alternative therapies for low back pain
TRANSCRIPT
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WHAT ARE THE BEST THERAPIES ?
BACK PAIN
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Low Back Pain Episodes
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Low Back Pain Episodes
Acute <3 months
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Low Back Pain Episodes
Sub Acute >5 weeks <3 months
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Low Back Pain Episodes
Chronic >3 months
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LBP affects 70% Adult PopulaKon • Episodes >2 wks have cumulaKve lifeKme prevalence in 14% cases
• Cause Nonspecific in 95%
• Australia : most frequently seen m/s condiKon in General PracKce
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NHMRC Evidence Based Management
Advice to Stay AcKve Reduces Sick Leave
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NHMRC Evidence Based Management
Massage • No controlled studies in LBP • Might be beneficial + exercises + educaKon • Cochrane 2012 :
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NHMRC Evidence Based Management
Lumbar Supports • No controlled studies, insufficient evidence are effecKve
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NHMRC Evidence Based Management
Bed Rest • Insufficient Evidence • >2 days increases sick leave • Evidence that prolonged bed rest is harmful
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NHMRC Evidence Based Management
Spinal ManipulaKon • ConflicKng evidence v’s placebo first 2-‐4wks
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NHMRC Evidence Based Management
Acupuncture • Insufficient evidence v’s injecKon therapy
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NHMRC Evidence Based Management
Back Exercises • Similar pain + funcKon outcomes to usual care • Reduces pain + sick leave • Paravert. Muscle ex’s • CoordinaKon/Stability + Strength/Resistance • Complements principle of acKvity
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Evidence Based Management
Physical Therapies Structured Exercise Programs + Spinal MobilisaKon effecKve Alongside early acKve movement
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Evidence Based Management
ChiropracKc Short term slightly improve pain and disability (Cochrane report) No clinical meaningful difference v’s other intervenKons
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NHMRC Evidence Based Management
Homeopathy Curing “like with like” PotenKsing
NHMRC : “Groundless”
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NHMRC Evidence Based Management
Review of Scope of Private Health Insurance Rebate !7 Therapies being reviewed Released 1 April 2015
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NHMRC Evidence Based Management
Provide InformaKon
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NHMRC Evidence Based Management
Provide InformaKon Provide Assurance
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NHMRC Evidence Based Management
Provide InformaKon Provide Assurance Advice to Remain AcKve
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NHMRC Evidence Based Management
Provide InformaKon Provide Assurance Advice to Remain AcKve Other Pain Management OpKons
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NHMRC Evidence Based Management
Acute LBP Management Aims IdenKfy Serious Causes (<5%) Self Management Maximize FuncKon Minimise Disability
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REHABILITATION AFTER BACK PAIN EPISODE
• MODIFY ACTIVITIES • CORRECT BIOMECHANICAL ABNORMALITIES • POSTURAL ASSESSMENT OF FUNCTIONAL POSITIONS • LIFTING MECHANICS • CORE STABILITY : LOCAL THEN GLOBAL • ASSESS / STRETCH TIGHTNESS • EDUCATION • HOME EXERCISE REGIME
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RehR
REFERRAL PRESCRIPTIONS
Acute Back Pain Local modaliKes for pain/spasm Encourage non-‐aggravaKng movement and exercise Educate / encourage neutral spine Manual therapy techniques Home exercise Back Care advice
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RehR
REFERRAL PRESCRIPTIONS
SUB-‐ACUTE BACK PAIN Local modaliKes for pain/spasm/hypo mobility Restore range with manual therapy and exercise Core stability regime and upgrade Review postures/biomechanics Home exercise / Cardio fitness
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FUNCTIONAL STABILITY NEED TO UTILISE BOTH MUSCLE FORCES AND PASSIVE STRUCTURES TO DYNAMICALLY STABILISE THE SPINE FUNCTIONALLY ANY DEFICITS ASSESSED NEED TO BE ADDRESSED IN A REHAB. PLAN
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CORE STABILITY • MUSCULAR CONTROL TO MAINTAIN FUNCTIONAL STABILITY
• MUSCULAR CORSET
• STABILITY INVOLVES PASSIVE AND ACTIVE STIFFNESS
• INSTABILITY WHEN EITHER COMPONENT DISTURBED
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CORE STABILITY
• GLOBAL : DYNAMIC / PHASIC MUSCLES = ACTIVE TRUNK MOVEMENT • RECTUS ABDOMINIS • EXTERNAL OBLIQUES • ILIOCOSTALIS (THORACIC PART) • LATISSIMUS DORSI
• LINK PELVIS TO THORACIC CAGE
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CORE STABILITY • LOCAL : POSTURAL / TONIC = INTERSEGMENTAL STABILITY • TRANSVERSUS ABDOMINIS • MULTIFIDIS • PSOAS MAJOR • QUADRATUS LUMBORUM • DIAPHRAGM • ILIOCOSTALIS ( LUMBAR SEGMENT) • INTERNAL OBLIQUE
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STABILITY TEACHING/RETRAINING
• EDUCATION : ANATOMY AND FUNCTION • ISOLATE DEEP LAYER T.A • MOTOR RELEARNING • TRAIN STABILISERS IN ISOLATION • ADD FUNCTIONAL MOVEMENTS WITH STABILITY • PAINFREE • NEUTRAL SPINE INITIALLY • FEEDBACK : TACTILE , PBU, ULTRASOUND
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STABILISATION EXERCISES
• INITIATE PELVIC FLOOR HELPS ISOLATE T.A. • PALPATE 1CM IN 1CM DOWN A.S.I.S. • FEEL TENSION, NOT BULGE • CONTROLLED BREATHING • SUPINE / 4 POINT KNEEL / STANDING / SITTING • PROGRESS UPGRADED POSITIONS/EXERCISES
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CONDITIONING • GENERAL AEROBIC FITNESS • POSTURAL CORRECTION • 20-‐30 MINUTE PERIODS • WEIGHT LOSS • POSITIVE RATHER THAN PURELY CLINICAL SETTING
NORMALISE SETTING : TAI CHI, PILATES, YOGA, GYM CLASSES, SWIM FOCUS ON SELF MANAGEMENT
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MULTIMODAL ROLE
• UNDERSTANDING • RELATIONSHIP • EARLY ACTIVITY • EARLY EXERCISE • EARLY MOBILITY • SHIFT ONUS OF RESPONSIBILITY • SELF MANAGEMENT