Low Back Pain Prevention and Treatment


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Sports and Physical Therapy Associates share a informational slideshow documenting prevention of back pain, causes, and treatment.
Most adults will experience back pain, find out how to prevent it and how to treat it.

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Low Back Pain Prevention and Treatment

  1. 1. Low Back PainSports and Physical Therapy Associates
  2. 2. It has been well documented thatlow back pain will afflict most adultsat one time or another.The costs of treatment of low backpain (LBP) are over 40 billiondollars each year and rising.
  3. 3. Back injuries are acommonphenomenon insports, estimated tooccur in 10%-15%of all participants.
  4. 4. Back injuries havebeen reported in11% of gymnastsand up to 50% ofAmerican footballlinemen.
  5. 5. A concern to sportsphysicians is therecurrence of thesedebilitatingproblems in 26% ofmales and 33% offemales.
  6. 6. Early intervention and appropriaterehabilitation often reduce thechronic nature and progression ofinjury.
  7. 7. LBP Treatment ProtocolExact treatment protocol through rehabilitativemedicine and physical therapy has been vagueand incomplete.The following information describes the role ofphysical therapy and athletic training in thetreatment of LBP.
  8. 8. Physical Therapy EvaluationAfter the patient isreferred torehabilitation with adefinitive diagnosisfrom the physician, anevaluation isperformed to gatherfurther information
  9. 9. The diagnosis of LBP by an MD, PA or NP cantell not only what it is but also what it isn’t. TheDiagnostic tests that can be performed canexpose underlying pathology that clinical signsand symptoms don’t always show. – Heck, AT and Sparano, PT
  10. 10. Patient HistoryA complete detailed history of the patient’s injury is taken.- How did the injury occur? - Date of the injury or length of chronicity - Description of symptoms - Do symptoms worsen at certain times or during certainmovements? - Discussion of the patients professionand hobbies. - LOOK for RED FLAGS!! Fever, Night Pain, etc
  11. 11. Clinical ExaminationAssessment of posture typeAssessment of active motion of the spineWhich movements cause pain?Which movements give relief?Assessment of lower extremities and flexibility.Strength testing of abdominals and paraspinalsthrough an exercise prescription.
  12. 12. Treatment PlanFrom the referring physician’s diagnosis,patient history and clinical exam the therapistcan formulate a treatment plan.
  13. 13. Therapeutic Exercise PrescriptionChoosing the proper exercises, movements,and stretches are a crucial part of the physicaltherapy program.
  14. 14. Isolation Movements/ExercisePurpose of these exercises – - Improve circulation - Decrease swelling - Reduce spasm - Improve motion to affected muscles, tendons and joint structures
  15. 15. Fiber TypeType I fibers accounted for 63% oflumbar deep paraspinals and 74% ofdeep thoracic muscles. Sirca A, Kostec V
  16. 16. Whats the Difference??Type I postural or tonic musclesbecome tighter and shorter whenweakened. This can account for anincrease in spasm with less andless trauma. Vladimir Janda
  17. 17. PAIN, SPASM, WEAKNESS?Marked asymmetryof lumbar multifidusmusculature wasnoted on same sideof pain using realtime ultrasound. Stokes, Hides et al
  18. 18. Acute Pain vs. Chronic PainAcute LBP Chronic LBP- The acute injury being - The chronic injury being defined as the time frame defined as the time in which the injured tissue frame in which the had time to heal, but still injured tissue is causes pain. continuing to heal. - Isolation movements can be more aggressive to- Isolation movements improve motion, circulation should minimize pain and strength for chronic LBP. for acute LBP.
  19. 19. Directional PreferencePrescribing exercises with a directionalpreference for pain reduction significantlyreduced symptoms. 74% of 300 patientsstudied experienced improvement. Long, Donelson and Fung DON’T YOU DO THIS WITH ALL OTHER INJURED STRUCTURES!!!
  20. 20. Prescribing Isolation Exercises- Flexion motion related injuries treat with extension exercises. - Extension motion related injuries treat with flexion exercises. - Almost all lumbar injuries respond favorably to rotational exercises in the isolation stage.
  21. 21. Direction of Isolation MovementsExamples:- Herniated discs are usually sustained in flexion motions- Acute spondylo fractures are usually sustained in repetitive extension motions- Chronic lumbar stenosis conditions are aggravated in extension positions.
  22. 22. Isolation Exercises/Therapeutic Movements- Exercises are prescribed with a minimum of 15 reps per set to ensure maximal localized circulation.- Williams flexion, McKenzie extension and spinal stabilization all could be beginnings but none is complete at the end !
  23. 23. Use of Modalities - Moist heat, massage, ultrasound and electrical stimulation increase circulation and decrease swelling. -Joint Mob and stretches stimulate increases in ROM -Remember only PRE’sCreate Protein Synthesis!!! EXERCISE
  24. 24. Other exercises implemented at the time ofisolation exercises can provide added benefitsto the patient, as long as they do not causeadded pain.
  25. 25. Postural Awareness ExercisesPeople are experiencingprolonged stress and strain totheir backs and necks, due totheir work environments.Patients with chronic workrelated injuries can usuallyprogress quickly, given thecorrect strengthening andexercise program.The McKenzie classificationsystem of spinal pain is usedby our clinics to lessenpostural pain.Introducing patients to posturalawareness techniques, like theAlexander technique havegiven our patients greatresults.
  26. 26. Flexibility ExercisesLack of flexibility in the lower extremitiesleads to greater strain to the lower back.– Tight hamstrings and piriformis in sitting leads to an exaggerated posterior tilt.– Tight hip flexors can lead to exaggerated lordosis when standing.
  27. 27. Cardiovascular TrainingEndurance training 3-5 times per week can bebeneficial to patient with LBP. - Walking, biking, and swimming are ideal.Exercises that are opposite the movement pattern ofthe injury are recommended. - Remember flexion injuries usually use extensionmovements for relief and vice versa. - A patient with a disc problem will benefit fromwalking. - A patient with a spondylo fracture will benefit fromrows.
  28. 28. Strengthening of the Lumbar MusculatureRehabilitationstrengthening exercisesare introduced onceisolation therapeuticexercises are tolerated.By strengthening theinjured structure of thelumbar spine along withthe hips and abdominals,more stabilization will beprovided to the injuredarea.
  29. 29. Goals of StrengtheningRaise the level of physicaltolerance.Introduce the use of freeweights by providingexercises that correlatewith daily activities,hobbies or work.The uses of MEDEXlumbar program to providea quantitative analysis ofsegmental strength.
  30. 30. Free weights vs. MachinesStrengthening tonicstabilizing muscles duringdynamic exercise i.e.lunges and squats keeps astrength balance withPhasic arm, leg and TrunkMusculature. This is why inthe sports specific/ returnto work phase free weightsare better than machines
  31. 31. Sports Specific TrainingThis would beimplemented to furtherspecialize thestrengtheningprogram.It would simulate thepatterns of sports orexercise that thepatient engages inregularly.
  32. 32. Stages Of RehabAcute Stage Exercises, Therapeutic Movement– 1st seven days -frequency- dailySubacute Exercises- add aerobic– 2nd seven days- frequency- every other dayRehabilitation Stage- strengthening, flexibility andfree weights/machines– Weeks 3 and 4- frequency- 3 times per weekSports Specific Stage– Weeks 4 on- frequency- 2-3 times per week
  33. 33. Injury/Exercise SummarySpondylo-– Strengthen abs– Stretch rectusDisc– Strengthen paraspinals– Stretch abs into extensionScheurmannsKyphosis– Strengthen Thoracolumbar extensors– Stretch abs and pecs
  34. 34. Through a comprehensive treatment planpatients can achieve great results, whilelearning ways to prevent recurrent injuries totheir lower backs.All above recommendations should be donein the guidance of an experienced physicaltherapist or athletic trainer