Academy of Orthopaedic Physical Therapy

American Physical Therapy Association (APTA)

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28.3 The lumbopelvic complex
Table of Contents

ACUTE AND SUBACUTE LOW BACK PAIN WITH MOBILITY DEFICITS:
LUMBOSACRAL SEGMENTAL/SOMATIC DYSFUNCTION

Abstract:

This monograph discusses acute and subacute low back pain (LBP) assessment and rehabilitation interventions. The assessment of LBP covers the medical triage process and examination. The medical triage evaluates the presence of red flags, neurological involvement, and significant co-morbidities. The examination covers the use of outcome measures of pain, disability, and psychosocial factors in individuals with LBP; it also provides a detailed description and interpretation of physical examination of LBP. Based on the findings of the examination, patterns of mobility deficits are identified. Each pattern is formed from clusters of signs and symptoms, and matched to a specific intervention. Interventions include non-thrust manual therapy, thrust manual therapy, directional preference exercises, neural mobilization, and soft tissue mobilization. Five case studies are presented. Each case study shows the process of clinical reasoning and the treatment-matching process. Case study 1 demonstrates how an individual can be started on non-thrust pattern interventions, pass through directional preference exercises, and end up with a thrust pattern. Case study 2 presents how an individual can be started on directional preference exercises, but then need a thrust manual therapy to be able to do the exercises correctly. Case study 3 exemplifies how an individual may present with simple LBP with a mobility deficit and respond to thrust patterns within very few sessions. Case study 4 is an example of how an individual may be started with a thrust technique and end up with another thrust technique due to changes in symptoms presentation. Case study 5 shows how an individual can have unresponsive symptoms that require further modifications specific to the unique area targeted.

Keywords:​

treatment classification, physical therapy, manual therapy, directional preference exercises

References:

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ACUTE, SUBACUTE, AND RECURRENT LOW BACK PAIN WITH MOVEMENT COORDINATION IMPAIRMENTS

Abstract:

This monograph reviews the movement control system as it relates to the lumbopelvic complex and low back pain. Components of the spinal stabilizing mechanism are discussed along with disruptions to the mechanism that may contribute to low back pain. A variety of theories on movement coordination based rehabilitation are discussed along with examination and intervention pathways to evaluate and treat patients with musculoskeletal low back pain. Finally, exercise progressions are discussed to achieve return to function. Four cases representing different ages, acuity levels, and functional goals are presented to highlight the examination algorithm and clinical decision-making process presented in the monograph. Case 1: 19-year-old male with a first time onset of low back pain. Case 2: an elite rower in his mid-20s with low back pain that conflicts with his competition goals. Case 3: female dental surgeon in her mid- 40s with a 20-year history of low back pain. Case 4: 68-year-old community dwelling female with a diagnosis of spinal stenosis that was treated using movement control principles to improve her walking ability.

Keywords:​

movement assessment, treatment subgroup, exercise progression

References:

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ACUTE AND SUBACUTE LOW BACK PAIN WITH RADIATING PAIN

Abstract:

This monograph discusses the demographics, anatomy, pathophysiology, and management for individuals who present with some form of acute or subacute low back pain with associated radiating pain into a lower limb. This monograph describes the prevalence and risk factors, and provides operational definitions for this condition(s). The most common and plausible causes for this condition are discussed followed by a thorough description to differentiate between radicular and referred pain as well as describe the concept of neuropathic pain. A very detailed management for patients with acute or subacute low back pain with radicular signs is presented inclusive of screening, common and/or expected examination findings, prognostic factors, appropriate outcome measures, and finally an evidence approach to interventions most commonly and most effectively used to manage individuals presenting with this condition. Three very interesting case studies are presented. Each case demonstrates appropriate patient management as well as uses advanced clinical reasoning skills. Case 1 involves an 83-yearold male with pain in his lower back and right lower limb of primarily insidious origin. Case 2 describes low back pain that radiates into the buttocks of a 65-year-old female. Case 3 presents a 36-year-old woman who presents via direct access (ie, without a physician referral) and complains of low back pain that radiates into her left lower limb following working in her yard.

Keywords:​

referred pain, radicular pain, prevalence, examination, intervention

References:

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LOW BACK PAIN IN THE GERIATRIC POPULATION

Abstract:

This monograph discusses the presence of low back pain in the rapidly growing older adult population. The high prevalence of low back pain is discussed and the use of the term “persistent” to describe low back pain in older adults is introduced. The multifactorial nature of persistent pain is discussed and includes concepts such as ageism, aging anxiety, and attitudes and beliefs about pain. The content of a comprehensive pain assessment as well as specific examination content for older adults with low back pain is addressed including the medication review, vital signs assessment, fall risk screening, red flag screening, and outcome measures assessment. The state of the evidence for nonpharmacologic interventions for older adults with persistent low back pain is discussed and includes exercise, manual therapy, cognitive behavioral therapy, and alternative therapies. Issues regarding pharmacologic interventions for older adults with persistent low back pain are also presented. Finally age-related changes that may affect the development of or recovery from low back pain are presented. Three case studies are presented. Each case depicts a clinical presentation and key clinical findings. A clinical plan of action is offered for each case. Readers are encouraged to engage in clinical reflection of each clinical presentation prior to reading the key clinical findings and associated clinical plan of action.

Keywords:​

persistent pain, older adult, patient- centered care, multifactorial​

References:

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ADOLESCENT SPINE

Abstract:

CONTENT: This monograph discusses pertinent topics in adolescent spine and sports rehabilitation, encompassing imaging considerations, triage and evaluation, classification, and treatment. Also included are special topics including sports medical management, psychosocial considerations, and special adolescent conditions. The monograph will outline evidence- based testing procedures, as well as describe treatment progressions from acute rehabilitation to return to sport. CASE ANALYSES: Three case studies are presented with athletes of various sports. Each case highlights the use of evidence guided strong classification and care. The first case involves a 16-yearold female field hockey player presenting with a primary complaint of sharp right-sided low back pain. The second case is a 13-year-old level 10 artistic gymnast evaluated for low back pain after a gradual onset of symptoms 4 weeks prior that began after a ring leap during her floor routine. The third case is a 14-year-old male soccer player who presented to the clinic with complaints of low back pain that started 6 weeks prior.

Keywords:​

evaluation, screening, sports, pediatric back pain, low back pain, injury

References:

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PATIENT EDUCATIONAL RESOURCES FOR THE SPINE PATIENT

 

References:

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The Lumbopelvic Complex

This course provides a comprehensive resource for the clinician who seeks evaluation and treatment expertise for patients who suffer low back pain.

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