Levels of Classification for TBC
First - Is patient appropriate for PT management?
Second - Level of acuity
Third - Treatment to use
Yellow Flags for TBC
- Depression, anxiety
- Fear-avoidance beliefs
- Preference for passive treatments
- Low mood, social withdrawal
FABQW Cutoff Scores
High - Above 34
Low - Below 29
Stage I Classification
- Oswestry > 30
- Unable to sit > 30 min
- Unable to stand > 15 min
- Unable to walk > 1/4 mile
Stage II Classification
- Oswestry 15-30
- Able to sit, stand, walk
- Unable to perform complex tasks
- No stage I findings
Stage III Classification
- Oswestry < 15
- Able to perform complex tasks
- Unable to perform demanding tasks
TBC Treatment Progression
Stage I: Assign to Stage I Classification (Manip, Specific Exercise, Stabilization, Traction
Stage II: Aerobic activity, eliminate impairments, trunk strength, general strength
Manipulation CPR
> 4 present:(45% -> 92% chance of 50% decrease in ODQ over 7 days):
1) Recent onset (< 16 days)*
2) 35° IR at one or both hips* (Flynn)
3) FABQW < 19
4) symptoms not distal to knee
5) At least 1 hypo-mobile L spine seg
* Key symptoms - 91% success if both present (Fritz)
Manipulation vs. Mobilization for Manip Subgroup
- Manip superior on Oswestry, not pain
- More side effects with mob
CPR for Dramatic Success for Stabilization Subgroup
3 or more present (33% -> 67% chance of 50% decrease in OWD over 8 weeks): 1) + Prone instability test 2) Aberrant motions 3) Average SLR > 91 4) Age < 40 (Fritz)
CPR for Improvement for Stabilization Subgroup
2 or more present (72% -> 94% success):
1) + Prone instability test
2) Aberrant motions
3) Hypermobility
4) FABQ-PA <= 8
Criteria for Specific Exercise Subgroup
- Centralization phenomenon
- Postural preference
Criteria for Traction Subgroup
- Neurologic signs
- Leg sx
- Peripheralization
- Crossed SLR
Stage II Proposed Length Tests
- TFL/ITB
- Rectus Femoris
- Glut Max
- Hamstrings
- Iliopsoas
- Piriformis/rotators
Stage II Proposed Strength Tests
- Abdominal bracing
- Upper abs
- Lower abs
- Glut med
- Glut max
- Side support (not sure what this means)
- Sahrmann exam items
Effect of early referral to PT for LBP
Lower costs for early referral
Stabilization Classification for Postpartum Patients
- Posterior pelvic pain provocation
- ASLR
- Modified Trenbelenberg
- Pnful palpation of long dorsal SI ligaments, pubic symphysis
