How to manage: Physiotherapy Non-operative and Post-operative BACK REHABILITATION.
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Transcript of How to manage: Physiotherapy Non-operative and Post-operative BACK REHABILITATION.
![Page 1: How to manage: Physiotherapy Non-operative and Post-operative BACK REHABILITATION.](https://reader035.fdocuments.us/reader035/viewer/2022081505/551ad82b550346b2288b5eab/html5/thumbnails/1.jpg)
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How to manage:
Physiotherapy
Non-operative and Post-operative
BACK REHABILITATION
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REHABILITATION PRINCIPLE
• Assess any Abnormality and treat to correct the Abnormality
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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
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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
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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
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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
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CORE STABILITY
• MUSCULAR CONTROL TO MAINTAIN FUNCTIONAL STABILITY
• MUSCULAR CORSET
• STABILITY INVOLVES PASSIVE AND ACTIVE STIFFNESS
• INSTABILITY WHEN EITHER COMPONENT DISTURBED
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CORE STABILITY
• GLOBAL : DYNAMIC / PHASIC MUSCLES = ACTIVE TRUNK MOVEMENT
• RECTUS ABDOMINIS
• EXTERNAL OBLIQUES
• ILIOCOSTALIS (THORACIC PART)
• LATISSIMUS DORSI
• LINK PELVIS TO THORACIC CAGE
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CORE STABILITY
• LOCAL : POSTURAL / TONIC = INTERSEGMENTAL STABILITY
• TRANSVERSUS ABDOMINIS
• MULTIFIDIS
• PSOAS MAJOR
• QUADRATUS LUMBORUM
• DIAPHRAGM
• ILIOCOSTALIS ( LUMBAR SEGMENT)
• INTERNAL OBLIQUE
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CORE STABILITY
• Transversus Abdominis
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ASSESSING FUNCTIONAL CORE STABILITY
• LUMBAR TORSION TEST
• PRONE PLANK
• SIDE PLANK
• SEATED TORSO FLEXION
• PRONE EXTENSOR ENDURANCE TEST
• SINGLE LEG SQUAT
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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
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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
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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
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STABILISATION EXERCISES
• Isometric Abdominals in Supine
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STABILISATION EXERCISES
• Side Lying + Gluteus Medius
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STABILISATION EXERCISES
• Supine Bridge
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STABILISATION EXERCISES
• Abdominal Curl
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STABILISATION EXERCISES
• 4 Point Kneel
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STABILISATION EXERCISES
• Prone Plank
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STABILISATION EXERCISES
• Side Plank
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STABILISATION EXERCISES
• Standing Lunges
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STABILISATION EXERCISES
• Step ups
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STABILISATION EXERCISES
• Gym Ball Seated
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STABILISATION EXERCISES
• Balance Disc
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POST OPERATIVE REHABILITATION
• UNDERSTANDING THE SURGERY
• REALISTIC GOALS / TIMELINES
• PAIN CONTROL
• EARLY EXERCISE
• EARLY MOBILITY
• DISCHARGE WITH REHABILITATION PACKAGE
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POST-OPERATIVE EXERCISE
• NEUTRAL SPINE
• INTERSEGMENTAL STABILITY REGIME
• GLOBAL ABDO WORK
• ADDRESS SPECIFIC WEAKNESS
• MOBILISE DAY 0 OR 1
• AVOID NEURAL STRETCH
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POST-OPERATIVE DISCHARGE
• DISCECTOMY : DAY 0-1
• LAMINECTOMY : DAY 1-3
• FUSION : DAY 3/4
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EARLY POST-OPERATIVE REVIEW
• WOUND REVIEW
• PAIN ISSUES
• ACTIVITY LEVEL
• EXERCISE UPGRADE
• STABILITY
• GYM, BALL, POOL, CARDIO INCREASE
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6 WEEK POST-OPERATIVE REVIEW
• OSWESTRY
• PROGRESSIVE BACK CARE
• INVOLVE GYM / WORKPLACE
• SELF MANAGED PLAN
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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
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MULTI MODAL ROLE
• UNDERSTANDING
• RELATIONSHIP
• EARLY ACTIVITY
• EARLY EXERCISE
• EARLY MOBILITY
• MANAGEMENT ROLE
• SHIFT ONUS OF RESPONSIBILITY
• SELF MANAGEMENT