Acute Low Back Pain A Physiotherapist’s Perspective Sean Buckley Bachelor of Science (Physiotherapy) Diploma Advanced Physiotherapy Fellow CAMPT

Sean Buckley Physiotherapist 14 years in clinical outpatient care Experience with urgent direct care model Diploma in Advanced Manual and Manipulative Physiotherapy Fellowship in Canadian Academy of Manual and Manipulative Physiotherapy

Thank you Kristy Klawitter Canadian Association of Physician Assistants Conference Organization Committee All of you for investing the time to better yourselves.

Objectives Define Acute Review general Lumbar Spine anatomy Propose a “Category System” Associate subjective findings to the categories Correlate objective findings to the categories Discuss management of Acute LBP

Definition of “Acute” Rapid Recent (less than 72 hours) Short duration Inflamed Sudden ++++ sore

Anatomy Vertebrae Discs Nerve roots Facet joints Ligaments Muscles

Categories of Acute LBP 1.Non-mechanical 2.Mechanical

Non-Mechanical Medical Tumour Visceral Bio-pyscho-social ……others

Mechanical Subdivided 1.Nerve 2.Structural

Mechanical- Nerve Nerve root Spinal cord Dura

Mechanical- Structural Joint Ligament Disc Bone Muscle

Think about a recent patient experience…

Non-Mechanical : Subjective Progressive No trauma (usually) Unremitting Generally “unwell” or just LBP Pain is consistent and routine “night pain” Non-consistent statements +/- neurological complaints ….. Other

Non-Mechanical : Objective +/- neurological signs +/- slump and/or SLR AROM no specific direction changes/limited “looks strong” Look deeply bothered by pain +/- consistent multi-directional limitation

Mechanical : Subjective +/- trauma (significant and insignificant) +/- “point in time” things changed +/- painfree position Work history of stressor(s) PMHx of stressor(s) Cannot do an ADL +/- certain position increases pain (ie sitting) ……other

Mechanical- Nerve : Objective +/- SLR/slump +/- change in reflexes +/- change in key muscles +/- change in dermatomes +/- shifted +/- change in sitting tolerance AROM usually decrease more in one direction …other

Mechanical- Structural : Objective Not the previous list AROM- one direction ++limited and reactive +/- shifted Uses hands to support movements +/- painful arc Points to area of pain to be in LS-gluteal area + anterior pressure to LS processes or muscles ….other

First Visit Management Is the treatment going to be different? What can I do? What can someone else do? What tests should be considered? What restrictions can be added? Should “days off” be granted? ….other

First Visit Management Educate!!!!

Education Mechanical LBP is not life threatening Usually will pass Have to respect it and work with it Progression of stressor Stay within tolerance levels by modifications

First Visit Management Decrease the irritant/inflammation Modify work (if possible) Physical Time Medicate Ice/heat Exercises

General approaches:  Core tight to support while in movement  Non-weight bearing thru LS movements  Hip stretches **Each patient is different so the above list isn’t always going to be the “way to go”.

Conclusion Acute LBP can be defined in recent significant episode of pain. Anatomy is complex but remember the vertebrae, discs, nerve roots, facets, ligaments and muscles are all potential parts of the puzzle.

Conclusion Categories of Acute LBP can be:  Non-mechanical  Mechanical Nerve Structural

Conclusion Subjective and objective findings for all groups Management  Educate  Medicate?  Modify stressors  Exercises

Thank-you!

Questions?