Lower Back Lower Back PainPain

ManagementManagement

DiagnosesDiagnoses Low back pain DDD Facet joint syndrome Sciatica Piriformis syndrome Disc herniation Sprain / Strain Muscle spasm

Low Back PainLow Back Pain

Arthritis/Degenerative Arthritis/Degenerative ChangesChanges

Maintain mobility (ROM) Strengthen +++ Address muscle imbalances Typical radiological finding Symptomatic / Non-symptomatic Anterolisthesis / Posterolisthesis

SciaticaSciatica

Lumbar nerve roots Piriformis Sacro-iliac joint

Nerve Root CompressionNerve Root Compression

Foraminal vs Central StenosisForaminal vs Central Stenosis

SciaticaSciatica

Sacro-Iliac JointsSacro-Iliac Joints

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

Disc HerniationsDisc Herniations

Avoid constant and repetitive flexion movements

- Crunches

- Bike

- Reading / TV in bed, counter top use

Favor extension

- Strengthen in this position

SprainsSprains

SprainsSprains

Rest / remain active Ice

Muscle SpasmsMuscle Spasms

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 +++

Our ClienteleOur Clientele

85% Private patients

15%- CSST

- SAAQ

- insurance companies

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 +++

CommunicationCommunication

Progress note Avis Motivé

Questions?

Thank youThank you