flash cards - L:sp and other.pdf

Non-specific lower back pain Treatments Info Education Pain neuroscience education, n...

Non-specific lower back pain Treatments Info Education Pain neuroscience education, natural hx, advice to stay active, expectations Mobilisations Think about derangement, dysfunction, postural PAIVMs ® Central PA and Transverse glide PPIVMs ® Mulligan ® for localised, diJuse pain, ¯ ROM and pain in the direction you are trying to treat Manipulation ® Lumbar distraction ® for OA, decreased ROM, Assessments radiculopathies, belt around gastroc Exercise ROM ® F, E, LF, Rot Is the best treatment option for patient with low back pain. They all work, Neuro ax ® SLR, slump, myotome, sensory, reflexes, Babinski/clonus but core strengthening, Pilates, functional restoration and McKenzie had PAIVMS ® find L4 (iliac crest and across) better eJects o PA central ® pain? Is vertebrae segment normal? Hyper/hypo? McKenzie o PA unilat/transverse ® pain? Is facet jt segment normal? Hyper/hypo? o E ® prone – puppy prone - cobra, cat/cow - bird dog, pelvic neutral, PPIVMs ® F, E, Rot, LF ® Mulligans plank, superman, DL bridge MMTs Core exercises and Pilates, Motor control, Graded activity, Mobility Functional tests ® endurance position, lift heavy object, perform specific exercises movement Spinal Stenosis Treatments Info Mulligans mobilisations Multilevel degenerative changes where there is narrowing of Into extension with the belt the spinal canal. Mobs Love flexion (vertebral column open - ¯ compression on Unilateral or Central PA to improve extension ROM nerve), love sitting, hate doing anything else (walking, Exercise standing), lean over the trolley. Common in 75+. Bilateral Gentle extension-based mobility exercise as it is direction ant/post thigh pain most limited ® standing extension or prone extension Stenosis doesn’t typically follow a nerve root, more whole leg Flexion exercises such as stationary cycling to maintain Cook clinical decision rule (at least 3/5 positive) conditioning or sit to stands/lunges in flexion to maintain Age > 48 years, bilateral symptoms, leg pain more than back conditioning pain, pain during walking/standing, pain relief upon sitting Assessments ROM ® F, E, LF, Rot (Reproduce pain on extension) + OP Neuro ax ® SLR, slump, myotome, sensory, reflexes, Babinski/clonus ® should be negative PAIVMS ® find L4 (iliac crest and across)  Lumbar spine radicular pain +/- radiculopathy Treatments Info Education Radicular pain ® referred pain from a spinal nerve with no nerve root compromise Prognosis ® Favourable ® 85% recovers within 12 mo. 50% at 6 (sharp, shooting pain) weeks, 70% at 3 mo Radiculopathy ® signs of nerve root compromise (­¯ sensation, ¯ reflex, ¯ myotome weakness) - Caused by lesion or disease Imaging ® complete absent myotomes, if significant myotomal Somatic referred ® pain from a musculoskeletal origin (dull aches, certain weakness (or not responding to treatment) – potential orthopaedic positions review. Also get GP involved – because things can happen overnight Pain worse in leg than back Short term ® massage for lumbar paraspinal tone, heat packs, hot Pain worsens on cough/sneeze/strain (Sn 40%, Sp 77%) showers Malalignment/scoliosis (lateral shift) (Sn 39-64%, Sp 62-89%) Decreased reflexes (achilles and patella tendon) (Sn 14-61%, Sp 60-93%) Assessment Manual therapy ® Special tests (2 main + historic ones) traction, PAIVMs (Crossed) SLR ® Hip MR + Add, Knee E, lift leg, px reproduction (Crossed = SpPIN, normal SLR = SnNOut) Exercise ® e[ective Slump test o Motor control exercises Bell test ® pressure applied with thumb between spinous process L4-5, L5-S1 (not o McKenzie exercises ® prone – puppy prone - cobra, cat/cow - Sn because LBP also would be sore) Kemps test ® E, LF, Rot + axial pressure (like spurlings, pretty much a combined bird dog, pelvic neutral, plank, superman, DL bridge movement) Myotome, sensory, reflex Neuro screening for L/sp  Neuromechanical sensitivity ® Lower limb Treatment Info Sliders: Same as upper limb o Aim to induce sliding of the peripheral nerves in relation to their Assessment surrounding structures with a minimal increase in nerve strain Nerve palpation o Simultaneous lengthening of the nerve bed at one joint while Myotome, sensory, reflexes shortening the nerve bed over another joint Neurodynamic test o For more irritable pts Tensioners: o Aim to ­ nerve strain by simultaneously elongating the nerve bed at multiple joints o For less irritable, in persistent px state pts Education What is it? ® sensitivity of nerves to mechanical stimuli. Can be a protective response of the body when nerves are subject to mechanical stress during movement. Will experience aggravation of symptoms when nerve placed under tension or stress. May be secondary to other conditions Prognosis ® positive and very patient specific however with treatments patients should see an improvement of symptoms in a few weeks, for some it may be months Lower limb Nerve Palpation  Red Flag Conditions Pathology Incidence Symptoms and Diagnostic accuracy Pathology Incidence Symptoms and Diagnostic accuracy Cauda Equina 0.002-0.4% Severe low back pain Cancer 0-5% Unexplained weight loss (