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Acute Low Back PainA Physiotherapist’s Perspective
Sean BuckleyBachelor of Science (Physiotherapy)Diploma Advanced Physiotherapy
Fellow CAMPT
Sean Buckley
• Physiotherapist• 14 years in clinical outpatient care• Experience with urgent direct care model• Diploma in Advanced Manual and
Manipulative Physiotherapy• Fellowship in Canadian Academy of Manual
and Manipulative Physiotherapy
Thank you
• Kristy Klawitter
• Canadian Association of Physician Assistants Conference Organization Committee
• All of you for investing the time to better yourselves.
Objectives
• Define Acute
• Review general Lumbar Spine anatomy
• Propose a “Category System”
• Associate subjective findings to the categories
• Correlate objective findings to the categories
• Discuss management of Acute LBP
Definition of “Acute”
• Rapid
• Recent (less than 72 hours)
• Short duration
• Inflamed
• Sudden
• ++++ sore
Non-Mechanical : Subjective
• Progressive• No trauma (usually)• Unremitting• Generally “unwell” or just LBP• Pain is consistent and routine “night pain”• Non-consistent statements• +/- neurological complaints• ….. Other
Non-Mechanical : Objective
• +/- neurological signs
• +/- slump and/or SLR
• AROM no specific direction changes/limited
• “looks strong”
• Look deeply bothered by pain
• +/- consistent multi-directional limitation
Mechanical : Subjective
• +/- trauma (significant and insignificant)• +/- “point in time” things changed• +/- painfree position• Work history of stressor(s)• PMHx of stressor(s)• Cannot do an ADL• +/- certain position increases pain (ie sitting)• ……other
Mechanical- Nerve : Objective
• +/- SLR/slump• +/- change in reflexes• +/- change in key muscles• +/- change in dermatomes• +/- shifted• +/- change in sitting tolerance• AROM usually decrease more in one direction• …other
Mechanical- Structural : Objective
• Not the previous list• AROM- one direction ++limited and reactive• +/- shifted• Uses hands to support movements• +/- painful arc• Points to area of pain to be in LS-gluteal area• + anterior pressure to LS processes or muscles• ….other
First Visit Management
• Is the treatment going to be different?• What can I do?• What can someone else do?• What tests should be considered?• What restrictions can be added?• Should “days off” be granted?• ….other
Education
• Mechanical LBP is not life threatening
• Usually will pass
• Have to respect it and work with it
• Progression of stressor
• Stay within tolerance levels by modifications
First Visit Management
• Decrease the irritant/inflammation• Modify work (if possible)
• Physical • Time
• Medicate• Ice/heat• Exercises
Exercises
• General approaches:Core tight to support while in movementNon-weight bearing thru LS movementsHip stretches
**Each patient is different so the above list isn’t always going to be the “way to go”.
Conclusion
• Acute LBP can be defined in recent significant episode of pain.
• Anatomy is complex but remember the vertebrae, discs, nerve roots, facets, ligaments and muscles are all potential parts of the puzzle.
Conclusion
• Subjective and objective findings for all groups• Management
EducateMedicate?Modify stressorsExercises