How to manage:

Physiotherapy

Non-operative and Post-operative

BACK REHABILITATION

REHABILITATION PRINCIPLE

• Assess any Abnormality and treat to correct the Abnormality

SEVERE LOW BACK PAIN

• AIM TO REDUCE PAIN AND INFLAMMATION

• COMFORT POSITONS – NEUTRAL SPINE

• ENCOURAGE MOVEMENT THAT RELIEVES

• BED REST<48HRS

• +/- TAPING

• ANALGESIA /NSAIDS

• LOCAL MODALITIES FOR PAIN/SPASM ( HEAT , ELECTRO, MANUAL TH.)

• EXERCISE AWAY FROM AGGRAVATION

• WATCH FOR NEURAL SIGNS

SUB-ACUTE LOW BACK PAIN

OFTEN WITH ASSOC. MUSCLE SPASM / IRRITATION, INCREASED NEURAL TENSION

HYPOMOBILE SEGMENTS –UTILISE MANUAL THERAPY

• POOR POSTURES, BIOMECHANICS

• REDUCE PAIN / INFLAMMATION

• RESTORE ROM ( MANUAL THERAPY, EXERCISE)

• FLEXIBILITY AND STRENGTH

• CARDIO FITNESS

REHABILITATION AFTER BACK PAIN EPISODE

• MODIFY ACTIVITIES

• CORRECT BIOMECHANICAL ABNORMALITIES

• POSTURAL ASSESSMENT OF FUNCTIONAL POSITIONS

• LIFTING MECHANICS

• CORE STABILITY : LOCAL THEN GLOBAL

• ASSESS / STRETCH TIGHTNESS

FUNCTIONAL STABILITY

NEED TO UTILISE BOTH MUSCULAR FORCES AND PASSIVE STRUCTURES TO DYNAMICALLY STABILISE THE SPINE

ANY DEFICITS ASSESSED NEED TO BE ADDRESSED INA REHAB. PLAN

CORE STABILITY

• MUSCULAR CONTROL TO MAINTAIN FUNCTIONAL STABILITY

• MUSCULAR CORSET

• STABILITY INVOLVES PASSIVE AND ACTIVE STIFFNESS

• INSTABILITY WHEN EITHER COMPONENT DISTURBED

CORE STABILITY

• GLOBAL : DYNAMIC / PHASIC MUSCLES = ACTIVE TRUNK MOVEMENT

• RECTUS ABDOMINIS

• EXTERNAL OBLIQUES

• ILIOCOSTALIS (THORACIC PART)

• LATISSIMUS DORSI

• LINK PELVIS TO THORACIC CAGE

CORE STABILITY

• LOCAL : POSTURAL / TONIC = INTERSEGMENTAL STABILITY

• TRANSVERSUS ABDOMINIS

• MULTIFIDIS

• PSOAS MAJOR

• QUADRATUS LUMBORUM

• DIAPHRAGM

• ILIOCOSTALIS ( LUMBAR SEGMENT)

• INTERNAL OBLIQUE

CORE STABILITY

• Transversus Abdominis

ASSESSING FUNCTIONAL CORE STABILITY

• LUMBAR TORSION TEST

• PRONE PLANK

• SIDE PLANK

• SEATED TORSO FLEXION

• PRONE EXTENSOR ENDURANCE TEST

• SINGLE LEG SQUAT

STABILITY TEACHING / RETRAINING

• EDUCATION : ANATOMY AND FUNCTION

• ISOLATE DEEP LAYER T.A

• MOTOR RELEARNING

• TRAIN STABILISERS IN ISOLATION

• ADD FUNCTIONAL MOVEMENTS WITH STABILITY

• PAINFREE

• NEUTRAL SPINE INITIALLY

• FEEDBACK : TACTILE , PBU, ULTRASOUND

STABILISATION EXERCISES

• INITIATE PELVIC FLOOR HELPS ISOLATE T.A.

• PALPATE 1CM IN 1CM DOWN A.S.I.S.

• FEEL TENSION, NOT BULGE

• CONTROLLED BREATHING

• SUPINE / 4 POINT KNEEL / STANDING / SITTING

STABILISATION EXERCISES

• ISOMETRIC ABDOMINALS IN SUPINE

• SIDE LYING + GLUTEUS MEDIUS

• SUPINE BRIDGE

• ABDOMINAL CURL

• 4 PT KNEEL

• PRONE PLANK

• SIDE PLANK

• STANDING LUNGES

• STEP UPS

• GYM BALL SEATED

• BALANCE DISC

STABILISATION EXERCISES

• Isometric Abdominals in Supine

STABILISATION EXERCISES

• Side Lying + Gluteus Medius

STABILISATION EXERCISES

• Supine Bridge

STABILISATION EXERCISES

• Abdominal Curl

STABILISATION EXERCISES

• 4 Point Kneel

STABILISATION EXERCISES

• Prone Plank

STABILISATION EXERCISES

• Side Plank

STABILISATION EXERCISES

• Standing Lunges

STABILISATION EXERCISES

• Step ups

STABILISATION EXERCISES

• Gym Ball Seated

STABILISATION EXERCISES

• Balance Disc

POST OPERATIVE REHABILITATION

• UNDERSTANDING THE SURGERY

• REALISTIC GOALS / TIMELINES

• PAIN CONTROL

• EARLY EXERCISE

• EARLY MOBILITY

• DISCHARGE WITH REHABILITATION PACKAGE

POST-OPERATIVE EXERCISE

• NEUTRAL SPINE

• INTERSEGMENTAL STABILITY REGIME

• GLOBAL ABDO WORK

• ADDRESS SPECIFIC WEAKNESS

• MOBILISE DAY 0 OR 1

• AVOID NEURAL STRETCH

POST-OPERATIVE DISCHARGE

• DISCECTOMY : DAY 0-1

• LAMINECTOMY : DAY 1-3

• FUSION : DAY 3/4

EARLY POST-OPERATIVE REVIEW

• WOUND REVIEW

• PAIN ISSUES

• ACTIVITY LEVEL

• EXERCISE UPGRADE

• STABILITY

• GYM, BALL, POOL, CARDIO INCREASE

6 WEEK POST-OPERATIVE REVIEW

• OSWESTRY

• PROGRESSIVE BACK CARE

• INVOLVE GYM / WORKPLACE

• SELF MANAGED PLAN

CONDITIONING NON-OP AND POST-OP

• GENERAL AEROBIC FITNESS

• POSTURAL CORRECTION

• 20-30 MINUTE PERIODS

• WEIGHT LOSS

• POSITIVE RATHER THAN PURELY CLINICAL SETTING

NORMALISE SETTING : TAI CHI, PILATES, YOGA, GYM CLASSES, SWIM

FOCUS ON SELF MANAGEMENT

MULTI MODAL ROLE

• UNDERSTANDING

• RELATIONSHIP

• EARLY ACTIVITY

• EARLY EXERCISE

• EARLY MOBILITY

• MANAGEMENT ROLE

• SHIFT ONUS OF RESPONSIBILITY

• SELF MANAGEMENT