Download - Rehabilitation for back pain
SEVERE LOW BACK PAIN
• AIM TO REDUCE PAIN AND INFLAMMATION
• COMFORT POSITONS – NEUTRAL SPINE
• ENCOURAGE MOVEMENT THAT RELIEVES
• BED REST<48HRS
• +/- TAPING
• ANALGESIA /NSAIDS
• LOCAL MODALITIES FOR PAIN/SPASM ( HEAT, ICE , ELECTRO, MANUAL TH.)
• EXERCISE AWAY FROM AGGRAVATION
• WATCH FOR NEURAL SIGNS
SUB-ACUTE LOW BACK PAIN
OFTEN WITH ASSOC. MUSCLE SPASM / IRRITATION, INCREASED NEURAL TENSION
HYPOMOBILE SEGMENTS –UTILISE MANUAL THERAPY
• POOR POSTURES, BIOMECHANICS
• REDUCE PAIN / INFLAMMATION
• RESTORE ROM ( MANUAL THERAPY, EXERCISE)
• FLEXIBILITY AND STRENGTH
• CARDIO FITNESS
• EDUCATION
REHABILITATION AFTER BACK PAIN EPISODE
• MODIFY ACTIVITIES
• CORRECT BIOMECHANICAL ABNORMALITIES
• POSTURAL ASSESSMENT OF FUNCTIONAL POSITIONS
• LIFTING MECHANICS
• CORE STABILITY : LOCAL THEN GLOBAL
• ASSESS / STRETCH TIGHTNESS
• EDUCATION
• HOME EXERCISE REGIME
FUNCTIONAL STABILITY
NEED TO UTILISE BOTH MUSCLE FORCES AND PASSIVE STRUCTURES TO DYNAMICALLY STABILISE THE SPINE FUNCTIONALLY
ANY DEFICITS ASSESSED NEED TO BE ADDRESSED IN A REHAB. PLAN
CORE STABILITY
• MUSCULAR CONTROL TO MAINTAIN FUNCTIONAL STABILITY
• MUSCULAR CORSET
• STABILITY INVOLVES PASSIVE AND ACTIVE STIFFNESS
• INSTABILITY WHEN EITHER COMPONENT DISTURBED
CORE STABILITY
• GLOBAL : DYNAMIC / PHASIC MUSCLES = ACTIVE TRUNK MOVEMENT
• RECTUS ABDOMINIS
• EXTERNAL OBLIQUES
• ILIOCOSTALIS (THORACIC PART)
• LATISSIMUS DORSI
• LINK PELVIS TO THORACIC CAGE
CORE STABILITY
• LOCAL : POSTURAL / TONIC = INTERSEGMENTAL STABILITY
• TRANSVERSUS ABDOMINIS
• MULTIFIDIS
• PSOAS MAJOR
• QUADRATUS LUMBORUM
• DIAPHRAGM
• ILIOCOSTALIS ( LUMBAR SEGMENT)
• INTERNAL OBLIQUE
STABILITY TEACHING/RETRAINING
• EDUCATION : ANATOMY AND FUNCTION
• ISOLATE DEEP LAYER T.A
• MOTOR RELEARNING
• TRAIN STABILISERS IN ISOLATION
• ADD FUNCTIONAL MOVEMENTS WITH STABILITY
• PAINFREE
• NEUTRAL SPINE INITIALLY
• FEEDBACK : TACTILE , PBU, ULTRASOUND
STABILISATION EXERCISES
• INITIATE PELVIC FLOOR HELPS ISOLATE T.A.
• PALPATE 1CM IN 1CM DOWN A.S.I.S.
• FEEL TENSION, NOT BULGE
• CONTROLLED BREATHING
• SUPINE / 4 POINT KNEEL / STANDING / SITTING
STABILISATION EXERCISES
• ISOMETRIC ABDOMINALS IN SUPINE
• SIDE LYING + GLUTEUS MEDIUS
• SUPINE BRIDGE
• ABDOMINAL CURL
• 4 PT KNEEL
• PRONE PLANK• SIDE PLANK• STANDING LUNGES• STEP UPS• GYM BALL SEATED • GYM BALL LIFTING• BALANCE DISC
POST-OPERATIVE REHABILITATION
• UNDERSTANDING THE SURGERY
• REALISTIC GOALS / TIMELINES
• PAIN CONTROL
• EARLY EXERCISE
• EARLY MOBILITY
• DISCHARGE WITH REHABILITATION PACKAGE
POST-OPERATIVE EXERCISE
• NEUTRAL SPINE
• INTERSEGMENTAL STABILITY REGIME
• GLOBAL ABDO WORK
• ADDRESS SPECIFIC WEAKNESS
• MOBLISE DAY 0 OR 1
• FUNCTIONAL ABDOMINAL CONTROL, GAIT
• AVOID NEURAL STRETCH
3 WEEK POST-OPERATIVE REVIEW
• WOUND REVIEW
• OSWESTRY
• PAIN ISSUES
• ACTIVITY LEVEL
• EXERCISE UPGRADE
• STABILITY
• GYM, BALL, POOL, CARDIO INCREASE
6 WEEK POST-OPERATIVE REVIEW
• WITH SURGEON
• OSWESTRY
• PROGRESSIVE BACK CARE
• INVOLVE EX.PHYSIOLOGIST / GYM / WORKPLACE
• SELF MANAGED PLAN
MULTIMODAL ROLE
• UNDERSTANDING
• RELATIONSHIP
• EARLY ACTIVITY
• EARLY EXERCISE
• EARLY MOBILITY
• SHIFT ONUS OF RESPONSIBILITY
• SELF MANAGEMENT
STRETCHING
• LUMBAR ROTATION
• LUMBAR FLEXION
• HIP FLEXION
• HIP EXTENSION
• HIP ADDUCTION
• STRAIGHT LEG RAISE
• DEEP HIP ROTATORS
• THORACO-LUMBAR ROTATION
• LUMBAR EXTENSION
ASSESSING FUNCTIONAL CORE STABILITY
• MANUAL SHEAR TEST
• LUMBAR TORSION TEST
• PRONE BRIDGE
• LATERAL BRIDGE
• SEATED TORSO FLEXION
• PRONE EXTENSOR ENDURANCE TEST
• SINGLE LEG SQUAT