Spine ICF - Chronic Low Back Pain w Related Generalized Pain

Overview & Causes

• Leading cause for seeking emergency care

• Affects 23% of individuals worldwide

• 1 yr recurrence rate: 24-80%

• Causes

  • Younger adults

    • Acute muscular strain

    • Ligament injury

    • IV disc herniation

  • Older adults

    • Degenerative disc herniation

    • Facet arthropathy

    • Compression fractures from osteoporosis

    • Spinal stenosis

  • Persistent symptoms from any of the above increase likelihood of LBP becoming chronic and long-term disability

Indications

• LBP or low back related lower extremity pain of more than 3 months

• Generalized pain not consistent w other impairment-based classification criteria

• Presence of depression, fear-avoidance beliefs, or catastrophizing (yellow flags)

• Hypomobility of thoracic, lumbopelvic, and hip joints

• Poor neuromuscular control and coordination of spinal motions

Factors affecting chronic back pain

• Psychosocial components of chronic pain

  • Elevated fear-avoidance beliefs

  • Depression

  • Anxiety disorders

  • Sleep impairments

• Underlying pathology

  • RA

  • OA

  • Ankylosing spondylitis

  • Fibromyalgia

  • Central sensitization

• Movement impairments

• Muscle imbalances

• Multiple joint impairment

• Deconditioning

• Longer duration of LBP

  • More deconditioned presentation

  • More secondary impairments

    • Movement impairments

    • Muscle imbalances

Examination

• Identify changes in movement patterns and pain responses to movements and posture

• Manual therapy examination (can help identify and treat muscle guarding and tissue sensitivity)

• Postural muscles: tightness, hypertonia, shortening

• Phasic muscles: hypotonia, inhibition, weakening

  • Less readily activated in most movement patterns

• Screening for yellow flags

  • Four-item patient health questionnaire

  • Central sensitization inventory

  • STarT back screening tool

    • Depression

    • Anxiety

    • Fear avoidance

    • Central sensitization

    • Pain catastrophizing

Interventions

• Manual therapy

  • Spinal thrust manipulation (has both good short and long-term effects)

  • Non-thrust manipulation

  • Therapist should be able to determine within 2 weeks if manual therapy is effective or if patients needs more exercise-focused treatment

• Motor control exercises

  • Spinal stabilization

    • Most effective in combination with spinal thrust manipulation

  • Start off with basic exercises and progress as patient improves in stability and strength

    • Phase I, II, III

• Muscle imbalances

  • Myofascial release

    • Muscles w hypertonia/muscle shortening

    • Postural muscles

      • Upper traps

      • Levator scap

    • Lower extremity muscles

      • Hamstrings

      • Thigh adductors

      • Iliopsoas

      • Tensor fascia lata

  • Mobility and strengthening exercises

  • Education programs

    • Addressing yellow flags

      • Pain neuroscience education

      • Graded exposure therapy for fear-avoidance behavior

      • Determining which factors are modifiable

      • Referring patient to other healthcare professionals

    • Ergonomics

    • Proper body mechanics

    • Joint protection

  • Lifestyle changes

    • Healthy eating

      • Plant-based diet

    • Mind-body exercise movements

      • Yoga

      • Pilates

    • Sleep quality

      • Better sleep environment

      • Minimizing bright lights before bed

    • Stress reduction