It is difficult to lay out the exercise prescription for low back pain. Exercise for low back pain is differ person to person. This presentation will describe about the general layout for patient with low back pain.
2. Prevalence
• Other neck related problems are
with prevalence of 48% in lifetime
and yearly of 23% to 39%.
• 50-80% of adult population
experiences back pain in lifetime
and 40% of them has back pain in
any one year.
3. Normal individuals
• Disc bulge : 50% - 66%
• Disc herniation : 30%
• Degenerative changes : up to 90%
4. Layout of LBP rehabilitation
• Treat the cause (phase 1)
• Focus on ROM (phase 2)
• Train the Muscles (group wise) (phase 3)
• Prescribe Exercise with activities (phase 4)
9. Assessing and Decision making
• PAIN is your fiend
• Nature of pain will describe about pathology
• Types of Pain
by origin – by receptors-
local(intact outer annulus fibrosus)
referred (herniated disc)
thermal
radicular (herniated disc)
chemical (organ ref. pain)
central (intact outer annulus fibrosus)
mechanical(structural changes/positional fault etc)
10. Assessment is the
KEY
Symptomatic
changes
Mechanical
changes
• Site
• Constant/intermittent
• Severity
• Paresthesia
• Numbers of analgesic
intake
• Pain on movement
• ADL
• ROM
• Deformity
• Movement deviation
• Movement quality
• Curve reversal
• Functional loss
13. Exercise to be perform in
• Sagittal plane: Flexion – Extension
• Transverse plane: Rotational component
• Frontal plane: Side flexion
14. Several House of thoughts or
confusion?
• Which one to select?
• Should we assess first?
• Should we apply only one
house of thoughts?
• Or we should combine
and deliver?
• Hippocrates (460 BC – 370
BC)
• Cato, Galen
• Bone setter
• Hutton’s manipulation
• D.D.Palmer, B.J.Palmer
• A.G.Timbrell Fisher
• James Cyriax
• John Mennel
• F.M.Kaltenborn
• G. Maitland
• R. McKenzie
• B.R.Mulligan
MANUAL THERAPY
26. CORE MUSCLE
1st to strengthen
• Traverse abdominis
• Internal and external obliques
• Rectus abdominis
• Multifidus and erector spinae
27. Transverse
abdominis
• With other abdominal muscles, TrA helps to
maintain abdominal tension and support
abdominal viscera, increase intraabdominal
pressure that is helpful in forceful expiration,
coughing, defecation.
• It's an important core muscle that supports
lumbopelvic during our movement.
• Unilateral action: ipsilateral trunk rotation
29. External
oblique
• Bilateral contraction of EO along with rectus
abdominis and internal oblique flexes the trunk
by drawing the pubis towards the xiphoid.
• Unilateral action: ipsilateral side flexion and
contralateral trunk rotation
• External abdominal oblique muscle with other
abdominal muscles helps to maintain abdominal
tension and support abdominal viscera, increase
intraabdominal pressure that is helpful in forceful
expiration, coughing, defecation.
31. Internal
oblique
• Internal abdominal oblique flexes the trunk when
bilaterally contracted and lateral flexion upon
unilateral contraction, compression causes
increase in the intraabdominal pressure
33. Rectus
abdominis
• The main action for rectus abdominis is flexion of
the trunk (flexion of thoracic and lumber spine),
while it works by drawing symphysis and
Sternum toward each other.
• Also, it works on posterior pelvic tilt with other
abdominal muscles.
47. Aerobic
• Aerobic activities make you breathe harder and make your
heart and blood vessels healthier. These include:
• Walking
• Dancing
• Swimming
• Water aerobics
• Jogging and running
• Aerobic exercise classes
• Bicycle riding (stationary or on a path)
• Some gardening activities, such as raking and pushing a lawn
mower
• Tennis
• Golfing (without a cart)
48. Flexibility
• Flexibility-enhancing activities ensure a good
range of motion in the joints. Loss of flexibility can
be a predisposing factor for physical issues, such as
pain syndromes or balance disorders. Gender, age,
and genetics may all influence range of motion.
Flexibility exercises include:
• Stretching
• Yoga
• Tai Chi or Qi Gong
• Pilates
49. Muscle-strengthening
•
• Muscle-strengthening activities
build up your strength. These
activities work all the different parts
of the body—legs, hips, back, chest,
stomach, shoulders, and arms—and
include:
• Heavy gardening (digging,
shoveling)
• Lifting weights
• Push-ups on the floor or against
the wall
• Sit-ups
• Working with resistance bands
(long, wide rubber strips that
stretch)
• Pilates
50. Pain should
decrease &
increase
ROM
If not
Change your
FLAPS
Force
Level
Angle
Pressure
Side
Always remember
Try to Treat in
weight bearing
position as
patient
complaints of
pain in loaded
only
When to treat not
loaded?
Joint is inflamed
or the SIN
(severity,
irritability &
nature of pain)
is high
Patient generated force is ext, fle, eis, fis, reis, rfis, etc. patient overpressure is breath out and do the movt and fix towel in the back and do the extension etc