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25 Cards in this Set
- Front
- Back
CLBP
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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 |
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Motor control and CLBP
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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 |
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Diagnosing CLBP
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Present >3 months
Clinical testing: other diagnoses have been ruled out Presence of segmental instability -Manual spinal segmental mobility testing -EMG -Videofluoroscopy |
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Treatment of CLBP
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Medical Intervention - NSAIDS
Cognitive-Emotional - Counseling Physical - Improving aerobic fitness and core stabilization |
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Acute Low Back Pain
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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%) |
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You do not necessarily need to contact an MD if
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-simple low back strain
-facet condition -No neurological S&S |
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It's safe to provide treatment, but team MD needs to be contacted if
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Chronic LBP
mild disc injury |
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Defer treatment and contact the team MD immediately if
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extruded or sequestered NP
stenotic presentation |
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Treatment classification groups
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Specific Exercise (extension and flexion syndrome)
Mobilization Traction Immobilization |
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Extension Syndrome
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Postural preference for extension
flexion makes them worse Mild disc herniation without radiculopathy symptoms worsen when seated and bending forward |
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Flexion Syndrome
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Postural preference for flexion
extension makes them worse spinal stenosis Symptoms worsen in standing and when extending |
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Mobilization
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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 |
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Five criteria for Prediction rule of Mobilization
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-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 |
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Traction
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Radiculopathy with or without lateral shift
Radicular pain Paresthesias Loss of sensation along dermatomes Myotomal weakness diminished DTRs (patellar and achilles) |
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Immobilization
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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 |
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Core Strengthening
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Stability of lumbar spine requires Passive Stiffness and Active Stiffness
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Passive stiffness
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Osseous and ligamentous structures
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Active stiffness
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Muscle function
adequate strength normal sequencing |
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Local Core Muscles
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Diaphragm
TA Multifidi Pelvic Floor muscles |
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Strengthen the Abdominals from
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Inside to OUt
Transverse, Oblique, Rectus |
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TA Exercises
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Very Important to keep spine neutral!
Prarie Dog with extremities moving Dead Bug with extremities moving Also good Multifidi exercises |
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Oblique Exercises
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Side Planks
Contralateral and Epsilateral crunches |
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Force Closure
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Exercises that incorporate global muscles working together
Core exercise example of force closure = glute activation with Lattissimus activation |
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Impaired Diaphragmatic Breathing
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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 |
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Low Back Injury Prevention
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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) |