Lumbopelvic Interventions PDF

Lumbopelvic Interventions Adam Squires PT, DPT, Cert SMT, Cert DN Board Certified Specialist in Orthopedic Physical Therapy  Objectives Understand the evidence supporting physical therapy interventions for low back pain. Understand technique for, and demonstrate ab...

Lumbopelvic Interventions Adam Squires PT, DPT, Cert SMT, Cert DN Board Certified Specialist in Orthopedic Physical Therapy  Objectives Understand the evidence supporting physical therapy interventions for low back pain. Understand technique for, and demonstrate ability to perform, lumbopelvic joint mobilizations. Understand technique for, and demonstrate ability to perform, lumbopelvic joint high-velocity, low-amplitude thrust manipulations. Demonstrate ability to perform muscle energy techniques for SI joint pain. Understand technique for, and demonstrate ability to coach, exercise interventions for the lumbopelvic region. Evidence  Interventions How do we decide what interventions to do? Things to consider What does the evidence say? What has the patient tried already? Identify beliefs and expectations associated with current problem (Get inside their head) What do you think is going on? What do you think it will take to get you better? What does success in physical therapy look/feel like to you? Evidence Based Practice  What is the Evidence? 2021 Clinical Practice Guideline (CPG) published by the Academy of Orthopedic Physical Therapy of the APTA Grade A evidence for mobilization and HVLAT manipulation in both acute and chronic low back pain Grade A evidence for exercise in chronic pain 2017 CPG published by the American College of Physicians Strong recommendation for manual therapy and exercise in patients with acute, subacute, or chronic LBP 2023 Systematic Review of CPGs for WHO Recommended spinal manipulation and exercise Interventions  Overview Treatment Based Classification System (2016) Symptom Modulation Manipulation/Mobilization, Specific Exercises, Traction Movement Control Stabilization Functional Optimization Strength and conditioning, Return to work, Return to sport Symptom Modulation  Overview Mobilization Manipulation Muscle Energy Technique Specific Exercises Traction Mobilization  Overview Central PA (CPA) Unilateral PA (UPA) Lateral Glide Rotation  General Information/Principles Firm and gentle “Iron fist in velvet gloves” Go slow! Gradually increase pressure and grade of mobilization based on feedback from patient Patient and therapist positioning and body mechanics Continuous assessment of patient response Communication, communication, communication!  Lumbar CPA/UPA Patient prone. Therapist standing to the side CPA –Therapist places “dummy” hand hypothenar eminence over desired level spinous process Force is directly anterior with the mobilizing UE straight UPA – Utilize “dummy” thumb approximately 1 thumb-width lateral to spinous process Force is directly anterior, elbows straight 30-60 seconds, 1-3 sets Lumbar CPA/UPA https://phcn-online.com/2021/11/24/jm-lumbopelvic-spine-part1/  Lumbar Lateral Glide Patient side-lying with involved side up. Therapist standing in front of patient Patient knees together and hips flexed to ~60 deg flexion Contact lateral muscle bulk with superior hand Force is applied toward table Contralateral forearm is on hip and provides increased lateral side bend. Lumbar Lateral Glide Institute of Clinical Excellence Lumbar Spine Management  Lumbar Rotation Patient side-lying with painful side up. Lower leg straight, top leg foot tucked behind bottom leg knee. Arms crossed holding onto forearms Therapist superior arm threads through patient top arm to hold trunk in place Therapist inferior hand contacts PSIS area Mobilize using inferior hand while stabilizing with top arm Lumbar Rotation Institute of Clinical Excellence Lumbar Spine Management Manipulation  Fritz 2007 Classification Selection Criteria Interventions Manipulation Recent onset of Sx (