Week 3: LBP

Question 1

Which treatments are not recommended for low back pain

Answer 1

electrotherapies
Taping
brace and tractions
injections of corticosteroids
anaesthetic
Sclerosing agent
denervation procedures
spinal injection
surgical intervention

Question 2

Second line care for low back pain

Answer 2

Multidisciplinary rehab
Exercise
manual therapy
psychological therapy (CBT/mindfulness)
Pharmacalogical intervention if patient is not responsive to non-pharmacological options

Question 3

Risk prediction tools to match patients to treatment packages based on their risk of poor clinical outcome

Answer 3

StartBack
Orebro musculoskeletal pain screening questionnaire
Pickup

Question 4

Spondylolysis vs spondylolisthesis

Answer 4

Spondylolysis = stress fracture
Spondylolisthesis = anterior displacement of part or all of one vertebra forward

Question 5

Spondylolisthesis Grades

Answer 5

Grade I: <25%
Grade II: >25%
Grade III: >50%
Grade IV: >75%

Question 6

How does acute radiculopathy occur

Answer 6

acute disc prolapse when the contents of the nucleus pulposus of the IV disc extrude into the spinal canal irritating the nerve root

Question 7

Is paracetamol recommended for low back pain

Answer 7

No

Question 8

Lancet low back pain series key messages (Reduce/Use)

Answer 8

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

Question 9

What is McKenzie method for LBP

Answer 9

diagnosis and treatment system for MSK disorders
Emphasises patient empowerment and self-treatment
subgroup based approach

Question 10

4 steps for McKenzie

Answer 10

Assessment
Classification
Treatment
Prevention with education and self-care

Question 11

What are the classifications of McKenzie

Answer 11

Derangement, Dysfunction, Postural or Other

Question 12

Derangement Syndrome

Answer 12

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

Question 13

Statement that describes the concept of pain centralisation in the context of McKenzie therapy

Answer 13

Pain moves from the periphery to a more central location in the lower back

Question 14

Explain Derangement Syndrome Directional preference

Answer 14

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

Question 15

Dysfunction syndrome

Answer 15

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)

Question 16

How do you treat dysfunction syndrome McKenzie

Answer 16

Treat with repeated movements in the direction of the dysfunction

Question 17

How do you treat Derangement syndrome McKenzie

Answer 17

Treat with movements in the opposite direction of the pain

Question 18

Postural Syndrome

Answer 18

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

Question 19

Treatment for postural syndrome

Answer 19

• patient education
• correction of posture by improving posture by restoring lumbar lordosis
• avoiding provocative postures
• avoid prolonged tensile stress on normal structure

Question 20

Best exercise for low back pain

Answer 20

Core strengthening
Pilates
Functional Restoration
McKenzie

Question 21

Acute low back pain or first line advice

Answer 21

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

Question 22

What is a SNAG

Answer 22

Mulligan mobilisation
Sustained Natural Apophyseal Glide

Question 23

What are the 2 types of derangement syndrome

Answer 23

Irreducible: no position changes pain (no directional preference)
Reducible: directional preference (good response to treatment)

Question 24

Goals of Mckenzie method

Answer 24

reduce peripheralisation and get closer to centralisation

Question 25

For Derangement syndrome if extension movements alleviate pain and centralise symptoms and flexion causes a pain response, what exercises will be prescribed

Answer 25

Extension exercises will be prescribed
Flexion initially avoided and once derangement is reduced. flexion may be introduced

Question 26

Goal of SNAG

Answer 26

To improve pain free range of motion and perform more activity
Improvement in ROM and reduction in pain after treatment