a patient has CLBP for a long period of time what may happen to them?
The more deconditioned the patient can become and more secondary impairments seem to develop, including movement impairments and muscle imbalances
Chronic Low Back Pain (CLBP) {Box 4.14}
What are Factors that compound Chronic Back Pain?
- Psychosocial components of chronic pain (Depression, sleep impairments, anxiety, fear avoidance)
- Underlying pathology (OA, RA, CS, etc)
- Movement Impairments
- Muscle imbalances
- Multiple Joint Impairments
- Deconditioning
Chronic Low Back Pain (CLBP)
Through the research found in the book, what are some evidence based interventions for patients with CLBP? why would this benefit them?
- Spinal Thrust (This improves functional movement for short and long term pain relief)
- Spinal Stabilization Exercises (Improved Pain and disability for short and long term)
- Manual PT, like Mobilizations and Manipulations (Helps pain reduction for patients with a higher initial pain rating scale {>50}, this is also beneficial for transitioning patients into an active exercise program)
Chronic Low Back Pain (CLBP)
As a movement exercise program is initiated its important to address muscle imbalances. How can we do this?
Through mobility, stretching exercises, strengthening exercises and use of myofascial techniques to target myofascial tighness or weaknessof both the trunk and LE
Chronic Low Back Pain (CLBP)
With Chronic LBP, the pathogenesis of spinal syndromes originate from imbalances in what?
Imbalances in muscle function between the phasic and postural muscles
Chronic Low Back Pain (CLBP)
With imbalances of Postual Muscles, what muscles will this include?
- Triceps
- Rectus Femoris
- Thigh adductors
- Hamstrings
- TFL
- some Trunk erectors
- QL
- sternal portion of Pec Major
- Upper Trap
- Levator Scap.
- UE flexors
The muscles with a predominantly Phasic Function show a tendency of what? (In terms of imbalances)
- Hypotonia
- Inhibition
- Weakening
These muscles are less readily activated in most movement patterns; and atrophy more easily to a greater extent when in dysfunction
Chronic Low Back Pain (CLBP)
If a patient has greater psychosocial issues and fear avoidance beliefs, what may they develop?
Chronic Low Back Pain conditions
Chronic Low Back Pain (CLBP)
The Fear-Avoidance Model (FAM) of MSK pain proposes that the primary affective and cognitive components influencing pain perception are what?
Anxiety and pain-related fear, including fear of movement and reinjury
Chronic Low Back Pain (CLBP)
With a patients with Acute LBP if they have a high FABQ score about work, what can this indicate?
This can predict which patients are likely to develop more chronic disability and longer-term absenses from work at a 4-week follow-up examination, after controlling for initial levels of pain intensity, physical impairment, disability, and the type of therapy recieved
Chronic Low Back Pain (CLBP)
What is Graded Exposure?
This is a behavior approach that strives to increase the performance of fearful activities through combination of education and activty implemation. Patients receive education that decreases the fear and threat associated with LBP and also receive positive reinforcement for performing fearful activites utilizing benefical coping strategies
Chronic Low Back Pain (CLBP)
How is Graded Exposure introduced to a patient?
- First pt. identifies activites that they are highly fearful of performing because of LBP
- Next the level of the activity is increased slightly to increase the level of fear, it is performed until fear rating decline, and then exposure is increased again.
Chronic Low Back Pain (CLBP)
What is a Key Aspect of Graded Exposure?
The exposure must occur outside the clinical setting
Chronic Low Back Pain (CLBP)
When working on a patinet with CLBP, what happens if psychosocial factors are low? How do you treat them?
The therapist can focus on treatment of mobility and motor control impairments
Chronic Low Back Pain (CLBP)
When working on a patient with CLBP, what happens if psychosocial factors are high?
A psychologically informed pain management approach should be incorporatd into the physcial therapy program with emphasis on an active therapeutic exercise approach that combines motor control exercise, graded exposure, and education on the neurophysiology of pain
Chronic Low Back Pain (CLBP)
How are sleep and chronic pain related?
Studies show that sleeping less than 6 hours and more than 9 hours per night was associated with increased frequency and intensity of chronic pain the following day
Chronic Low Back Pain (CLBP)
What 3 factors are commonly associated with both chronic pain and insomnia?
Anxiety, stress and depression
Chronic Low Back Pain (CLBP)
Why is sleep hygiene education important?
Sleep Hygiene Education can improve sleep quality and reduce pain and fatigue in people with chronic pain and fibromyalgia
