Geriatric LBP

trend in LBP and aging

exponential rise in low back related disability

aspects of geriatric LBP

experiences, biopsychosocial influences, consequences

consequences of pain and impaired movement on the geriatric population

decreased physical activity and function, morbidity

what are older adults with LBP at greater risk of compared to healthy older adults

functional decline (worse mobility)

relationship between LBP and function

declines in 4 years but more extreme LBP has worse decline

relationship between geriatric LBP and falls

fall more times and more often than the national estimate

characteristics of older adults with chronic LBP

no standardized method of movement-evoked pain, pain behavior varies

how to capture functional movement and movement evoked pain in older adults

chair rising, stairs, walking (6MWT)

what happens when you increase movement evoked pain

worse perceived and performance-based physical function

is movement evoked pain associated with future pain and disability in older adults with chronic LBP

it is associated with disability and self-efficacy but not gait speed

why is movement evoked pain most important in geriatric chronic LBP

it leads to greater energy cost during walking

relationship between chronic LBP and energy reserve

chronic pain decreases the reserve capacity and a spike in pain decreases energy cost further

how to combat reduced energy capacity in older adults with chronic pain

increase CV exercise

benefit of 400m walk test over 6MWT

a designated distance vs time gets a better effort out of pts

what can be inferred if a pt takes a rest break during the 400m walk test

greater risk of mobility disability

characteristics of a better performance on the 400m walk test

faster walking speed, increased HR, increased systolic BP

first level classification serious pathology that can mask as LBP

abdominal aortic aneurysm

sxs of abdominal aortic aneurysm

sever back pain, pulsating in abdomen, nausea/vomiting, light-headedness with upright posture, rapid pulse

depression and LBP

disabling LBP increases odds of depressive sxs in 2 years

questionnaires for depression screening in geriatric population

5-item geriatric depression scale, 2 question depression test

how does the 5-item geriatric depression screen work

2 positive answers predicts depressive sxs

parts of spinal stabilizing system

passive system, active system, neuromuscular control

aging effect on the active spinal stabilizing system

decreased muscle strength and mass (especially fast-twitch fibers), decreased attenuation (increased intramuscular fat)

relationship between back pain and trunk muscle composition

increasing severity of back pain is related to decreased trunk muscle attenuation

function that is affected by trunk muscle attenuation

walking speed, STS, standing balance performance

effect of NMES and trunk muscle training on function

better ODI and TUG compared to passive approach

effect of active vs passive approaches on global rating of improvement

active is preferred but passive works if the pt cannot tolerate it

which specific movement classification do most older adults fit into

flexion syndrome

characteristics of lumbar spinal stenosis

acquired due to degenerative changes, leg pain is common, neurologic changes common

key exam findings of lumbar spinal stenosis

age above 65, no pain when seated, improved walking tolerance with lumbar flexion

neurogenic vs vascular claudication during bike test

neurogenic pts can go further bc of flexed spine

clinical tests for lumbar spinal stenosis

bike test, ankle-brachial index, treadmill test

ABI that indicates PAD

less than 0.9

neurogenic vs vascular claudication during treadmill test

earlier onset of sxs on level than incline surface indicates neurogenic

management of spinal stenosis

surgical intervention like fusion or decompression

PT vs surgery for spinal stenosis

no difference in 2 years, but women do better with PT

outcome measures for lumbar spinal stenosis

combine a back pain disability questionnaire (ODI, quebec) with a stenosis specific questionnaire

hip-spine syndrome

LBP exists in the context of concurrent hip and spine degenerative pathology

simple hip-spine syndrome

either the hip or the spine is primary source of pain

complex hip-spine syndrome

both hip and spine are responsible for pain

secondary hip-spine syndrome

hip dysfunction due to degenerative pathology directly influences spinal biomechanics

findings of hip OA

pain, pain with hip IR (>15), morning stiffness, age above 50

latent classes of geriatric LBP

strong/non-symptomatic (30%), weak/non-symptomatic (41%), weak/symptomatic (28%)

weak and symptomatic class compared to non-symptomatic class

worse back pain/disability, slower gait speed

consequence of decreased hip ROM and strength

worse self-reported and performance-based physical function at 12 months

consequence of more hip OA criteria met

increased fall risk by 23%, increased odds of multiple falls of 41%

quebec back pain disability in hip focused vs spine focused treatment

hip was better after 8 weeks but spine caught up at 6 months

gait speed in hip focused vs spine focused treatment

better in spine group but not statistically significant

30 sec chair rise in hip focused vs spine focused treatment

hip group continued to improve and spine plateaued at 8 weeks

6MWT in hip focused vs spine focused treatment

hip focused group was better

results of MASH study

hip and spine groups led to improvements in LBP-related disability

overall effects of hip focused PT vs spine focused PT

greater improvement in 6MWT and 30 sec chair rise

key factors driving impact of the MASH study

tx focused on hip pain which is not typically what is done in clinical practice, older adults have better adherence