2Nd Half Of Lumbar Pathology

Front 1

CLBP

Back 1

Chronic Low Back Pain
Non-specific, pain of at least 3 months
currently seeking care for LB_
Ages >18 and <65 (outside this age group typically have other problems)
No other confirmed spinal pathology
often physical and cognitive-behavioral component
Aberrant Motor Control and/or segmental instability

Front 2

Motor control and CLBP

Back 2

People have changes in the strategy for control of the deep trunk muscles (Hodges 1996, Hides 1994)
There is evidence that people with LBP tend to adopt a strategy for increased stiffness and stability oat the expense of spinal function

Front 3

Diagnosing CLBP

Back 3

Present >3 months
Clinical testing: other diagnoses have been ruled out
Presence of segmental instability
-Manual spinal segmental mobility testing
-EMG
-Videofluoroscopy

Front 4

Treatment of CLBP

Back 4

Medical Intervention - NSAIDS
Cognitive-Emotional - Counseling
Physical - Improving aerobic fitness and core stabilization

Front 5

Acute Low Back Pain

Back 5

Back strains are local muscle injury causing pain with palpation, limitation in bending
Must rule out other pathologies (disc herniation, stenosis, sondylolithesis, infection, malignancy)
Many will not completely recover and this will become CLBP (10 to 20%)

Front 6

You do not necessarily need to contact an MD if

Back 6

-simple low back strain
-facet condition
-No neurological S&S

Front 7

It's safe to provide treatment, but team MD needs to be contacted if

Back 7

Chronic LBP
mild disc injury

Front 8

Defer treatment and contact the team MD immediately if

Back 8

extruded or sequestered NP
stenotic presentation

Front 9

Treatment classification groups

Back 9

Specific Exercise (extension and flexion syndrome)
Mobilization
Traction
Immobilization

Front 10

Extension Syndrome

Back 10

Postural preference for extension
flexion makes them worse
Mild disc herniation without radiculopathy
symptoms worsen when seated and bending forward

Front 11

Flexion Syndrome

Back 11

Postural preference for flexion
extension makes them worse
spinal stenosis
Symptoms worsen in standing and when extending

Front 12

Mobilization

Back 12

Unilateral LBP with segmental hypomobility
a clinical prediction rule to identify LBP patients most likely to benefit from spinal manipulation when 4 of 5 criteria met, 92% of successful outcome

Front 13

Five criteria for Prediction rule of Mobilization

Back 13

-Duration of current episode of LBP <16 days
-Referred pain does not go below the knee
-Fear - avoidance beliefs quest <19 points
-Segmental mobility testing >= 1 lumbar hypomobile segment
>=1 hip with >35 degrees of internal rotation ROM

Front 14

Traction

Back 14

Radiculopathy with or without lateral shift
Radicular pain
Paresthesias
Loss of sensation along dermatomes
Myotomal weakness
diminished DTRs (patellar and achilles)

Front 15

Immobilization

Back 15

Segmental Hypermobility
frequent prior episodes of LBP
history of trauma
ligmaentous laxity
"instability catch" during lumbar flexion ROM
Treatment = core training exercises
Most LBP individuals (if not al) will need core training

Front 16

Core Strengthening

Back 16

Stability of lumbar spine requires Passive Stiffness and Active Stiffness

Front 17

Passive stiffness

Back 17

Osseous and ligamentous structures

Front 18

Active stiffness

Back 18

Muscle function
adequate strength
normal sequencing

Front 19

Local Core Muscles

Back 19

Diaphragm
TA
Multifidi
Pelvic Floor muscles

Front 20

Strengthen the Abdominals from

Back 20

Inside to OUt
Transverse, Oblique, Rectus

Front 21

TA Exercises

Back 21

Very Important to keep spine neutral!
Prarie Dog with extremities moving
Dead Bug with extremities moving
Also good Multifidi exercises

Front 22

Oblique Exercises

Back 22

Side Planks
Contralateral and Epsilateral crunches

Front 23

Force Closure

Back 23

Exercises that incorporate global muscles working together
Core exercise example of force closure = glute activation with Lattissimus activation

Front 24

Impaired Diaphragmatic Breathing

Back 24

Disuse of the lower abdominal muscles and the resulting lowered resting position of the diaphragm and having a slumped posture restricts diaphragmatic breathing
- With diaphragmatic breathing restricted, upper chest breathing predominates, leading to shallow inspiration and a chronic state of fatigue

Front 25

Low Back Injury Prevention

Back 25

Core stability exercises for prevention!
Maintain spine and hip flexibility
Proper Nutrition and Exercise (maintaining optimal body weight)
Walking and/or jogging to increase bone density
Don't smoke
Minimize occupational injury (chair and desk height, proper lifting techniques)