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Krishna (general info. (ergonomics (adjust plinth height), Physio, 23 y.o.…
Krishna
general info.
Physio
23 y.o.
wokrs full time and long hour
intermitted pain 6 month
sharp pain when lifting patient
history of LBP at work
tender at PA and unilateral
ergonomics
adjust plinth height
ergonomics
physical
change of work environments
mechanics
correct posture
appropriate height
equipment assistance
cognitive
Stress and fatigue
social support
opportunities to enhance skills
Risk management
management
Interview
RED FLAGS
night pain
general health
fevers
Loss of weight
No universal approach
according to symptoms
treatment-based classification system
Oswestry Disability Index
Stage 1:subgroups
Manipulation
correct identification>choice of technique
Specific exercises
improve ROM
specific single or repeated trunk movement
Flexion exercises
Posterior pelvic tilt
Single/double knee to chest
Extension exercises
Prone lying
Lateral shift exercises
For disc pathology
Stabilisation
Strenghthening
TA
Erector spinae
Multifidus
Quadratus lumborum
Traction
Leg symptoms
+ve crossed SLR
centralise pain and stabilise
Stage 2 and 3
not well understood
target impairment
flexibility
Strength
endurance
joint impairment
Other treatment
Stay active
Pain Medication?
No bed rest
graded activity
reduce pain and disability
outcome measures
Owestry LBP Disability Questionnaire
Gold standard
score interpratation
minimal
moderate
severe
crippled
Roland-Morris disability questionnaire
yes/no items
address physical function disability due to LBP
Quebec back pain disability score
Vermont Disability Prediction Questionnaire
Post occupational low back injury
SF-36
Musculoskeletal
Prognosis
often chronic
fluctuating pattern
rapidly decrease in pain within one month
pain decrease at slower rate for remainder 3 months
Prognostic indicators
Less complaints at baseline
younger age
Lower disability at baseline
No psychiatric comorbidities
different diagnosis
facet arthropathy
decrease ROM
pain with extension
radiating pain to back thigh or knee
no nerve root compromise
MRI finding
inflammatory spondyloarthropathy
Herniated Disc
Radiating pain in dermeatomal distribution
Pins and needles
muscle weakness and spasm
+ve SLR
Lumbar Muscular strain/sprain
Sharp intense pain for 1-2 days
localised pain over lumbosacral area
Muscle spasm
No nerve root compromise
Prevent chronic pain
address problem
stay fit
focus on body postition
Resume normal activity
Graded Motor Imagery
treat chronic pain
neuroplasticity