Week 3: LBP Flashcards
Which treatments are not recommended for low back pain
electrotherapies
Taping
brace and tractions
injections of corticosteroids
anaesthetic
Sclerosing agent
denervation procedures
spinal injection
surgical intervention
Second line care for low back pain
Multidisciplinary rehab
Exercise
manual therapy
psychological therapy (CBT/mindfulness)
Pharmacalogical intervention if patient is not responsive to non-pharmacological options
Risk prediction tools to match patients to treatment packages based on their risk of poor clinical outcome
StartBack
Orebro musculoskeletal pain screening questionnaire
Pickup
Spondylolysis vs spondylolisthesis
Spondylolysis = stress fracture
Spondylolisthesis = anterior displacement of part or all of one vertebra forward
Spondylolisthesis Grades
Grade I: <25%
Grade II: >25%
Grade III: >50%
Grade IV: >75%
How does acute radiculopathy occur
acute disc prolapse when the contents of the nucleus pulposus of the IV disc extrude into the spinal canal irritating the nerve root
Is paracetamol recommended for low back pain
No
Lancet low back pain series key messages (Reduce/Use)
Reduce:
- imaging
- invasive procedures
- use of opioids
Use:
- evidence based non-pharmacological treatments
- education within a biopsychosocial model
- exercises
- manual therapy (as adjunct)
- physical activity promotion
- psychological therapy
What is McKenzie method for LBP
diagnosis and treatment system for MSK disorders
Emphasises patient empowerment and self-treatment
subgroup based approach
4 steps for McKenzie
Assessment
Classification
Treatment
Prevention with education and self-care
What are the classifications of McKenzie
Derangement, Dysfunction, Postural or Other
Derangement Syndrome
Most common
Variable clinical pattern - symptoms can be local, referred, radicular or a combination, constant or intermittent or vary through the day
Symptoms can be influenced by postures or normal daily activities
Directional preference is main characteristic of this subgroup, which a specific repeated movement or sustained position causes a relevant improvement in symptoms
Treatment involves specific movements that cause the pain to decrease, centralise and/or abolish
Statement that describes the concept of pain centralisation in the context of McKenzie therapy
Pain moves from the periphery to a more central location in the lower back
Explain Derangement Syndrome Directional preference
one direction (e.g. flexion) reduces pain or centralises symptoms or improves mechanics
Another direction (e.g. extension) increases pain or peripheralises symptoms or worsens mechanics
Dysfunction syndrome
Related to musculoskeletal injury/adhesions
Symptoms for at least 6-8 weeks
Consistent movements will reproduce pain (usually arises at the end of range of a restricted movement)
Treatment includes repeated movements in the direction of the dysfunction (or that reproduces the pain)
How do you treat dysfunction syndrome McKenzie
Treat with repeated movements in the direction of the dysfunction
How do you treat Derangement syndrome McKenzie
Treat with movements in the opposite direction of the pain
Postural Syndrome
Pain arises during static positioning of the spine
Pain disappears when patient is moved out from static position
No pain when performing movement or activity
Time related symptoms and sedentary individuals
Treatment
- patient education
- correction of posture by improving posture by restoring lumbar lordosis
- avoiding provocative postures
- avoid prolonged tensile stress on normal structure
Treatment for postural syndrome
- patient education
- correction of posture by improving posture by restoring lumbar lordosis
- avoiding provocative postures
- avoid prolonged tensile stress on normal structure
Best exercise for low back pain
Core strengthening
Pilates
Functional Restoration
McKenzie
Acute low back pain or first line advice
Explain the non-specific nature (and likelihood of serious pathology)
Explain likely course of low back pain (good natural history)
Promote self management and self efficacy
Encourage the patient to be as physically active as possible
Remain at work
What is a SNAG
Mulligan mobilisation
Sustained Natural Apophyseal Glide
What are the 2 types of derangement syndrome
Irreducible: no position changes pain (no directional preference)
Reducible: directional preference (good response to treatment)
Goals of Mckenzie method
reduce peripheralisation and get closer to centralisation
For Derangement syndrome if extension movements alleviate pain and centralise symptoms and flexion causes a pain response, what exercises will be prescribed
Extension exercises will be prescribed
Flexion initially avoided and once derangement is reduced. flexion may be introduced
Goal of SNAG
To improve pain free range of motion and perform more activity
Improvement in ROM and reduction in pain after treatment
