Spine Week 2

Complex regional pain syndrome (CRPS)

Excess and prolonged pain and inflammation that follows an injury to an arm or leg

Severe pain; changes in skin temperature, color, texture, hair; vasoconstriction, leads to motor wasting

Fibromyalgia

Diagnosis of exclusion → diagnosed when everything else has been ruled out

Symptoms: tiredness, sleep disorders, concentration problems, fatigue, headache, depression; neck/back pain, chest pain; difficulties swallowing, toothache, increased noise sensitivity, photosensitivity, sensitivity to cold; arrhythmia, shortness of breath, increased susceptibility to infection; irritable bowel and stomach; chronic pain, joint pain in arms and legs, morning stiffness, cramps, trembling hands; swelling in feet, hands or face

Must have pain in at least 4/5 areas for more than 3 months: left upper region, right upper region, left lower region, right lower region, axial region

Neurophysiology of pain questionnaire

Have the pt take it to see their knowledge of pain and determine where they need further education

Hypomobile joint treatment

Manual therapy

Hypermobile joint treatment

Strengthening, motor control, bracing

Altered muscl recruitment/weakness Treatment

Motor control/strengthening

Muscle stiffness or pain treatment

Stretching, METs, soft tissue mobs, dry needling

Sensitized CNS treatment

TNE, CFT, motivational interviewing

Therapeutic Neuroscience Education

Educating pts about neurobiology and neurophysiology of pain in contrast to anatomical or tissue model

Chronic MSK pain disorders → education can have a positive effect on pain, disability, catastrophization, and physical performance

Cognitive functional therapy

Making sense of pain

Gradual exposure to challenging/valued tasks with pain control

Healthy lifestyle changes → referral for psychological support or pain management, consider need for intermittent booster sessions if required long-term

Neuromatrix theory of pain

Pt’s nociception combines with environment, beliefs, experience, social support, and immune, autonomic, and endocrine systems to change the sensitization of afferent neuron signaling which changed efferent pain output

Passive accessory intervertebral motion

Slide, glide, translation that is arthrokinematic motion required for joint movement

Passive physiologic intervertebral motion

Osteokinematic motion

PAIVM = CPA

When PAIVM assesses hypomobility in a pt, they experienced greater benefit from an intervention including manipulation

More likely to benefit from stabilization exercise and joint mobilization

Indications to test PAIVMs and PPIVMs

No centralization or peripheralization

Suspect segmental hypo or hypermobility

PPIVM

High SP (rule in), low SN (rule out)

Compare to AROM findings

Used to localize motion segment for intervention

Assess for reproduction of pain

Muscle performance

Capacity of a muscle or a group of muscles. To generate forces to produce, maintain, sustain, and modify postures and movements that are prerequisite to functional activity

Motor control

Recruitment of motor units, fuel storage, and fuel delivery, in addition to balance, timing, and sequencing of contraction mediate integrated muscle performance

Lumbar Surgery Candidates

Leg pain

Most Common Lumbar Surgeries

Laminectomy, fusion, discectomy

Lumbar Laminectomy

Alleviates pain caused by nerve root compression

Small portion of bone over nerve root and/or disc material are removed to give nerve root more space and provide better healing environment

Spinal Fusion

Stop motion at a painful segment → decrease pain generated from the joint

Adding bone between vertebral elements to stop motion

Can get excess motion above and below

Treatment for joint mobility impairments

Joint mobilizations, soft tissue mobilization, muscle energy techniques

Treatment for motor control impairments

Lumbar stabilization training/exercise, rehab ultrasound imaging, higher level TA exercises

Treatment for referred pain/radiculopathy

Direction specific exercise, neurodynamic gliding, traction

CPA and UPA indications

T&M: painful/hypomobile segment via PAIVM

Dx: LBP with mobility deficits, LBP with referred LE pain, direction specific exercise

Spinal manipulation contraindications

Pathology that leads to significant bone weakening or ligamentous laxity

Cord compression, cauda equina compression, severe or worsening nerve root compression with increasing neurological deficit

Aortic aneurism, bleeding into joints

Lack of dx

Unable to put pt into standard position

Clinical prediction rule for manipulation

Pain lasting less than 16 days

No symptoms distal to the knee

FABQ score less than 19

IR greater than 35 degrees for at least 1 hip

Hypomobility of at least 1 level of lumbar spine

Racial disparity

Exists

Phases of Motor Learning

Cognitive: learning what to do

Associative: refining movement pattern

Automatic phases: developing skill

Direction specific exercise

Directional preference

Symptoms improve/centralize with repeated motions into that direction

Neural glides

Induce sliding of nerve relative to surrounding structures by performing joint movements that elongate nerve bed

Indications: low irritability, positive neurodynamic tests, no precautions or contraindications, MT and exercises don’t improve SLR or slump test

Spinal traction contraindications

Spinal infection, tumor; osteoporosis; vertebral artery disease; rheumatoid arthritis/Down’s syndrome; ligament laxity or segmental instability; pregnancy or prolonged steroid use; condition where movement is contraindicated; trauma or suspected trauma; sx worsen with manual traction; hiatal hernia