W3: MC Flashcards
When should medications be used for backpain? What specific medication should be reduced?
Medications are a second line treatment if non-pharma fails. Opioids should be reduced.
What is the general finding for spinal manipulative treatment for acute and non-specific LBP?
Small effects with short-term improvements
Article: Benefits and harms of spinal manipulative therapy for the treatment of chronic low back pain: systematic review and meta-analysis of randomised controlled trials
Conclusion: the immediate changes in pain intensity and pressure pain threshold after a single high-velocity manipulation do not differ by region-specific versus non-region specific manipulation techniques in patients with chronic low back pain
If there is no change after a technique application what should be done?
Increase one variable
If there are improvements following technique application what should be done?
Repeat 1-5 sets
What are the findings of the McKenzie method for non-specific LBP?
Not clinically important effect for sub(acute) low back pain. Superior to other forms of exercise for chronic low back pain
What is the McKenzie method?
- The McKenzie method, also known as mechanical diagnosis and therapy (MDT), is a diagnosis and treatment system for musculoskeletal disorders.
- Emphasizing patient empowerment and self-treatment
- Subgroup-based approach (direction preference classification)
What are the steps in the McKenzie method?
- Assessment (1)
- Classification: based on assessment the symptomatic response during the repeated or sustained movement testing, a classification is given (derangement syndrome, dysfunction syndrome, postural syndrome or other) – (2)
- Treatment: treatment consists of first finding a repeated or sustained movement that reduces the symptoms (3)
- Prevention with education and self-care (4)
Explain Derangement syndrome (McKenzie method for LBP)
- More common of the subgroups
- Variable clinical pattern eg local, referred or radicular pain. Constant or intermittent, etc.
- Symptoms can be influenced by postures or normal daily activities
- Directional preference - specific repeated movement or sustained position causes an improvement in symptoms
- Treatment involves specific movements that aim to centralise symptoms
Explain the directional preference in relation to derangement syndrome
- One direction (eg, flexion): reduce pain or centralise symptoms or improve mechanics
- Another direction (eg, extension) increase pain or peripheralise symptoms or worsening mechanics
**Treatment is in the direction of preference (decrease, abolish or centralise symptoms), 10-15 reps every 2 hrs
Explain Dysfunction syndrome (McKenzie)
- Refers to pain as a result of mechanical deformation of structurally impaired tissues like scar tissue or adhered or adaptively shortened tissue
- Consistent movements will provoke symptoms typically at end-range
- Symptoms atleast 6-8 weeks
- Treatment includes repeated movements in the direction of the dysfunction (or that reproduces the pain)
Explain Postural syndrome (McKenzie)
- Pain arises during static positioning of the spine
- No pain in movement or activity
- Time-related symptoms and sedentary individuals eg after 1hr working/sitting all day they feel pain
What is the treatment for postural syndrome (McKenzie)
- The treatment includes patient education, correction of the posture by improving posture by restoring lumbar lordosis, avoiding provocative postures and avoid prolonged tensile stress on normal structure
What is the other or non-mechanical syndrome (McKenzie)
- There are patients who do not fit within one of the three mechanical syndromes but who demonstrate symptoms and signs of other pathologies
In the McKenzie method what happens at the follow-up if they are better/worse?
Better: often no change is given to their prescribed activity
Worse: If the patient returns worse, reassess the patient.
Studies have determined that what treatment is best for LBP? What sub-group is specifically best?
Exercise
- All exercise works but core strengthening, pilates, functional restoration & McKenzie had better effects.
When providing advice and education it is important to….
Not overdo it!
40-80% of all you say is forgotten immediately by most patients and 50% of what is remembered is misinterpreted.
What type of education is generally more beneficial for LBP patients?
The effects of education about pain with neurophysiology tend to be higher (in comparison to education about anatomy and biomechanics)
Radiological imaging is discouraged unless…..
- Serious pathology is suspected
- There has been an unsatisfactory response to conservative care or unexplained progression of signs and symptoms
- It is likely to change management.
Common problems in treatment of LBP?
- Overuse of imaging:
- 25% to 42% of patients with low back pain undergo imaging
- Overuse of surgery
- Overuse of opiods
- The early use of opioids has been associated with poorer outcomes
- Failure to provide education and advice
- Only 20% of patients with LBP were given advice and education in a primary care setting
What are the two types of derangement syndrome?
- Irreducible: no position changes pain- suggestive of non-responder to treatment (this theory won’t apply for them!)
- Reducible: good response to treatment –> sore in a particular movement eg flexion (also generally with repeated movement eg repeated flexion)
General principles for McKenzies treatment?
General Principle of treatment
- Repeated movements 10-15 reps, 3 sets.
- 30-60 sec for static postures X 2-3 sets.
- Assess during and after movement.
- Increase range as tolerated.
- Pain must not increase peripherally.
Mulligans techniques should be:
Pain-free, instant & long-lasting (PIL)
Best treatment options for LBP
Education
- Pain neuroscience education
- CBT
- Natural hx
- Advice to stay active
- Expectations
Manual therapy
- PAIVMs/PPIVMs
- Mulligan
- Manipulation
Exercise
- Any form of exercise
- Core exercises and Pilates
- Motor control
- Graded activity
- McKenzie
- Mobility exercises
