PT lecture - week 1, block 2.2

Spinal complaints - low back/neck pain

THIS LECTURE IS USELESS, GO ANALYZE THE GUIDELINE

Low back/neck pain → MSK - problem

READ KNGF GUIDELINE

Introduction

• Global burden disease

• look at the MB lecture for epidemiology, costs, prognostic factors

GP role → pick the ones that have a serious pathology

“non-specific complaints”

The majority of patients have “non-specific complaints“ → we say to patients “low back pain“

• 90%

• multifactorial (MB lecture)

• Episodic

• Clinical presentation vary strongly

How do we look at the patient?

• tissues

• Biopsychosocial → ICF, MLCM

• Understanding of pain is very important

Clinical reasoning

• We need to understand why they are in pain

• We need to explain the pain to the patient

Guidelines → read it

• appropriate care

• less money for society

• relevant research

In the guidelines, the patients are categorized based on

1) their prognostic factors

2) persisting pain complaints

• The patient needs fitting care for their complaints

• There is not one kind of low back pain patient

• each profile has a specific plan

• Time-related, goal-oriented, interventions, dosage, amount of treatments

Prognostic factors

Profile 1

Management strategy of the normal course

• informing, reassuring, advising

• Be aware of the use of language

• Gradual increase activities that promote recovery

• Decrease in pain between 10 - 12 weeks

• window of opportunity of 3 months

• After that pain becomes systematic

• explain the natural course of pain, and make sure they understand they are in control

Profile 2

• As in Profile 1, plus:

• Design an exercise program that fits in with patients’ needs and your expertise and experience as a therapist

• Limit the use of passive therapies

• Focus on self-efficacy

more pain doesn’t equal more damage

Profile 3

• Pain education → discuss the factors that might hinder the recovery

  • change the perception of pain

  • people are scared to make more damage because they feel more pain

  • Self-management

• Advise to stay active → gradual increase in activities

• Graded activity program → time contingent

Guideline Neck pain

Red flag

Abnormal course If the neck pain keeps increasing → send to GP

DAP

Responsibility

• Identify serious pathology ( non-specific) spinal complaints

• Only 1 % of all patients

• Limit the delay in adequate care!

From this tract, check the ones that might be involved with neck pain

• tractus respiratorius → if you are physically active, does the pain get worse

• Tractus circulatorius → do you have excessive increase in respiration, do you have pain in the shoulder blades, pain in the left arm

• Tractus neurologicus

• Tractus locomotorius

• Tractus digestivus

• Tractus urogenitalis → do you have problems urinating, bowel, problem with intercourse

Dizzy? could puke? → 991

Don’t hesitate to contact the GP

After screening, as usual:

• anamnesis (SCEBS)

• Physical examination → inspection, totally/local, functional

• Palpation

• Rom

• specific testing

SCEBS

• can I estimate the profile?

• What are the prognostic factors?

• What further info is necessary?

• Can we understand the pain mechanism?

• RPS