lower back pain management. diagnoses low back pain ddd facet joint syndrome sciatica ...
TRANSCRIPT
DiagnosesDiagnoses Low back pain DDD Facet joint syndrome Sciatica Piriformis syndrome Disc herniation Sprain / Strain Muscle spasm
Arthritis/Degenerative Arthritis/Degenerative ChangesChanges
Maintain mobility (ROM) Strengthen +++ Address muscle imbalances Typical radiological finding Symptomatic / Non-symptomatic Anterolisthesis / Posterolisthesis
Nerve Root CompressionNerve Root Compression
Foraminal vs Central StenosisForaminal vs Central Stenosis
Neurological vs Neurological vs Mechanical OriginsMechanical Origins
Neurological- Pain into the leg
- Pins and needles, burning, numbness in the leg
- Dermatomes/myotomes
- Diminished reflexes
- Lateral shifting, its causes and its relevance
- SLR test
Neurological vs Neurological vs Mechanical OriginsMechanical Origins
Mechanical- Primary area of pain is in the lumbar area
- There may be pain in the buttock or down the leg, almost always above the knee
- Neurological tests are negative
SciaticaSciatica
Maintain / Improve mobility (ROM) Strengthen +++ Address imbalances / stabilize Monitor pain, weakness
Disc HerniationsDisc Herniations
Avoid constant and repetitive flexion movements
- Crunches
- Bike
- Reading / TV in bed, counter top use
Favor extension
- Strengthen in this position
Muscle SpasmsMuscle Spasms
Massage Ice / Heat Light stretching Use of muscle relaxants – When
and Why?
Early Referral to Early Referral to PhysiotherapyPhysiotherapy
Ehrmann-Feldman et al 1996- with early referral, increase chance of return
to work in less than 60 days
Wand et al 2004- increase function, mood, quality of life,
general health
- assess/advise/treat model of care is more beneficial than a assess/advise/wait model for acute lower back pain
Treatment ProtocolTreatment Protocol
pain- treat the cause, not the symptoms
- differentiate the cause of pain
ROM Strengthen / stabilize Educate the patient on dos and don’ts,
ergonomics, lifestyles, sports
Long TermLong Term
Stabilization and Reconditioning exercises
“Core stability” Lifestyle adaptation
(work/sports/leisure) Prevention +++
Multi-disciplinary Multi-disciplinary ApproachApproach
Physiotherapy
Physiotherapy / Occupational Therapy
Rehabilitation- PT
- OT- AT- Osteopathy- Psychology (as needed)
Occupational TherapyOccupational Therapy
Case managers Functional Capacity Evaluations (FCE) Rehabilitation Programs Driving Evaluations PT – OT Splinting Communication +++