lower back Tx

Question 1

14

Principles of treatment

Answer 1

• Person-centred care
• Focus on restoring and maintaining function
• self-management and healthy lifestyles
• Help patients to have a better understanding of their problem
• Pain control
• Relaxation
• Decrease fear of movement
• Encourage normal movement
• Try to modify painful movements so they are immediately less painful or pain free
• General health and wellbeing (MECC)
• Give people control
• To self-manage
• Control any future exacerbations
• Write it down or video exercises (video them or you)

Question 2

5

Diaphragmatic breathing

Answer 2

• hourly x 5 in sit / stand
• crook lying particularly if a patient finds it difficult to do
• crook lying 5mins daily
• encourage breathing during movement e.g. sit to stand, bending etc.
• no holding breathe

Question 3

· Lateral expansion in sitting – lower and upper trunk

Answer 3

· 5 normal, 2 deep; x 2 per day (use towel)

Question 4

Sit to stand

8

Answer 4

• bottom forward in chair, feet slightly behind knees, but flat on floor. Easier to get body over centre of gravity
  hip flexion
• relax back (neutral initially), but can even flex slightly
• hip & knee extension i.e. use gluteals & quads, & push up through feet
  feet, thigh, bottom not back
• equal weight bearing
• patella alignment
• knees controlled to extension
• breathe in as stand-up
• quickly avoid using hands

Question 5

10

· Stand to sit

Answer 5

• gravity lowers you
• hip & knee flexion
• relax back (neutral initially), but can even flex slightly
• bend whole trunk from Tx down
  initially relaxed neutral low back if fear++
• breathe out
• equal weight bearing
• patella alignment
• lower bottom to front of chair & then
• take bottom to back of chair
• quickly avoid using hands

Question 6

1/4 squat e.g. picking up / put down; at sink

Answer 6

• gravity helps lower you and relax arms
• hip & knee flexion
• relax back (neutral initially), but can even flex slightly
• bend whole trunk from Tx down
  initially relaxed neutral low back if fear++
• breathe out
• equal weight bearing
• patella alignment
• return to neutral i.e. use gluteals & quads, & push up through feet NOT Lx
• 1 x 5 reps then 2 x 5; x 1 per day then x 2 per day

Question 7

Standing on 1-leg

Answer 7

• neutral pelvis – no shift to same side as weightbearing (WB) leg
• neutral shoulders – no drop of shoulders to same or opposite side as WB leg
• knee control

Question 8

walking

Answer 8

• gluteal awareness contraction & holding time
• neutral pelvis & shoulders
• patient can palpate upper gluteal muscles
• knee control
• heel control - neutral heel, so avoid e.g. eversion of heel
• decrease pounding
• heel toe gait
• thoracic spine rotation; hands shake and arm swing
• Sorbothane insoles

Question 9

stairs / steps

Answer 9

Up
* power through gluteals
* patella alignment
* feet, thigh, bottom
* neutral pelvis & shoulders, so gluteals
* knee control

Down
* heel lift
* patella alignment

Question 10

· Palpation treatment – trunk muscles

Answer 10

• QL / ES, leading to latissimus dorsi to help rotation
• QL to help lateral expansion
• ES to decrease compressive loading from extension+
• gentle picking-up; 3 to 4 mins
• monitor effect on transverse
• pressures when in side-lying
• self-treatment
• lateral expansion to relax QL
• feet, thigh, bottom not back e.g. sit to stand

Question 11

Palpation treatment – lower muscles

Answer 11

• soft tissue massage anterior quads, ITB, hip adductors
• gentle picking-up; 3 to 4 mins
• self-massage 20 to 30 secs x 2 to 3 per day - before / after e.g. walking if walking problem