Regional Interdependence in Low Back Pain: Interventions: Difference between revisions

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== Examination  ==
== Examination  ==


 
*Screen patient for red flags<ref name="Diletto et al.">Delitto A, George S.Z. et al, Low Back Pain Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability, and Health from the Orthopaedic Section of the American Physical Therapy Association. J Orhtop Sports Phys Ther. 2012;42(4):A1-A57 Pub Med Link: http://www.ncbi.nlm.nih.gov/pubmed/22466247 (accessed 26 October 2013).</ref>
 
*Screen patient for red flags<ref>Delitto A, George S.Z. et al, Low Back Pain Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability, and Health from the Orthopaedic Section of the American Physical Therapy Association. J Orhtop Sports Phys Ther. 2012;42(4):A1-A57 Pub Med Link: http://www.ncbi.nlm.nih.gov/pubmed/22466247</ref>


{| border="1" cellpadding="1" cellspacing="1"
{| border="1" cellpadding="1" cellspacing="1"
|-
|-
| Condition
| Condition  
| Red Flags
| Red Flags
|-
|-
| Back-related tumor
| Back-related tumor  
|  
|  
*Constant pain not affected by position or activity; worse with weight bearing, worse at night  
*Constant pain not affected by position or activity; worse with weight bearing, worse at night  
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|-
|-
| Cauda equina syndrome
| Cauda equina syndrome  
|  
|  
*Urine retention  
*Urine retention  
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|-
|-
| Back-related infection
| Back-related infection  
|  
|  
*Recent infection (eg, urinary tract or skin), intravenous drug user/abuser  
*Recent infection (eg, urinary tract or skin), intravenous drug user/abuser  
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|-
|-
| Spinal compression fracture
| Spinal compression fracture  
|  
|  
*History of major trauma, such as vehicular accident, fall from a height, or direct blow to the spine  
*History of major trauma, such as vehicular accident, fall from a height, or direct blow to the spine  
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|-
|-
| Abdominal aneurysm
| Abdominal aneurysm  
|  
|  
*Back, abdominal, or groin pain  
*Back, abdominal, or groin pain  

Revision as of 01:21, 27 October 2013

 

Regional Interdependence[edit | edit source]

  • Regional interdependence is the concept that a musculoskeletal treatment targeting a specific area of the body could have effects in another, seemingly unrelated, part of the body[1]. 
  • Examples of Regional Interdependence:

          -  Elbow

          -  Shoulder

Examination[edit | edit source]

  • Screen patient for red flags[2]
Condition Red Flags
Back-related tumor
  • Constant pain not affected by position or activity; worse with weight bearing, worse at night
  • Age over 50
  • History of cancer
  • Failure of conservative intervention (failure to improve within 30 days)
  • Unexplained weight loss
Cauda equina syndrome
  • Urine retention
  • Fecal incontinence
  • Saddle anesthesia
  • Sensory or motor deficits in the feet (L4, L5, S1 areas)
Back-related infection
  • Recent infection (eg, urinary tract or skin), intravenous drug user/abuser
  • Concurrent immunosuppressive disorder
  • Deep constant pain, increases with weight bearing
  • Fever, malaise, and swelling
  • Spine rigidity; accessory mobility may be limited
  • Fever: tuberculosis osteomyelitis
  • Fever: pyogenic osteomyelitis
  • Fever: spinal epidural abscess
Spinal compression fracture
  • History of major trauma, such as vehicular accident, fall from a height, or direct blow to the spine
  • Age over 50
  • Age over 75
  • Prolonged use of corticosteroids
  • Point tenderness over site of fracture
  • Increased pain with weight bearing
Abdominal aneurysm
  • Back, abdominal, or groin pain
  • Presence of peripheral vascular disease or coronary artery disease and associated risk factors (age over 50, smoker, hypertension, diabetes mellitus)
  • Smoking history
  • Family history
  • Age over 70
  • Non-Caucasian
  • Female
  • Symptoms not related to movement stresses associated with somatic low back pain
  • Abdominal girth <100 cm
  • Presence of a bruit in the central epigastric area upon auscultation
  • Palpation of abnormal aortic pulse
  • Aortic pulse 4 cm or greater
  • Aortic pulse 5 cm or greater

References[edit | edit source]

  1. ↑ Wainner RS, Whitman JM, Cleland JA, Flynn TW. Regional Interdependence: A Musculoskeletal Examination Model Whose Time Has Come. J Orthop Sports Phys Ther 2007;37(11):658-660. Pub Med Link: http://www.ncbi.nlm.nih.gov/pubmed/18057674 (accessed 26 Oct 2013).
  2. ↑ Delitto A, George S.Z. et al, Low Back Pain Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability, and Health from the Orthopaedic Section of the American Physical Therapy Association. J Orhtop Sports Phys Ther. 2012;42(4):A1-A57 Pub Med Link: http://www.ncbi.nlm.nih.gov/pubmed/22466247 (accessed 26 October 2013).
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