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

Anatomy• Vertebrae

• Discs

• Nerve roots

• Facet joints

• Ligaments

• Muscles

Categories of Acute LBP

1. Non-mechanical

2. Mechanical

Non-Mechanical

• Medical• Tumour• Visceral• Bio-pyscho-social• ……others

Mechanical

• Subdivided1. Nerve2. Structural

Mechanical- Nerve

• Nerve root• Spinal cord • Dura

Mechanical- Structural

• Joint• Ligament• Disc• Bone• Muscle

Think about a recent patient experience…

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

First Visit Management

Educate!!!!

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

• Categories of Acute LBP can be:Non-mechanicalMechanical• Nerve• Structural

Conclusion

• Subjective and objective findings for all groups• Management

EducateMedicate?Modify stressorsExercises

Thank-you!

Questions?