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Back rehabilitation. How to manage: Physiotherapy Non-operative and Post-operative. Rehabilitation Principle. Assess any Abnormality and treat to correct the Abnormality. SEVERE LOW BACK PAIN. AIM TO REDUCE PAIN AND INFLAMMATION
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Back rehabilitation How to manage: Physiotherapy Non-operative and Post-operative
Rehabilitation Principle • Assess any Abnormality and treat to correct the Abnormality
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 , ELECTRO, MANUAL TH.) • EXERCISE AWAY FROM AGGRAVATION • WATCH FOR NEURAL SIGNS
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
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
FUNCTIONAL STABILITY NEED TO UTILISE BOTH MUSCULAR FORCES AND PASSIVE STRUCTURES TO DYNAMICALLY STABILISE THE SPINE ANY DEFICITS ASSESSED NEED TO BE ADDRESSED INA REHAB. PLAN
CORE STABILITY • MUSCULAR CONTROL TO MAINTAIN FUNCTIONAL STABILITY • MUSCULAR CORSET • STABILITY INVOLVES PASSIVE AND ACTIVE STIFFNESS • INSTABILITY WHEN EITHER COMPONENT DISTURBED
CORE STABILITY • GLOBAL : DYNAMIC / PHASIC MUSCLES = ACTIVE TRUNK MOVEMENT • RECTUS ABDOMINIS • EXTERNAL OBLIQUES • ILIOCOSTALIS (THORACIC PART) • LATISSIMUS DORSI • LINK PELVIS TO THORACIC CAGE
CORE STABILITY • LOCAL : POSTURAL / TONIC = INTERSEGMENTAL STABILITY • TRANSVERSUS ABDOMINIS • MULTIFIDIS • PSOAS MAJOR • QUADRATUS LUMBORUM • DIAPHRAGM • ILIOCOSTALIS ( LUMBAR SEGMENT) • INTERNAL OBLIQUE
Core stability • Transversus Abdominis
ASSESSING FUNCTIONAL CORE STABILITY • LUMBAR TORSION TEST • PRONE PLANK • SIDE PLANK • SEATED TORSO FLEXION • PRONE EXTENSOR ENDURANCE TEST • SINGLE LEG SQUAT
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
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
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 • BALANCE DISC
Stabilisation exercises • Isometric Abdominals in Supine
Stabilisation exercises • Side Lying + Gluteus Medius
Stabilisation exercises • Supine Bridge
Stabilisation exercises • Abdominal Curl
Stabilisation exercises • 4 Point Kneel
Stabilisation exercises • Prone Plank
Stabilisation exercises • Side Plank
Stabilisation exercises • Standing Lunges
Stabilisation exercises • Step ups
Stabilisation exercises • Gym Ball Seated
STABILISATION EXERCISES • Balance Disc
POST OPERATIVE REHABILITATION • UNDERSTANDING THE SURGERY • REALISTIC GOALS / TIMELINES • PAIN CONTROL • EARLY EXERCISE • EARLY MOBILITY • DISCHARGE WITH REHABILITATION PACKAGE
POST-OPERATIVE EXERCISE • NEUTRAL SPINE • INTERSEGMENTAL STABILITY REGIME • GLOBAL ABDO WORK • ADDRESS SPECIFIC WEAKNESS • MOBILISE DAY 0 OR 1 • AVOID NEURAL STRETCH
POST-OPERATIVE DISCHARGE • DISCECTOMY : DAY 0-1 • LAMINECTOMY : DAY 1-3 • FUSION : DAY 3/4
EARLY POST-OPERATIVE REVIEW • WOUND REVIEW • PAIN ISSUES • ACTIVITY LEVEL • EXERCISE UPGRADE • STABILITY • GYM, BALL, POOL, CARDIO INCREASE
6 WEEK POST-OPERATIVE REVIEW • OSWESTRY • PROGRESSIVE BACK CARE • INVOLVE GYM / WORKPLACE • SELF MANAGED PLAN
CONDITIONING NON-OP AND POST-OP • 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
MULTI MODAL ROLE • UNDERSTANDING • RELATIONSHIP • EARLY ACTIVITY • EARLY EXERCISE • EARLY MOBILITY • MANAGEMENT ROLE • SHIFT ONUS OF RESPONSIBILITY • SELF MANAGEMENT