How to Manage

Non-operative and Operative

BACK REHABILITATION

REHABILITATION PRINCIPLE

• Assess any Abnormality and treat to correct the Abnormality

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

POST-OPERATIVE DISCHARGE

• DISCECTOMY : DAY 0

• LAMINECTOMY : DAY 1/2

• FUSION : DAY 2/4

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

CONDITIONING• GENERAL AEROBIC FITNESS

• POSTURAL CORRECTION

• 20-30 MINUTE PERIODS

• WEIGHT LOSS

• POSITIVE RATHER THAN PURELY CLINICAL SETTING

NORMALISE SETTING : TAI CHI, PILATES, YOGA, GYM CLASSES, SWIM

FOCUS ON SELF MANAGEMENT