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

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= Outcomes  =
= Outcomes  =
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| Decreased Pain
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Increased Pain Free&nbsp;Grip Strength
| Increased Pressure Pain Threshold
| Decreased Disability [[DASH Outcome Measure|(DASH)]]
| Perception of Change
| Global Improvement
| Increased Max Grip Force
| Improved Carpal Mobility
| Improved Elbow Flexion Test
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| Cervical <ref name="1">Fernández-Carnero J, Fernández-de-las-Peñas C, Cleland J. Immediate hypoalgesic and motor effects after a single cervical spine manipulation in subjects with lateral epicondylalgia. Journal Of Manipulative and Physiological Therapeutics. November 2008;31(9):675-681.</ref>&nbsp;<ref name="2">Fernández-Carnero J, Cleland J, Touche. Examination of Motor and Hypoalgesic Effects of Cervical vs Thoracic Spine Manipulation in Patients With Lateral Epicondylalgia: A Clinical Trial. Journal Of Manipulative and Physiological Therapeutics. September 2011;34(7):432-440.</ref>
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| CT <ref name="3">Cleland J, Flynn T, Palmer J. Incorporation of manual therapy directed at the cervicothoracic spine in patients with lateral epicondylalgia: a pilot clinical trial. Journal Of Manual and Manipulative Therapy (Journal Of Manual and Manipulative Therapy). September 2005;13(3):143-151.</ref>
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| Thoracic <ref name="2" />
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Wrist&nbsp;<br><ref name="4">Struijs P, Damen P, Bakker E, Blankevoort L, Assendelft W, van Dijk C. Manipulation of the wrist for management of lateral epicondylitis: a randomized pilot study. Physical Therapy. July 2003;83(7):608-616.</ref>
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| Carpal Mobilization <ref name="5">Kearns G. Medical diagnosis of cubital tunnel syndrome ameliorated with thrust manipulation of the elbow and carpals. Journal Of Manual and Manipulative Therapy (Maney Publishing). December 2010;18(4):228.</ref>
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| Median/Radial Nerve Mob&nbsp;<ref name="6">Ekstrom R, Holden K. Examination of and intervention for a patient with chronic lateral elbow pain with signs of nerve entrapment. Physical Therapy [serial online]. November 2002;82(11):1077-1086.</ref>&nbsp;
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= References  =
= References  =


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Revision as of 07:41, 12 November 2013

Original Editors - Brandan Lym, Mitchell Blythe, Cory Horstman, Nathan Domino, and Dana Schmidt part of the Des Moines University Student Project    

 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

Physical Impairment Measures[2]

  • Evaluate Thoraco-Lumbar Active and Passive ROM

          -  Quadrant Test

  • Segmental Mobility
  • Pain Provocation with Segmental Mobility Testing
  • Judgments of Centralization during Movement Testing

          - Look for a centralization of pain with repeated motion in a specific direction.

  • Prone Instability Test
  • Judgments of the presence of aberrant movement
  • Straight Leg Raise
  • Slump Test
  • Trunk Muscle Power and Endurance
  • Passive Hip Internal Rotation, External Rotation, Flexion, and Extension
  • Mental Impairment Measures

          -  Depression

          -  Yellow Flags

          -  Fear Avoidance Beliefs Questionnaire

Also consider Hip Examination

  • Active and Passive ROM
  • Joint Mobility
  • Strength


Outcome Measures Used[edit | edit source]

Interventions[edit | edit source]

Thoracic Spine[3][edit | edit source]

Manipulation

  • Supine Thoracic Posterior to Anterior HVLA Manipulation

   

Hip[4][5][6][edit | edit source]

Manipulation

  • Supine Long Axis Distraction HVLA Manipulation

  

Mobilizations

  • Supine Hip Caudal Glide Mobilization
  • Prone Hip Posterior to Anterior Mobilization

          - Hip Mobilizations

  

Therapeutic Exercise

  •  Strengthening

          - Hip Abduction with slight extension and internal rotation

  •  Flexibility

          - Supine Iliopsoas Stretch

          - Prone Rectus Femoris Stretch

          - 

Outcomes[edit | edit source]




 Decreased Pain

Increased Pain Free Grip Strength

Increased Pressure Pain Threshold Decreased Disability (DASH) Perception of Change Global Improvement Increased Max Grip Force Improved Carpal Mobility Improved Elbow Flexion Test
Cervical Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title X X
CT Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title X X X X
Thoracic Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title X

Wrist 
Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title

X X X X X
Carpal Mobilization Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title X X X X
Median/Radial Nerve Mob Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title  X X


 

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. ↑ 2.0 2.1 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).
  3. ↑ Oliveira RF, Liebano RE, Costa LCM, Rissato LL, Costa LOP. Immediate Effects of Region-Specific and Non-Region-Specific Spinal Manipulative Therapy in Patients With Chronic Low Back Pain: A Randomized Controlled Trial. Phys Ther 2013;93(6):748-756. Pub Med Link: http://www.ncbi.nlm.nih.gov/pubmed/23431209 (accessed 28 Oct 2013).
  4. ↑ Whitman JM, Flynn TW, Fritz, JM. Nonsurgical management of patients with lumbar spinal stenosis: a literature review and a case series of three patients managed with physical therapy. Phys Med Rehabil Clin N Am 2003;14:77-101. Pub Med Link: http://www.ncbi.nlm.nih.gov/pubmed/12622484 (accessed 29 Oct 2013).
  5. ↑ Whitman JM, Flynn TW, Childs JD, et al. A comparison between two physical therapy treatment programs for patients with lumbar spinal stenosis: a randomized clinical trial. Spine 2006;31(22):2541-2549. Pub Med Link: http://www.ncbi.nlm.nih.gov/pubmed/17047542 (accessed 29 Oct 2013).
  6. ↑ Cibulka MT. Low Back Pain and its Relation to the Hip and Foot. J Orthop Sports Phys Ther 1999;29(10):595-601. Pub Med Link: http://www.ncbi.nlm.nih.gov/pubmed/10560068 (accessed 26 Oct 2013)
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