Rehabilitation of Low Back Pain - Bone & Joint Center

Rehabilitation of Low Back Pain - Bone & Joint Center

PHYSICAL REHABILITATION OF THE DEGENERATIVE SPINE 18TH ANNUAL PRIMARY CARE ORTHOPAEDIC AND SPORTS MEDICINE SYMPOSIUM JANUARY 26TH, 2018 DISCLOSURES NO FINANCIAL AND/OR CONFLICTS WILL BE DISCUSSED

AMANDA BLUME, PT, DPT, ATC AT RIB MOUNTAIN SPORT AND SPINE CLINIC KARISSA CLARK, PTA AT RIB MOUNTAIN SPORT AND SPINE CLINIC OBJECTIVES FORMULATE TREATMENT PLAN FOR PATIENT BASED ON PATIENT PRESENTATION AND DIAGNOSIS IDENTIFY APPROPRIATE EXERCISE AND TREATMENT BASED ON DIAGNOSIS TO ADDRESS LIMITATIONS OR DYSFUNCTIONS

IMPLEMENT APPROPRIATE SELF-MANAGEMENT TECHNIQUES LOW BACK PAIN DIAGNOSES ANKYLOSING SPONDYLITIS DEGENERATIVE SPONDYLOLISTHESIS LUMBAR STENOSIS PRESENTATION AND EVALUATION PRESENTATION

ANKYLOSING SPONDYLITIS AND SPONDYLOLITHESIS EVALUATION ANKYLOSING SPONDYLITIS AND SPONDYLOLITHESIS MANDIBLE PROTRUSION VISUAL EXAMINATION OF PATIENT

FORWARD HEAD PALPATION SHOULDER PROTRUSION LUMBAR ROM SCAPULAR PROTRACTION

THORACIC HYPERKYPHOSIS REVERSAL OF LUMBAR LORDOSIS INCREASED POSTERIOR PELVIC ROTATION FLEXIBILITY STORK TEST STAND ON ONE FOOT. EXTEND LUMBAR SPINE. PAIN = POSSIBLE PARS FRACTURE

FLEXION WITH INTERNAL ROTATION OF HIP STRENGTH FLEXION AT THE KNEES SENSATION DECREASED PERIPHERAL JOINT MOBILITY

REFLEXES SACROILLIAC DYSFUNCTION PRESENTATION AND EVALUATION PRESENTATION LUMBAR STENOSIS

EVALUATION LUMBAR STENOSIS UNILATERAL AND/OR BILATERAL LEG PAIN VISUAL EXAMINATION OF PATIENT DECREASED BALANCE

NEUROMUSCULAR EXAM CRAMPING THAT IS RESOLVED WITH SITTING STRENGTH WEAKNESS

PALPATION PELVIC POSITION FLEXIBILITY Fritz 2007; 37(6), 291 TREATMENT SESSION

INITIAL EVALUATION = 45-60 MINUTES FREQUENCY AND DURATION PT SESSIONS = 30-75 MINUTES MANUAL THERAPY THERAPEUTIC EXERCISE THERAPEUTIC ACTIVITY NEUROMUSCULAR RE-EDUCATION MODALITIES ULTRASOUND, ELECTRICAL STIMULATION, HEAT OR ICE, MECHANICAL TRACTION, PHONOPHORESIS

THE ULTIMATE PLAN PRESERVE GOOD MUSCLE TONE PREVENT FURTHER DEGENERATION OF ANKYLOSES IMPROVE MOBILITY OF SPINE AND LOWER QUADRANT/LUMBOPELVIC REGION AND HIP JOINT IMPROVE PAIN IMPLEMENT AND EDUCATE A HOME EXERCISE PROGRAM FOR LIFETIME LEARNING

PREVENT THE NEED FOR SURGICAL INTERVENTION Fritz 2007; 37(6), 298 MANIPULATION MANIPULATION MAY BE USED TO ADDRESS JOINT DYSFUNCTION OR RESTRICTION BASED ON RESULTS OF INITIAL EVALUATION MET FOR LLD

STABILIZATION STABILITY DYSFUNCTION APPEARS TO PRESENT AS A DYSFUNCTION OF THE RECRUITMENT AND MOTOR CONTROL OF THE DEEP SEGMENTAL STABILITY SYSTEM RESULTING IN POOR CONTROL OF THE NEUTRAL JOINT POSITION (CUMERFORD 2001) RETRAINING IS IMPORTANT AT A LOCAL AND GLOBAL LEVEL FOR INCREASED CARRYOVER TO IMPROVE FUNCTIONAL OUTCOMES Fritz 2007; 37(6), 294

SPECIFIC EXERCISE DEVELOPED FOR EACH INDIVIDUAL PATIENT BASED ON EXAMINATION STRETCH REFLEX LOCAL AND GLOBAL STRENGTHENING Cumerford 2001; 6(1) 13 MODALITIES

SPINAL TRACTION ULTRASOUND ELECTRICAL STIMULATION HEAT/ICE HOME EXERCISE PROGRAM AND SELFMANAGEMENT SKILLS EACH PROGRAM IS SPECIFICALLY DESIGNED WITH THE PATIENTS NEEDS IN MIND PROGRAMS ARE DEVELOPED THROUGHOUT THE COURSE OF TREATMENT

PATIENT EDUCATION IS A KEY COMPONENT TO THE COMPLIANCE OF THE PROGRAM Fritz 2007; 37(6), 292 WHAT IS THE GOAL? INCREASE PATIENTS AWARENESS OF POSITIVE AFFECTS OF PHYSICAL THERAPY VERSUS SURGERY FOR LONG-TERM BENEFITS OF PATIENTS SUFFERING FROM LOW BACK PAIN

SURGERY VS NON-SURGERY NO SIGNIFICANT DIFFERENCES ARE FOUND NON-SURGERY SHOWED MODEST IMPROVEMENTS OVERTIME, WILLING TO ADHERE TO THE PROGRAM DUE TO NOT WANTING SURGERY MORE PATIENTS DROP OUT OF USUAL CARE THAN FROM EARLY PHYSICAL THERAPY GROUPS CONCLUSION

CURRENT RESEARCH SUGGESTS THAT LSS PATIENTS CAN SEE BENEFITS FROM PHYSICAL THERAPY INTERVENTIONS THE RECENTLY PUBLISHED REPORT OF THE INTERNATIONAL PARIS TASK FORCE ON BACK PAIN SUMMARIZED THE EVIDENCE FOR PATIENTS WITH ACUTE LBP BY STATING IT APPEARS THAT THE KEY TO SUCCESS IN PHYSICAL ACTIVITY ITSELF (I.E. ACTIVITY OF ANY FORM) RATHER THAN ANY SPECIFIC ACTIVITY. REFERENCES

COMERFORD, M, MOTTRAM, S. FUNCTIONAL STABILITY RE-TRAINING:PRINCIPLES AND STRATEGIES FOR MANAGING MECHANICAL DYSFUNCTION. HARCOURT 2001; 6(1), 3-14 FRITZ, J. EARLY PHYSICAL THERAPY VS USUAL CARE IN PATIENTS WITH RECENT-ONSET LOW BACK PAIN: A RANDOMIZED CLINICAL TRIAL. JAMA 2015;314(14), 1459-1467 FRITZ, J. SUBGROUPING PATIENTS WITH LOW BACK PAIN: EVOLUTION OF A CLASSIFICATION APPROACH TO PHYSICAL THERAPY. JOSP 2007; 37 (4), 290-299 GARET, M, REIMAN, M, MATHERS, J, SYLVAIN, J. NONOPERATIVE TREATMENT IN LUMBAR SPONDYLOLYSIS AND SPONDYLOLISTHESIS: A SYSTEMIC REVIEW. NCBI 2013; 5(3), 225232

REFERENCES SCOLLON-GRIEVE, K, MAY, J, CHOU, L. LUMBAR SPNDYLOLYSIS AND SPONDYLOLISTHESIS. 2013; 307-353 SILVA, E, ANDRADE S, VILAR M. EVALUATION OF THE EFFECTS OF GLOBAL POSTURAL REEDUCATION IN PATIENTS WITH ANKYLOSING SPONDYLITIS. RHEUMATOL INT 2012; 32, 2155-2163 WEINSTEIN, J, TOSTESON, T, LURIE, J, BLOOD, E, HERKOWITZ, H, CAMMISA, F, ALBERT, T, BODEN, S, HILIBRAND, A, GOLDBERG, H, BERVEN, S, HOWARD, A. SURGICAL VERSUS NON-OPERATIVE TREATMENT FOR LUMBAR SPINAL STENOIS FOUR-YEAR RESULTS OF THE

SPINE PATIENT OUTCOMES RESEARCH TRIAL. NCBI 2012; 35(14), 1329-1338

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