Download Physical Therapy Intervention of Low Back Pain

Physical Therapy Intervention of Low Back
Pain
原文地址：http://www.huizhi123.com/view/d66f097374113be8889650985b3f4d6f.html
2015/12/9
Overview Physical Therapy Intervention of Low Back Pain
Min Huang, MD, Ph.D, PT ? Low back pain is a common problem ? 80% of population will
have lower back pain at some time in their lives ? Each year, 20% will have back pain ? Most
common cause of disability for persons < 45 years ? 1% of US population is disabled ? Costs to
society: $20-50 billion/year
Anatomy of the Vertebrae
Ligaments of the spine
? Interspinal ligament ? Anterior longitudinal ligament ? Posterior longitudinal ligament ?
Ligamentum flavum ? Supraspinous ligament ? Iliolumbar ligament ? Pain sensitive structures
– PLL and ALL
????
Vertebral Body Spinous process Transverse process Intervertebral disc ( annulus fibrous, nucleus
pulposus) ? Superior and inferior facet ( zygoapophyseal joint) ? Lamina ? Pedicle
3
4
Kinematics and Biomechanics
? Functional spinal unit- two adjacent vertebrae , the intervertebral disc, and all the ligaments
that connect the vertebrae ? Sagittal plane movement – Flexion - inferior articular facets of the
superior vertebrae slide superior and anterior over the superior articular facets of the inferior
vertebrae ? Sagittal plane movement – Extension – inferior articular facets of the superior
vertebrae slide inferior and slightly posterior on the superior articular facets of the inferior
vertebrae ? Horizontal plane movement – rotation to the right – left inferior articular facet of the
superior vertebrae approximates with the superior articular facet of the inferior vertebrae and the
right inferior articular facet of the superior vertebrae separates with the right superior articular
facet of the inferior vertebrae ? Frontal plane – lateral flexion – Side opposite of the flexion
opens up and the side towards the flexion compresses
6
1
2015/12/9
Classification
? Based on the onset of back pain
– Acute – Subacute – Chronic
Causes of Low Back Pain…
? ? ? ? ? ? ? ? Soft tissue “strain” or “sprain” – 70% Degenerative changes – 10% Herniated disk
– 4% Osteoporosis compression fractures – 4% Spinal stenosis – 3% Traumatic fracture - <1%
Congenital disease - <1% Cancer – 0.7%
? Based on the type of pain
– Local pain: muscular problem: acute sprain, pain in the back – Disk pain: poor body mechanic,
felt a pop, flexion=pain – Referred pain: back pain caused by internal organ damage – Radicular
pain: pain goes down beyond the low back
Physical therapy examination
? Must take a good history to have a clear clinical presentation ? Where is the pain – back (
central / symmetrical, unilateral / asymmetrical) Is the pain in the back, thigh or referred to
below the knee ? When did it start - Is it acute, sub-acute, chronic ? Is the pain improving,
unchanging, worsening ? Descriptors of pain (sharp, stabbing, throbbing, ache, dull) ? How
many episodes have you have of back/leg pain or neck /arm pain ? Identification of any red flags
/ contraindications ? Job requirements ? Limitations that affect the person’s quality of life
(leisure activities)
Physical Therapy goals
? Decrease, better centralize pain on first visit ? Return patient to prior level of function
Physical Therapy goals
? Decrease, better centralize pain on first visit ? Return patient to prior level of function
Acute Low back Pain
? Bed rest ? Medication ? Cold pack
2
2015/12/9
Chronic Low back Pain
? Acupuncture
– Very little quality research and data – Seems to indicate that acupuncture is not effective for
the treatment of back pain
Chronic Low back Pain
? Exercise
?????
Back Brace/Corset/Lumbar Support: Traction: TENS: Hot/Cold: Ultrasound:
Chronic Low back Pain
? Stretching
– HS stretching
Chronic Low back Pain
? Stretching
– HS stretching
Chronic Low back Pain
? Stretching
– Piriformis stretching
Chronic Low back Pain
? Stretching
– Piriformis stretching
3
2015/12/9
Chronic Low back Pain
? Stretching
– Piriformis stretching
Chronic Low back Pain
? Stretching
– IT Band stretching
Chronic Low back Pain
? Stretching
– IT Band stretching
Chronic Low back Pain
? McKenzie exercise
– The goal of McKenzie therapy is to centralize the pain, or move the pain from the leg into the
low back, as low back pain is generally better tolerated than leg pain. – McKenzie extension: ?
Lying prone - Progress to elbows - Full press up
Chronic Low back Pain
– McKenzie extension:
Chronic Low back Pain
? Williams flexion exercise
– Lying supine - Knees bent - Knees to chest
4
2015/12/9
Chronic Low back Pain
– William flexion
Chronic Low back Pain
? Coupling movement
– In flexion: flexion, side bending and rotate to the same side. – In extension: extension, side
bending and rotate to the opposite site
Chronic Low back Pain
? Coupling movement
Chronic Low back Pain
? Coupling movement
Chronic Low back Pain
? Lumbar segmental spring movement
Chronic Low back Pain
? Vertical oscillatory pressure
– Patient is in prone – The mobilizing hand is placed on spinous process of the vertebra that is to
be mobilized – Gentle oscillatory pressure is applied and sustained for 30 to 60 seconds – Grade
I to IV can be applied depending on patient’s condition
5
2015/12/9
Chronic Low back Pain
? Muscle energy technique for left posterior innominate
Chronic Low back Pain
? Muscle energy technique for right anterior innominate
6