Week 2- Treatment Based Classification LBP Overview Flashcards
Levels of patient management
- Medical management (RED LIGHT)
- Self-care management (GREEN LIGHT
- Rehabilitation management (YELLOW LIGHT)
Clinical findings for medical management
- Red flags
- Medical comorbidities precluding rehab
- Leg pain w/ progressive neurologic deficits
Clinical findings for self-care management
- Low psychosocial risk status
- Predominantly axial LBP
- Minor or controlled medical comorbidities
Clinical findings for rehabilitation management
- Medium-high psychosocial risk status
- Low psychosocial risk status with predominantly leg pain
- Minor or controlled medical comorbidities
Sighs of serious spinal pathology
- Signs of infection (fever >100, BP >160/95, HR 100+, respiration 25+/min)
- Constant pain
- Severe night pain
- Unexplained weight loss 10+ lb
- Direct blunt trauma
- Acutely ill
- Abdominal pain
- Sexual dysfunction
- Menstrual irregularities
- Bowel/bladder dysfunction
Levels of rehabilitation management
- Symptom modulation
- Movement control
- Functional optimization
Symptom modulation characteristics
- Disability: High
- Symptom status: volatile
- Pain: high-moderate
Movement control characteristics
- Disability: moderate
- Symptom status: stable
- Pain: moderate to low
Functional optimization characteristics
- Disability: low
- Symptom status: controlled
- Pain: low to absent
Symptom modulation treatments
- Directional preference exercises
- Manipulation/mobilization
- Traction
- Active rest
Movement control treatments
- Sensorimotor exercises
- Stabilization exercises
- Flexibility exercises
Functional optimization treatments
- S&C exercises
- Work- or sport-specific tasks
- Aerobic exercises
- General fitness exercises
Factors Favoring Manipulation
- Recent onset of symptoms
- Hypomobility with spring testing
- LBP only, no distal symptoms
- Low FABQ scores (FABQW <19)
Factors Against Manipulation
- Symptoms below the knee
- Increasing episode frequency
- Peripheralization w/ motion testing
- No pain w/ spring testing
Factors Favoring Stabilization
- Young
- Positive prone instability test
- Aberrant motions present
- Greater SLR ROM
- Hypermobility w/ spring testing
- Increasing episode frequency
- 3+ prior episodes
Factors Against Stabilization
- Discrepancy in SLR ROM (>10 deg)
- Low FABQ scores (PA < 9)
Factors Favoring Specific Exercise
- Strong preference for sitting or walking
- Centralization w/ motion testing
- Peripheralization in direction opposite centralization
Factors Against Specific Exercise
- LBP only (no distal symptoms)
- Status quo with all movements
Intervention procedures for manipulation
- Manipulation of the lumbopelvic region
- Active ROM exercises
Intervention procedures for stabilization
- Promoting isolated contraction and cocontraction od the deep stabilizing muscles (multifidus, transversus abdominus)
- Strengthening of large spinal stabilizing muscles (erector spinae, oblique abdominals)
Intervention procedures for specific exercise (extension)
- End-range extension exercises
- Mobilization to promote extension
- Avoidance of flexion activities
Intervention procedures for specific exercise (flexion)
- Mob of the spin/lower extremities
- Exercises to address impairments of strength or flexibility
- Body-weight supported ambulation
Intervention procedures for specific exercise (lateral shift)
- Exeercises to correct lateral shift
- Mechanical or auto-traction
Intervention procedures for traction
Mechanical or auto-traction
