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Back Rehabilitation
- 1. How to Manage Non-‐opera/ve and Opera/ve BACK REHABILITATION Stephen Boyd -‐ Physiotherapist
- 2. REHABILITATION PRINCIPLE • Assess any Abnormality and treat to correct the Abnormality
- 3. 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, ICE , ELECTRO, MANUAL TH.) • EXERCISE AWAY FROM AGGRAVATION • WATCH FOR NEURAL SIGNS
- 4. 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 • EDUCATION
- 5. 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 • EDUCATION • HOME EXERCISE REGIME
- 6. ehR REFERRAL PRESCRIPTIONS Acute Back Pain Local modali/es for pain/spasm Encourage non-‐aggrava/ng movement and exercise Educate / encourage neutral spine Manual therapy techniques Home exercise Back Care advice
- 7. RehR REFERRAL PRESCRIPTIONS SUB-‐ACUTE BACK PAIN Local modali/es for pain/spasm/hypo mobility Restore range with manual therapy and exercise Core stability regime and upgrade Review postures/biomechanics Home exercise / Cardio fitness CHRONIC DISEASE MANAGEMENT PLAN
- 8. FUNCTIONAL STABILITY NEED TO UTILISE BOTH MUSCLE FORCES AND PASSIVE STRUCTURES TO DYNAMICALLY STABILISE THE SPINE FUNCTIONALLY ANY DEFICITS ASSESSED NEED TO BE ADDRESSED IN A REHAB. PLAN
- 9. CORE STABILITY • MUSCULAR CONTROL TO MAINTAIN FUNCTIONAL STABILITY • MUSCULAR CORSET • STABILITY INVOLVES PASSIVE AND ACTIVE STIFFNESS • INSTABILITY WHEN EITHER COMPONENT DISTURBED
- 10. CORE STABILITY • GLOBAL : DYNAMIC / PHASIC MUSCLES = ACTIVE TRUNK MOVEMENT • RECTUS ABDOMINIS • EXTERNAL OBLIQUES • ILIOCOSTALIS (THORACIC PART) • LATISSIMUS DORSI • LINK PELVIS TO THORACIC CAGE
- 11. CORE STABILITY • LOCAL : POSTURAL / TONIC = INTERSEGMENTAL STABILITY • TRANSVERSUS ABDOMINIS • MULTIFIDIS • PSOAS MAJOR • QUADRATUS LUMBORUM • DIAPHRAGM • ILIOCOSTALIS ( LUMBAR SEGMENT) • INTERNAL OBLIQUE
- 12. 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
- 13. 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
- 14. 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 • GYM BALL LIFTING • BALANCE DISC
- 20. STRETCHING • LUMBAR ROTATION • LUMBAR FLEXION • HIP FLEXION • HIP EXTENSION • HIP ADDUCTION • STRAIGHT LEG RAISE • DEEP HIP ROTATORS • THORACO-‐LUMBAR ROTATION • LUMBAR EXTENSION
- 21. POST-‐OPERATIVE REHABILITATION • UNDERSTANDING THE SURGERY • REALISTIC GOALS / TIMELINES • PAIN CONTROL • EARLY EXERCISE • EARLY MOBILITY • DISCHARGE WITH REHABILITATION PACKAGE
- 22. POST-‐OPERATIVE EXERCISE • NEUTRAL SPINE • INTERSEGMENTAL STABILITY REGIME • GLOBAL ABDO WORK • ADDRESS SPECIFIC WEAKNESS • MOBLISE DAY 0 OR 1 • FUNCTIONAL ABDOMINAL CONTROL, GAIT • AVOID NEURAL STRETCH
- 23. POST-‐OPERATIVE DISCHARGE • DISCECTOMY : DAY 0 • LAMINECTOMY : DAY 1/2 • FUSION : DAY 2/4
- 24. 3 WEEK POST-‐OPERATIVE REVIEW • WOUND REVIEW • OSWESTRY • PAIN ISSUES • ACTIVITY LEVEL • EXERCISE UPGRADE • STABILITY • GYM, BALL, POOL, CARDIO INCREASE
- 25. 6 WEEK POST-‐OPERATIVE REVIEW • WITH SURGEON • OSWESTRY • PROGRESSIVE BACK CARE • INVOLVE EX.PHYSIOLOGIST / GYM / WORKPLACE • SELF MANAGED PLAN
- 26. MULTIMODAL ROLE • UNDERSTANDING • RELATIONSHIP • EARLY ACTIVITY • EARLY EXERCISE • EARLY MOBILITY • SHIFT ONUS OF RESPONSIBILITY • SELF MANAGEMENT
- 27. CONDITIONING • 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