What are the biomechanics/physical risk factors for LBP?
- Heavy or frequent lifting
- Whole body vibration (i.e. driving)
- Prolonged or frequent bending or twisting
- Postural stresses (high spinal load or awkward postures)
What are the psychosocial risk factors for LBP?
- Low job satisfaction
- Relationships at work
- High job demand
- Monotony
- Stress and anxiety
What elements should be included for an optimal management approach to treating LBP?
- Avoidance of bed rest and encourage return to normal activity
- Educate to make pts less fearful
- Advise pts how they can manage what may be an ongoing or recurrent problem
- Inform pts that their active participation is vital in restoring full function, and encouraging self-management
- Provide pts with the means to affect symptoms, thus gaining some control over their problem
How does a disco gram work?
- Asymptomatic disc will feel uncomfortable when fluid is injected
- Symptomatic disc will have severe pain
- Symptomatic disc will also have fluid leak out
disco gram and CT discography must be positive for disc disruption
How can we as PTs detect discogenic vs nondiscogenic pain?
repeated end-range lumbar test movements can distinguish btwn an competent and incompetent annulus
- incompetent = pain with repetitive movement
What are the specific indicators for surgery?
- Cauda Equina Syndrome
- Progressive neurological deficit
- Profound neurological deficit (e.g. foot drop) showing no improvement over 6 weeks
What are the known causes of specific back pain?
- Disc herniation
- Spondylolisthesis, usually in the young
- Spinal stenosis, usually in the older age group
- Definite instability, exceeding 4-5mm on flexion-extension radiographs
- Vertebral fractures, tumors, infections and inflammatory diseases
- fewer than 15% of persons with back pain can be assigned to one of these categories
What are the most common sources of spinal metastases?
breast, lung, and prostate
What are cord signs?
- caused by bony or fiscal protrusions into the spinal canal or spinal neoplasms
- SandS of UMN lesions:
1. Non-dermatomal sensory loss (stocking paresthesia).
2. Non-myotomal muscle weakness (multiple segments).
3. + Babinski sign
4. Ankle clonus
5. Generalized hypertonicity or flaccidity
One of the inflammatory arthropathies that may affect the spine; Systemic, multi-system disease that include a primary NMS component; Characterized by chronic inflammation and tissue damage affecting principally the spine and S-I joints
ankylosing spondylitis
What are McKenzie’s 3 non-specific mechanical syndromes?
- posture
- dysfunction
- derangement
Syndrome with variable and unpredictable symptoms; Pain = constant or intermittent, gradual or sudden onset, may move from side to side/proximally and distally, may be somatic, radicular or combined; Usually includes decreased ROM or obstruction to movement; May include temporary deformity (kyphotic, lordotic, etc.)
derangement syndrome
- Internal derangement causes a disturbance in the normal resting position of the affected joint surfaces. Internal displacement of articular tissue of whatever origin will cause pain to remain constant until such time as the displacement is reduced. Internal displacement of articular tissue obstructs movement
Only occurs in derangement syndrome; Occurs with the reduction of the derangement; Involves lasting abolition of peripheral or radiating pain; May occur rapidly or gradually; Is accompanied by improvements in mechanical presentation; Occurs in response to loading strategies (repeated movements or postural correction)
centralization
syndrome where pain is never constant; Appears only as affected structures are mechanically loaded; Pain will stop almost immediately on cessation of loading; Characterized by intermittent pain and a restriction of end-range movement
dysfunction
- abnormal tissue may be product of previous trauma, inflammatory, or degenerative processes
- seen when normal tissue has gone through adaptive shortening
- adherent nerve root
- pain is felt when abnormal tissue is loaded
Syndrome characterized by intermittent pain brought on only by prolonged static loading of normal tissues; No pain with movement or activity; Rarely seen clinically
postural syndrome
- i.e., poor sitting posture
What is the progression of static extension exercises?
- Lying prone
- Lying prone in extension
- Sustained extension
- Posture correction
What is the progression of dynamic extension exercises?
- Extension in lying – EIL
- Extension in lying with patient overpressure
- Extension in lying with clinician overpressure
- Extension in lying with belt fixation - Extension mobilization (neutral or in extension)
- Extension manipulation
- Extension in standing – EIS
- Slouch – overcorrect/correct sitting postu
What is the progression of extension exercises with a lateral component?
- Extension in lying with hips off center
- Extension in lying with hips off center with clinician overpressure
- Extension mobilization with hips off center
- Rotation mobilization in extension
- Rotation manipulation in extension
What is the progression of lateral exercises?
- Self-correction of lateral shift or side gliding
2. Manual correction of lateral shift
What is the progression of flexion exercises?
- Flexion in lying – FIL
- Flexion in sitting
- Flexion in standing –FIS
- Flexion in lying with clinician overpressure
What is the progression of flexion exercises with a lateral component?
- Flexion in step standing – FISS
- Rotation in flexion
- Rotation mobilization in flexion
- Rotation manipulation in flexion
