low back pain lecture
DESCRIPTION
TRANSCRIPT
![Page 1: Low back pain lecture](https://reader033.vdocuments.mx/reader033/viewer/2022061205/5480fe1c5806b50b118b45e3/html5/thumbnails/1.jpg)
EXERCISE AND LBP
A/Prof Kathryn Refshauge
![Page 2: Low back pain lecture](https://reader033.vdocuments.mx/reader033/viewer/2022061205/5480fe1c5806b50b118b45e3/html5/thumbnails/2.jpg)
Kathryn Refshauge 2
![Page 3: Low back pain lecture](https://reader033.vdocuments.mx/reader033/viewer/2022061205/5480fe1c5806b50b118b45e3/html5/thumbnails/3.jpg)
Kathryn Refshauge 3
![Page 4: Low back pain lecture](https://reader033.vdocuments.mx/reader033/viewer/2022061205/5480fe1c5806b50b118b45e3/html5/thumbnails/4.jpg)
Kathryn Refshauge 4
Low back pain
15%85%
no specificpathologyspecific
pathology NSLBP(mechanical)
![Page 5: Low back pain lecture](https://reader033.vdocuments.mx/reader033/viewer/2022061205/5480fe1c5806b50b118b45e3/html5/thumbnails/5.jpg)
Kathryn Refshauge 5
“Mechanical” NSLBP
• pain is worsened with movement
• pain is improved with rest
![Page 6: Low back pain lecture](https://reader033.vdocuments.mx/reader033/viewer/2022061205/5480fe1c5806b50b118b45e3/html5/thumbnails/6.jpg)
Kathryn Refshauge 6
Triage
• Is the LBP due to serious pathology?
• Duration of the LBP?
• What treatment is indicated for the LBP?
![Page 7: Low back pain lecture](https://reader033.vdocuments.mx/reader033/viewer/2022061205/5480fe1c5806b50b118b45e3/html5/thumbnails/7.jpg)
Kathryn Refshauge 7
Hypotheses generated about:
• diagnosis
• physical examination
• treatment
• prevention
• contra-indications/precautions
![Page 8: Low back pain lecture](https://reader033.vdocuments.mx/reader033/viewer/2022061205/5480fe1c5806b50b118b45e3/html5/thumbnails/8.jpg)
Kathryn Refshauge 8
Need knowledge about:
• causes of LBP
• pathology
• tests (odds ratio, sensitivity and specificity)
• treatment effects and efficacy
![Page 9: Low back pain lecture](https://reader033.vdocuments.mx/reader033/viewer/2022061205/5480fe1c5806b50b118b45e3/html5/thumbnails/9.jpg)
Kathryn Refshauge 9
Serious spinal pathology
• Cancer• Infection eg osteomyelitis• Cauda equina syndrome• Cord compression• Fracture (osteoporotic)• Inflammatory diseases/arthritides• Abdominal or cardio-thoracic pathology
![Page 10: Low back pain lecture](https://reader033.vdocuments.mx/reader033/viewer/2022061205/5480fe1c5806b50b118b45e3/html5/thumbnails/10.jpg)
Kathryn Refshauge 10
![Page 11: Low back pain lecture](https://reader033.vdocuments.mx/reader033/viewer/2022061205/5480fe1c5806b50b118b45e3/html5/thumbnails/11.jpg)
Kathryn Refshauge 11
Typical Non-typicalPresentation Presentation
![Page 12: Low back pain lecture](https://reader033.vdocuments.mx/reader033/viewer/2022061205/5480fe1c5806b50b118b45e3/html5/thumbnails/12.jpg)
Kathryn Refshauge 12
Eliminate serious pathology
(red flags)• unexplained weight loss• night pain• poor general health/systemic symptoms• fever• previous history of cancer• no relief with bedrest• failure to improve with therapy
![Page 13: Low back pain lecture](https://reader033.vdocuments.mx/reader033/viewer/2022061205/5480fe1c5806b50b118b45e3/html5/thumbnails/13.jpg)
Kathryn Refshauge 13
Red flags (cont’d)
• history of trauma
• steroid use (osteoporosis)
• very severe pain/muscle spasm
• bowel/bladder frequency (cauda equina syndrome)
• widespread neurological symptoms
• non-mechanical behaviour of symptoms
![Page 14: Low back pain lecture](https://reader033.vdocuments.mx/reader033/viewer/2022061205/5480fe1c5806b50b118b45e3/html5/thumbnails/14.jpg)
Kathryn Refshauge 14
Red Flags (cont’d)
• Age > 50 years
• Constant progressive non-mechanical pain
• Thoracic pain
• Persisting severe restriction of lumbar flexion
• Pain that worsens in supine
![Page 15: Low back pain lecture](https://reader033.vdocuments.mx/reader033/viewer/2022061205/5480fe1c5806b50b118b45e3/html5/thumbnails/15.jpg)
Kathryn Refshauge 15
Cancer (Deyo 1988)
Sensitivity Specificity
Age > 50 0.77 0.71
Unexplained weight loss (>5kg in 6/12)
0.15 0.94
Previous history of cancer
0.31 0.98
Not improving with medical care (1/12)
0.31 0.90
![Page 16: Low back pain lecture](https://reader033.vdocuments.mx/reader033/viewer/2022061205/5480fe1c5806b50b118b45e3/html5/thumbnails/16.jpg)
Kathryn Refshauge 16
Cancer (cont’d)
Sensitivity Specificity
No relief with bed rest
1.00 0.46
Insidious onset 0.61 0.42
Duration > 1/12 0.50 0.81
Recent back injury 0.00 0.82
Thoracic pain 0.17 0.84
![Page 17: Low back pain lecture](https://reader033.vdocuments.mx/reader033/viewer/2022061205/5480fe1c5806b50b118b45e3/html5/thumbnails/17.jpg)
Kathryn Refshauge 17
Compression fracture
Sensitivity Specificity
Age > 50 years 0.84 0.61
Age > 70 years 0.22 0.96
Trauma 0.30 0.85
Corticosteroid use 0.06 0.995
![Page 18: Low back pain lecture](https://reader033.vdocuments.mx/reader033/viewer/2022061205/5480fe1c5806b50b118b45e3/html5/thumbnails/18.jpg)
Kathryn Refshauge 18
Decisions
seriousnesss
probability
![Page 19: Low back pain lecture](https://reader033.vdocuments.mx/reader033/viewer/2022061205/5480fe1c5806b50b118b45e3/html5/thumbnails/19.jpg)
Kathryn Refshauge 19
• If suspect pathology, refer patient to appropriate health professional
• If NSLBP, use knowledge (evidence-based practice)
![Page 20: Low back pain lecture](https://reader033.vdocuments.mx/reader033/viewer/2022061205/5480fe1c5806b50b118b45e3/html5/thumbnails/20.jpg)
Kathryn Refshauge 20
Yellow flags
• Previous history of LBP
• Radiating leg pain, NR involvement
• Poor fitness
• Poor extensor endurance
• Poor general health
• Psychological distress (fear avoidance behaviour, depressed)
![Page 21: Low back pain lecture](https://reader033.vdocuments.mx/reader033/viewer/2022061205/5480fe1c5806b50b118b45e3/html5/thumbnails/21.jpg)
Kathryn Refshauge 21
Yellow flags (con’td)
• Much time lost from work
• Disproportionate illness behaviour
• Low job satisfaction
• Personal problems (alcohol, marital, financial)
• Adversarial medico-legal proceedings
![Page 22: Low back pain lecture](https://reader033.vdocuments.mx/reader033/viewer/2022061205/5480fe1c5806b50b118b45e3/html5/thumbnails/22.jpg)
Kathryn Refshauge 22
6 weeks 3 months
acute sub-acute chronic
Time
![Page 23: Low back pain lecture](https://reader033.vdocuments.mx/reader033/viewer/2022061205/5480fe1c5806b50b118b45e3/html5/thumbnails/23.jpg)
Kathryn Refshauge 23
acute sub-acute chronic
most recoverwithout
intervention
some recover very fewrecover
psychosocial domainfear of activity
![Page 24: Low back pain lecture](https://reader033.vdocuments.mx/reader033/viewer/2022061205/5480fe1c5806b50b118b45e3/html5/thumbnails/24.jpg)
Kathryn Refshauge 24
acute sub-acute chronic
Rx:
spinal manualtherapy
McKenzie exercises
spinal manualtherapy
exercises
exercisecognitive
behaviouraltherapy
![Page 25: Low back pain lecture](https://reader033.vdocuments.mx/reader033/viewer/2022061205/5480fe1c5806b50b118b45e3/html5/thumbnails/25.jpg)
Kathryn Refshauge 25
Routine Tests:
observation active movements tension tests *** palpationAs applicable: stress active movements neurological examination muscle performance passive tests
![Page 26: Low back pain lecture](https://reader033.vdocuments.mx/reader033/viewer/2022061205/5480fe1c5806b50b118b45e3/html5/thumbnails/26.jpg)
Kathryn Refshauge 26
Biering-Sorensen test
![Page 27: Low back pain lecture](https://reader033.vdocuments.mx/reader033/viewer/2022061205/5480fe1c5806b50b118b45e3/html5/thumbnails/27.jpg)
Kathryn Refshauge 27
Active treatment
• acute NSLBP:
- McKenzie exercises
- specific stabilisation
exercises
![Page 28: Low back pain lecture](https://reader033.vdocuments.mx/reader033/viewer/2022061205/5480fe1c5806b50b118b45e3/html5/thumbnails/28.jpg)
Kathryn Refshauge 28
![Page 29: Low back pain lecture](https://reader033.vdocuments.mx/reader033/viewer/2022061205/5480fe1c5806b50b118b45e3/html5/thumbnails/29.jpg)
Kathryn Refshauge 29
multifidus
![Page 30: Low back pain lecture](https://reader033.vdocuments.mx/reader033/viewer/2022061205/5480fe1c5806b50b118b45e3/html5/thumbnails/30.jpg)
Kathryn Refshauge 30
![Page 31: Low back pain lecture](https://reader033.vdocuments.mx/reader033/viewer/2022061205/5480fe1c5806b50b118b45e3/html5/thumbnails/31.jpg)
Kathryn Refshauge 31
![Page 32: Low back pain lecture](https://reader033.vdocuments.mx/reader033/viewer/2022061205/5480fe1c5806b50b118b45e3/html5/thumbnails/32.jpg)
Kathryn Refshauge 32
Active treatment
• sub-acute NSLBP
- specific stabilisation
exercises
- McKenzie exercises
- general exercises
![Page 33: Low back pain lecture](https://reader033.vdocuments.mx/reader033/viewer/2022061205/5480fe1c5806b50b118b45e3/html5/thumbnails/33.jpg)
Kathryn Refshauge 33
Active treatment
• chronic NSLBP
- general exercises
use principles of cognitive-behavioural therapy
(CBT)
![Page 34: Low back pain lecture](https://reader033.vdocuments.mx/reader033/viewer/2022061205/5480fe1c5806b50b118b45e3/html5/thumbnails/34.jpg)
Kathryn Refshauge 34
Exercise:
• chronic NSLBPexercise: supervised
gradedwhole body
CBT: quotasgoal settingpacingreinforcement
(+ job application/CV)
![Page 35: Low back pain lecture](https://reader033.vdocuments.mx/reader033/viewer/2022061205/5480fe1c5806b50b118b45e3/html5/thumbnails/35.jpg)
Kathryn Refshauge 35
General aims
• Improve physical function
• Increase confidence in normal movement
• Teach patients how to cope with present and future episodes
• Reduce reliance on health professionals
![Page 36: Low back pain lecture](https://reader033.vdocuments.mx/reader033/viewer/2022061205/5480fe1c5806b50b118b45e3/html5/thumbnails/36.jpg)
Kathryn Refshauge 36
Specific aims
• Strengthen main muscle groups
• Stretch main muscle groups
• Increase CV fitness with low impact aerobic exercises
![Page 37: Low back pain lecture](https://reader033.vdocuments.mx/reader033/viewer/2022061205/5480fe1c5806b50b118b45e3/html5/thumbnails/37.jpg)
Kathryn Refshauge 37
The program
• Warm-up and stretching
• Individual exercises
• Warm-down
• Tip for the day
• Relaxation session
![Page 38: Low back pain lecture](https://reader033.vdocuments.mx/reader033/viewer/2022061205/5480fe1c5806b50b118b45e3/html5/thumbnails/38.jpg)
Kathryn Refshauge 38
![Page 39: Low back pain lecture](https://reader033.vdocuments.mx/reader033/viewer/2022061205/5480fe1c5806b50b118b45e3/html5/thumbnails/39.jpg)
Kathryn Refshauge 39
![Page 40: Low back pain lecture](https://reader033.vdocuments.mx/reader033/viewer/2022061205/5480fe1c5806b50b118b45e3/html5/thumbnails/40.jpg)
Kathryn Refshauge 40
![Page 41: Low back pain lecture](https://reader033.vdocuments.mx/reader033/viewer/2022061205/5480fe1c5806b50b118b45e3/html5/thumbnails/41.jpg)
Kathryn Refshauge 41
Treatment
• treatments that are harmful:
bedrest
![Page 42: Low back pain lecture](https://reader033.vdocuments.mx/reader033/viewer/2022061205/5480fe1c5806b50b118b45e3/html5/thumbnails/42.jpg)
Kathryn Refshauge 42
Treatment
• Treatments that are ineffective:
back school
TENS
laser
![Page 43: Low back pain lecture](https://reader033.vdocuments.mx/reader033/viewer/2022061205/5480fe1c5806b50b118b45e3/html5/thumbnails/43.jpg)
Kathryn Refshauge 43
Treatment
• Treatments with unknown effect:
massage
ice
heat
short wave diathermy
ultrasound
![Page 44: Low back pain lecture](https://reader033.vdocuments.mx/reader033/viewer/2022061205/5480fe1c5806b50b118b45e3/html5/thumbnails/44.jpg)
Kathryn Refshauge 44
Conclusion
Need broad and deep knowledge base to recognise:
• Contraindications and pathology
• Stage of LBP
• Effective exercise programs
![Page 45: Low back pain lecture](https://reader033.vdocuments.mx/reader033/viewer/2022061205/5480fe1c5806b50b118b45e3/html5/thumbnails/45.jpg)
Kathryn Refshauge 45
Conclusions
• knowledge of clinical trials to determine the most effective treatment.
www.pedro.fhs.usyd.edu.au