Lumbar Treatment

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Lumbar Treatment
2011-10-24 14:53:38
Ortho Fall 2011

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  1. Muscle Disorders
    • Spinal disorders that are primarily muscular in orgin are umcommon
    • Those that od occur can be cliassified as strains, contusion, and inflammations
  2. Muscle Disorders History
    • Trauma, blow to the back - sports
    • Subtle history of aggravation such as constant repetition of new activity
  3. What does the Pt report with muscles disorders
    • relieft with rest but will complain of stiffness
    • Movement will initially hurt but activity will loosen up the stiffness
  4. Muscle disorders objective findings
    • Pain uually referred over several spinal levels
    • Pt has troubles pinpointing the pina
    • Pain on palpation of the muscles but not pain with palpation of the joint or with ligamentous testing
    • Neurological exam will have no ture positive findings
  5. Important Rehab considerations for Muscle disorders
    • It is not secessary to wait until the pt is pain free to begin active exercises
    • If pain ith exericses is present it is not necessarily the harmful sign. If the pain is not severe, does not last and is not progressive the exercise should be encouraged
    • Exeriencce shows that more long term harm is cause by too lil activity then by too much
    • ask how much pain? how does it change with exericse? How long does it take to decrease after exercise?
  6. Acute treatment for muscles disorders
    • Rest - gentle activity in painfree range
    • Postural support - lumbar pillow or corset
    • Identify functional position that reduces symptoms - usually shortened position
    • Modalities
    • Begin gentle isometrics - prone lift hear from pillow or alternately lift leg from bed Supine press head and neck into pillow
  7. Subacute treatment ofr Muscle disorders
    • Gradually allow muscles to elongate - put pillow under abdomen and do extension thourgh greater ROM only to tolerance
    • Find position bias and progress exercises
    • Modalities if needed
  8. Chronic Treatment for Muscle Disorders
    • Restoration of ull function and normal posture should be the most important goals of treatment
    • Once acute symptoms are under control determine the impairment and functional limitations and treat accordeingly - stiffness, weakness, postural changes
  9. Facet joint impingment
    • Mechanism of injury is usually a sudden unguarded movement involving backward bending, sidebending and/or rotation with little to no trauma
    • The synovial and capsular tissue that lines the facet jiont capsule become impinged between the jiont surfaces
  10. What the Pt reports with facet impingement
    • rest relieves
    • movement hurts
    • certain passive and active moevements are restricted and /or painful
    • Will ssume protective posture"locking" - some component of sidebend and roatation, pain and restriction will be present when attempting to moe in the direction opposite the postion of locking
  11. Facet Sprain
    • History of moderate to severe trauma
    • mobility tests palpation and other signs and symptoms will be similar to joing impingement except movement mya be generally more restricted and may involve more than one segment
  12. facet inflammation
    • History - insidiou onset fequently following sprain or chronic posture sprain
    • Occur secondary to aggravation or overuse in the presence of degenerative joint/ disc disease
    • Pt reports - movement hurts, complain of pain and stiffness at rest, may have intermittent numbess and tingling
  13. Importand Rehab consideration for Facet joint issues
    • Generally will tend to start treament with movements toward the position the person is assuming and then gradually work towards opposite direction
    • Pt holding head in left Sb and rotation - work towards right SB and rotation
    • flex - open and unloaded
    • ext compression
  14. Acute Treatment for Joint Disorders
    • Lumbar corset to protect the area - discontinue device as acute symptoms decrease so the muscles can learn dynamic control
    • Functional position of comfort
    • Traction - gentle intermittent joint distraction and gliding
    • Self Traction
    • Joint Mobs/ manipulation
  15. Subacute and Chronic Joint Disorder Treatment
    • Hypomobility joint require stetchi thought joint mobs 3-4 grade
    • Develop dynamic stability through muscle control in the hypermobile regoins
    • Pt ed - avoid positions of hyperextension such a reaching r looking over head for prolonged periods of time
  16. Disc Disorders
    • Herniated nucleus pulposis is classified as the disorder in which there is displacment of the nuclear material and other disc components beyond the normal vonfines of the annulus
    • Proturion - with our whout nerve root involvement
    • Extrustion
    • Sequestration
    • Most common site L4-5 L5-S1
  17. Causes of Disc Disorders
    Caused by cumulative effects of months or even years of forward bending and lifting and/or sitting in a slumped forward bent posture
  18. Symptoms of Disc Disorders
    • Early stages are asymptomatic
    • As protrusion prgoressed - 1st experiences back pain,
    • then back and leg pain,
    • then back, leg pain and neurological involvement
  19. What does the Pt report with disc disorders
    • Prolonged sitting will cuase pin to move from back to leg
    • Difficulty when assuming an erect posture wafter sitting or laying down
    • After standing and walking around usually obtains some relief of pain - ext activities
    • Report pain greater on one side of back
    • Referred leg pain is usually unilateral
    • May report sudden onset of symptoms
    • may report occupation or activity that related a long history of a flexed lumbar posture
    • Multiple episodes over several months or years
  20. Clinical examination with people with disc disorders with no root involvement
    • Pt sits in slumped posture with lumbar spine in flexion - self tractions
    • May have lateral shift
    • No positive neurological signs
    • Spinal segment will be tender to palpation
    • x-rays will be negative
    • Correction of lateral shirt = centralization of pain
    • Forward bending limited due to severity of pain and muscle guarding
    • Repeated lumbar flexion = increased pain and pain that lingers
    • Extension after shift correction is restricted and may centralize pain
  21. Clinical examination with people with disc disorders WITH root involvement
    • has all the signs and symptoms of HNP
    • Positive neurological signs - strength loss, decreased muscle stretch, reflexes, loss of senstaion and a positive SLR test
    • X-ray may show narrowed disc space
    • Spinal flexion in recument position may afford frlief of some symtoms
    • Corretction of lateral shift may peripheralize pain
    • attempts to extension may peripheralize pain
    • traction may decrease symptoms
  22. HNP extrusion
    is a disorder inwhich the displaced nuclear material extrudes into the spinal canal through disrupted fibers of the annulus
  23. HNP sequestration
    Is a conditions in which the nuclear material escapes into the spinal canal as free fragments tha may migrate to other locations
  24. Pts history with disc problems
    • pt will have simial hisotries S&S as ptw with protrusions exceps taht the peripheral symptoms will predomiate
    • symptoms may change suddenly become intermittent or follow an inexact or incomplete dermatomal patter
    • Pt has gradual worsening history
  25. Acute Treatment ideas for disc disorders
    • with severe symptoms bed rest (short duration) is indicated with short peridos of walking - promotes ext, stimulated fluid mechanics, decreased swelling,
    • Correct lateral shif: pain should centralize, ext exercises after, may to peform several times before pt can hold on own, pt shown self correction
    • Passive ext: prone with pillow, prone on elbows, prone on hands,
    • Pt Ed: ex and lateral shift correction, stop activity if increased pain, extended posture, avoid low chairs of soft couches, Keep lorodsis when sit to stand,
    • Modalities
    • Traction
    • Support of corest
  26. Subacute treamtent for Disc Disorders
    • Teach simple spinal movemnet in pain free ranges - supine, sitting standing, on all 4s
    • Teach basic stabiliztion techniques utilizing core
    • walking, swimming
  27. Management when disc symptoms have stabilized
    • Emphasis duing this stage are recovery of function, development of a healthy back care plan, and teaching the pt how to prevent recurrences
    • Pt is taught that following any flexion activity to perform ext
    • if porlonged flexed posture is necessary, break up activity and perofmr ext
  28. Spinal Stenosis
    • Spinal Stenosis is an anatomic narrowing of the spinal canal, which can cause significant symptoms in older people
    • Most spinal stenosis occurs due to degenerative changes in the vertebral bodies facet joints, and intervertebral discs.
  29. Causes of Spinal Stenosis
    • Osteophytes
    • a thickended joint capsule
    • A bulging annulus - leads to compression of the spinal cord or the spinal roots
    • After spinal surgery (disectomy or fusion) or as a reult of a metabolic bon disease
    • Pagets disease
    • Osteoporosis
  30. Symptoms of Spinal Stenosis
    • Walking or standing aggravates the symptoms and only forward flexion or sitting alleviates the symptoms
    • Symptoms more pronounced when pt is standing or lying flat with supine extended
    • Pain relieve in flexion
  31. Important Rehab Considerations for Spinal Stenosis
    • Ext aggravates symptoms of stenosis
    • Flexion eases symptoms of stenosis
    • Flexion bias, for the rest of their life
  32. Conservative Treatment for Spinal Stenosis
    Conservative measure usually do not allevitate the mechanical problem of bony origin however most pt opt not to have surgery and are referred to therapy
  33. Therapy Treatment for Spinal Stenosis
    • Modalities - heat, ultrasound, massage
    • Exercises - flexion bias, stabilization exercises in posterior tilt, conditioning program (bike)
    • Pt ed - avoid ext activites (prolonged standing, walking, prone lying)
  34. Surgery for spinal stenosis
    Decompression laminectomy
  35. Rehab after sergery
    • Pt can be mobilized rapidy - more ambulatory ability after surgery
    • Exercises:
    • Gentl active exercise program in the pain free range to regain strength and ROM and works on ambulation endurance
    • Continue flexion and/or lumbar stabilization exercises
    • Work on exercises in the developmental sequence - helps restore functional mobility in differnt positions