Axial: Lumbar Interventions

What does THEMM stand for?

T = Therapeutic Exercise

H = Home Program

E = Education

M = Manual

M = Modalities

What are 3 not so common, but should be important pieces of education for LBP pts?

Sleep, nutrition, and exercise habits

What type of education should you not use for LBP pts?

If it increases their perceived threat of fear associated with LBP

What is a good intervention strategy for Acute LBP pts?

Stay active; motion is lotion

What is “restless bed rest” ?

Avoid prolonged laying and use self lumbar traction

If a pt is attempting to avoid prolonged laying, how often should they get up to walk or move?

Every 20 minutes or during commercial breaks

Why is it helpful to stay moving?

Flushes out chemical irritants from the body

If a pt is attempting to perform some form of positional self lumbar traction, what could the pt do?

Lay on the unaffected side with a towel roll above iliac crest, incorporate flexion via knees to chest, and if desired can add rotational movement (AWAY typically, so face down)

What are the 2 ways to perform a cross-handed stretch?

One hand anchors skin, other pushes away; both hands push away

What is important to always do when performing Effleurage?

A definitive stop at the end of a stroke

What are the 2 phases of Kneading?

Pressure phase - hand and skin/muscle move together on the deeper structures

Movement phase - pressure releases and glides smoothly to adjacent area

Where is wringing best used at?

UT and lateral lumbar spine

Which muscles have a direct/indirect effect on the LB we should stretch?

Iliopsoas

Rectus

Hamstrings

Piriformis

Glut Max

How do you perform bilateral facet distraction for the lumbar spine?

Pt prone, wedge used with tip towards feet, cuff or towel under cranial segments. Apply a ventral and slightly caudal force for mobilization

How do you perform bilateral facet glide for flexion in the lumbar spine?

Pt prone and wedge used with tip towards head. Apply a ventral and slightly cranial force for mobilization on the cranial vertebrae

How do you perform bilateral facet glide for extension in the lumbar spine?

Pt prone, wedge used with tip towards feet, cuff or towel under cranial segments. Apply a ventral and slightly cranial force for mobilization

When performing a PA mobilization of the caudal vertebrae during an extension mob, is this a direct or relative mobilization?

Relative extension due to force being through caudal vertebrae, cranial vertebrae is being mobilized

How do you perform unilateral facet distraction for the lumbar spine if therapist is on R side?

For ipsilateral distraction → Stabilize caudal vertebrae on ipsi, mobilize cranial vertebrae on contra.

For contralateral distraction → Stabilize cranial vertebrae on ipsi, mob caudal vertebrae on contra.

Force is straight ventral

What is the Lateral Shift Correction?

Manually correcting a shifted pelvis into a neutral position

How do you know which direction the “shift” is in when you are assessing someone’s posture for a Lateral Shift Correction?

Where their shoulders go = the shift direction

Should you mobilize a hip if someone has LBP?

Yes!

What hip mobilization is likely the “most” beneficial to perform for a patient with LBP?

Longitudinal traction

What are the 3 main rules for lumbar disc traction?

1. Make sure you keep traction at the LUMBAR spine (avoid unnecessary strain)

2. Keep it close to an “axial unload” (don’t want a pelvic tilt)

3. Keep it close to lumbar spine (pulling through knees in hook lying is not best)

Which lumbar traction technique requires a belt around the pt’s pelvis?

The 3 belt technique

What is the KEY to performing s/l lumbar traction?

Use therapist body to get force to lock the spine

What is the purpose of Williams Flexion Exercises?

Opening up IVF, stretching ligamentous structures, and distraction of apophyseal joints

What is the purpose of McKenzie Exercises?

A symptom based model which uses direction of preference to treatment (primarily extension)

If prone press-ups for extension are not tolerated well for a patient, what might you do instead since you are such a great PT?

Position them in supine and use a roll or wedge to extend over

What are the mCPR items which help identify patients with LBP who will likely receive short term success?

1. Aberrant lumbar movement

2. Positive prone instability test

Why is rotational strength SO important in LBP patients?

Because the multifidus muscle recovery is not spontaneous on remission of painful symptoms. Lack of localized muscle support may be one reason for high recurrent rate of LBP!

How should you teach a patient to maintain a neutral spine during exercises?

Coach them to experience a tilting pelvis, then encourage them to draw in when they are in neutral during exercises

A swiss ball which has been deflated is more ideal for what?

Patients who need more support during the exercise

What should you always consider according to research in patients with chronic LBP?

Posterior chain resistance training

What are the 8 levels of superman’s?

1. Ball under arms

2. Arms down at side (iron man)

3. alternating arm swings (no weight)

4. alternating arm swings with weight

5. B/L arm raises w/out weight

6. B/L arm raises w/ weight

7. Elbows on ball knee planks (focus on anterior trunk)

8. Elbows on ball full planks (focus on anterior trunk)

What should you keep in mind when treating an adolescent athlete with acute spondylolysis?

Avoid extension and rotation for healing, rest from sport for 3 months, and bracing is not ABSOLUTELY necessary.

Start with relatively static and neutral lumbar position training to build strength without stressing the pars interarticularis.

As symptoms improve, motion is promoted NOT avoided.