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Lumbar Clinical Guidelines

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by

Hannah Farr

on 28 February 2014

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Transcript of Lumbar Clinical Guidelines

Categories of Lumbar Dysfunction
Lumbar Clinical Guidelines
no repeated movements
no end range movements
no mobilization
lower extremity stretching
strengthening - core and LE's
aquatic therapy
posture/body mechanics
estim/TENS/hot pack/cold pack
wellness/fitness
stretching-lumbar spine and LE's
strengthening-core, hip extensors and abductors
aquatic therapy
posture/body mechanics instruction
manual therapy for spasm including Jones Technique, MFR, mobilizations
ice pack/hot pack
wellness/fitness
screen for hip pathology/LLD
correct shift if present
repeated movements-follow direction of centralization
mobilizations-central, rotational or flex/rotate
lumbar stabilization exercises
LE strengthening-hip abductor, hip extensor
LE stretching
nerve gliding/flossing
posture/body mechanics
aquatic therapy
aerobic exercise-encourage walking
estim/TENS/hot pack/cold pack
if acute, manipulation-refer to Dr. Tsarouhas
pain management with physiatry
wellness/fitness
screen for hip pathology/LLD
repeated movements-follow direction of centralization
mobilization
LE stretching
nerve gliding/flossing
lumbar stabilization exercises
LE strengthening-hip abductor, flexor
posture/body mechanics
aquatic therapy
estim/TENS/hot pack/cold pack
if acute-refer to Dr. Tsarouhas for manipulation
pain management-refer to physiatry
wellness/fitness
mechanical evaluation
lumbar stabilization/core strengthening
posture/body mechanics
aquatic therapy
modalities as needed
LE stretching
LE strengthening
SI assessment-address as needed
wellness/fitness
Spondylolisthesis/Retrolisthesis
Grade 1 and 2
no mobilization, avoid flexion, u/s
lumbar stabilization
posture/body mechanics
aquatic therapy
modalities as needed
LE stretching
LE strengthening
SI assessment-address as needed
wellness/fitness
Non-operative LBP
Vertebral Diagnoses
Compression/Spinous Fractures
Low Back Pain with radiculopathy
Centralized Low Back Pain
Lumbar Fusion
Lumbar Discectomy
Post-operative physical therapy
Lumbar Laminectomy
no repeated movements initially
mobilizations as needed
no excessive end range movements
strengthening-core and LE's
aquatic therapy
posture/body mechanics
estim/TENS/hot pack/cold pack
wellness/fitness
Precautions and Red Flags
Precautions
osteoporosis
history of cancer
prednisone use
actonal/fosomax use
surgical hardware
traumatic onset without imaging
SLE
ankylosing spondylitis
history of radiation therapy
history of aortic aneurism
CABG-BP before and after each visit
Red Flags
severe night pain
night sweats
cauda equina
change in bowel/bladder function
increased warmth, redness around incision
elevated temperature post-operatively
sign of the buttock (SLR and knees to chest both positive)
sudden onset of foot drop
increased weakness over time
second injury while being seen (i.e. MVA)
back pain with other significant diagnoses/neurological symptoms
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