![Page 1: Current Concepts of Low Back Pain - Creighton … Concepts of Low Back Pain Terry L. Grindstaff, PhD, PT, ... Management • Mobility of ... Key Concepts • The number one](https://reader033.vdocuments.us/reader033/viewer/2022052516/5ab818e27f8b9ad3038c6e28/html5/thumbnails/1.jpg)
Current Concepts of Low Back Pain
Terry L. Grindstaff, PhD, PT, ATC, SCS, CSCS
![Page 2: Current Concepts of Low Back Pain - Creighton … Concepts of Low Back Pain Terry L. Grindstaff, PhD, PT, ... Management • Mobility of ... Key Concepts • The number one](https://reader033.vdocuments.us/reader033/viewer/2022052516/5ab818e27f8b9ad3038c6e28/html5/thumbnails/2.jpg)
Low Back Pain• 28% population
reports LBP in past 3 months (CDC 2010)
• 60% recurrence rate (Turner et al, 1992)
![Page 3: Current Concepts of Low Back Pain - Creighton … Concepts of Low Back Pain Terry L. Grindstaff, PhD, PT, ... Management • Mobility of ... Key Concepts • The number one](https://reader033.vdocuments.us/reader033/viewer/2022052516/5ab818e27f8b9ad3038c6e28/html5/thumbnails/3.jpg)
Low Back Pain
• In most cases, low back pain is mild and disappears on its own– Within 6 weeks 90% of episodes will resolve
![Page 4: Current Concepts of Low Back Pain - Creighton … Concepts of Low Back Pain Terry L. Grindstaff, PhD, PT, ... Management • Mobility of ... Key Concepts • The number one](https://reader033.vdocuments.us/reader033/viewer/2022052516/5ab818e27f8b9ad3038c6e28/html5/thumbnails/4.jpg)
Low Back Pain
• Acute (< 2 weeks)– Stay active (avoid bedrest)– Medications– Follow up with health care professional
• 2 Weeks: seek care• 6 Weeks: multidisciplinary approach
– Avoid disability
![Page 5: Current Concepts of Low Back Pain - Creighton … Concepts of Low Back Pain Terry L. Grindstaff, PhD, PT, ... Management • Mobility of ... Key Concepts • The number one](https://reader033.vdocuments.us/reader033/viewer/2022052516/5ab818e27f8b9ad3038c6e28/html5/thumbnails/5.jpg)
Psychosocial Education
• Brief psychosocial education reduces incidence of LBP (George et al, 2011)
– Understand anatomical causes– Favorable natural history– Decrease fear-avoidance
![Page 6: Current Concepts of Low Back Pain - Creighton … Concepts of Low Back Pain Terry L. Grindstaff, PhD, PT, ... Management • Mobility of ... Key Concepts • The number one](https://reader033.vdocuments.us/reader033/viewer/2022052516/5ab818e27f8b9ad3038c6e28/html5/thumbnails/6.jpg)
Medical Emergency• Low back pain
– Loss of bowel or bladder control
– Numbness in the groin or inner thigh
![Page 7: Current Concepts of Low Back Pain - Creighton … Concepts of Low Back Pain Terry L. Grindstaff, PhD, PT, ... Management • Mobility of ... Key Concepts • The number one](https://reader033.vdocuments.us/reader033/viewer/2022052516/5ab818e27f8b9ad3038c6e28/html5/thumbnails/7.jpg)
Types of Low Back Pain
• Acute• Recurrent• Chronic
![Page 8: Current Concepts of Low Back Pain - Creighton … Concepts of Low Back Pain Terry L. Grindstaff, PhD, PT, ... Management • Mobility of ... Key Concepts • The number one](https://reader033.vdocuments.us/reader033/viewer/2022052516/5ab818e27f8b9ad3038c6e28/html5/thumbnails/8.jpg)
Causes
• Overuse• Strain• Repetitive motion• Prolonged sitting• Stress/Emotion• Inability of muscles, ligaments, and joints
to work as they should
![Page 9: Current Concepts of Low Back Pain - Creighton … Concepts of Low Back Pain Terry L. Grindstaff, PhD, PT, ... Management • Mobility of ... Key Concepts • The number one](https://reader033.vdocuments.us/reader033/viewer/2022052516/5ab818e27f8b9ad3038c6e28/html5/thumbnails/9.jpg)
Strength• The lumbar spine is
very unstable without muscular control (Panjabi, 1992)
![Page 10: Current Concepts of Low Back Pain - Creighton … Concepts of Low Back Pain Terry L. Grindstaff, PhD, PT, ... Management • Mobility of ... Key Concepts • The number one](https://reader033.vdocuments.us/reader033/viewer/2022052516/5ab818e27f8b9ad3038c6e28/html5/thumbnails/10.jpg)
Core Defined• Area between the
sternum and the knees– Abdomen– Lumbar Spine– Pelvis– Hips
![Page 11: Current Concepts of Low Back Pain - Creighton … Concepts of Low Back Pain Terry L. Grindstaff, PhD, PT, ... Management • Mobility of ... Key Concepts • The number one](https://reader033.vdocuments.us/reader033/viewer/2022052516/5ab818e27f8b9ad3038c6e28/html5/thumbnails/11.jpg)
Function
• Coordinated, properly sequenced muscle activity increases spine stiffness/rigidity– Trunk Muscles: Spine– Rigging: Ship Mast
![Page 12: Current Concepts of Low Back Pain - Creighton … Concepts of Low Back Pain Terry L. Grindstaff, PhD, PT, ... Management • Mobility of ... Key Concepts • The number one](https://reader033.vdocuments.us/reader033/viewer/2022052516/5ab818e27f8b9ad3038c6e28/html5/thumbnails/12.jpg)
Low Back Pain• Lumbar Segmental Instability
![Page 13: Current Concepts of Low Back Pain - Creighton … Concepts of Low Back Pain Terry L. Grindstaff, PhD, PT, ... Management • Mobility of ... Key Concepts • The number one](https://reader033.vdocuments.us/reader033/viewer/2022052516/5ab818e27f8b9ad3038c6e28/html5/thumbnails/13.jpg)
Common Conditions• Degenerative disk disease• Lumbar spinal stenosis• Fractures• Herniated disk• Osteoarthritis• Osteoporosis• Tumors of the spine• Often not able to identify specific cause of pain
![Page 14: Current Concepts of Low Back Pain - Creighton … Concepts of Low Back Pain Terry L. Grindstaff, PhD, PT, ... Management • Mobility of ... Key Concepts • The number one](https://reader033.vdocuments.us/reader033/viewer/2022052516/5ab818e27f8b9ad3038c6e28/html5/thumbnails/14.jpg)
Low Back Pain
• Not all low back pain is the same– Treatment should be tailored to address
specific symptoms and condition• Identify contributing factors • Design treatment plan
![Page 15: Current Concepts of Low Back Pain - Creighton … Concepts of Low Back Pain Terry L. Grindstaff, PhD, PT, ... Management • Mobility of ... Key Concepts • The number one](https://reader033.vdocuments.us/reader033/viewer/2022052516/5ab818e27f8b9ad3038c6e28/html5/thumbnails/15.jpg)
Low Back Pain
• Difficult to identifying the involved anatomical structure (Abenhaim et al, 1995)
– 90% of patients do not have precise diagnosis• Treatment classifications
– Cluster of common signs and symptoms (Delitto et al, 1995; George and Delitto, 2005)
– Matched to treatment strategy
![Page 16: Current Concepts of Low Back Pain - Creighton … Concepts of Low Back Pain Terry L. Grindstaff, PhD, PT, ... Management • Mobility of ... Key Concepts • The number one](https://reader033.vdocuments.us/reader033/viewer/2022052516/5ab818e27f8b9ad3038c6e28/html5/thumbnails/16.jpg)
Long Term Effects
• Patients who received specific exercises experienced fewer recurrences of LBP than controls (Hides et al, 2001)
– Exercises focused on multifidus• Recurrence Rates
– Year 1: 30% vs 84%– Year 2: 35% vs 75%
![Page 17: Current Concepts of Low Back Pain - Creighton … Concepts of Low Back Pain Terry L. Grindstaff, PhD, PT, ... Management • Mobility of ... Key Concepts • The number one](https://reader033.vdocuments.us/reader033/viewer/2022052516/5ab818e27f8b9ad3038c6e28/html5/thumbnails/17.jpg)
Management• Mobility of joints and soft tissues
– Manual therapy, manipulation, flexibility• Strengthening and endurance
– Aerobic exercise• Education • Ergonomics
– Lifting, bending, sitting, and sleeping • Pain relief
– Ice, heat, electrical stimulation– Medications
![Page 18: Current Concepts of Low Back Pain - Creighton … Concepts of Low Back Pain Terry L. Grindstaff, PhD, PT, ... Management • Mobility of ... Key Concepts • The number one](https://reader033.vdocuments.us/reader033/viewer/2022052516/5ab818e27f8b9ad3038c6e28/html5/thumbnails/18.jpg)
Education and Prevention• Avoid
– End ranges of motion– Spine overload– Exacerbating activities– Prolonged sitting
• Promote– Proper posture– Muscle endurance– Physical activity
• Safe exercises and healthy alternatives– Proper lifting techniques
![Page 19: Current Concepts of Low Back Pain - Creighton … Concepts of Low Back Pain Terry L. Grindstaff, PhD, PT, ... Management • Mobility of ... Key Concepts • The number one](https://reader033.vdocuments.us/reader033/viewer/2022052516/5ab818e27f8b9ad3038c6e28/html5/thumbnails/19.jpg)
Desk Ergonomics
• Use upright chair with good support– Feet on floor
• Screen eye level• Mouse close to body• Take breaks
![Page 20: Current Concepts of Low Back Pain - Creighton … Concepts of Low Back Pain Terry L. Grindstaff, PhD, PT, ... Management • Mobility of ... Key Concepts • The number one](https://reader033.vdocuments.us/reader033/viewer/2022052516/5ab818e27f8b9ad3038c6e28/html5/thumbnails/20.jpg)
EXERCISE
![Page 21: Current Concepts of Low Back Pain - Creighton … Concepts of Low Back Pain Terry L. Grindstaff, PhD, PT, ... Management • Mobility of ... Key Concepts • The number one](https://reader033.vdocuments.us/reader033/viewer/2022052516/5ab818e27f8b9ad3038c6e28/html5/thumbnails/21.jpg)
Exercise Evidence
• Recent systematic review regarding exercise (Colle et al, 2002)
– Chronic > Acute
![Page 22: Current Concepts of Low Back Pain - Creighton … Concepts of Low Back Pain Terry L. Grindstaff, PhD, PT, ... Management • Mobility of ... Key Concepts • The number one](https://reader033.vdocuments.us/reader033/viewer/2022052516/5ab818e27f8b9ad3038c6e28/html5/thumbnails/22.jpg)
The Best Exercise?• Walking (Nutter, 1988)
– Produces low levels of passive tissue loading and prolonged activation of supporting musculature
– Fast walking with arm swing
![Page 23: Current Concepts of Low Back Pain - Creighton … Concepts of Low Back Pain Terry L. Grindstaff, PhD, PT, ... Management • Mobility of ... Key Concepts • The number one](https://reader033.vdocuments.us/reader033/viewer/2022052516/5ab818e27f8b9ad3038c6e28/html5/thumbnails/23.jpg)
Quadruped Arm/Leg Extension• ~27% MVC for spinal
extensors– Load is over 3000N
• Maintain neutral spine– Do not let back curve or
hyperextend– Dowel, ball, cup
![Page 24: Current Concepts of Low Back Pain - Creighton … Concepts of Low Back Pain Terry L. Grindstaff, PhD, PT, ... Management • Mobility of ... Key Concepts • The number one](https://reader033.vdocuments.us/reader033/viewer/2022052516/5ab818e27f8b9ad3038c6e28/html5/thumbnails/24.jpg)
Side Bridge• Produces greatest
muscle activity – 54% MVC
• Low compressive loads – 2500 N
• Knee, hip, shoulder in straight line
![Page 25: Current Concepts of Low Back Pain - Creighton … Concepts of Low Back Pain Terry L. Grindstaff, PhD, PT, ... Management • Mobility of ... Key Concepts • The number one](https://reader033.vdocuments.us/reader033/viewer/2022052516/5ab818e27f8b9ad3038c6e28/html5/thumbnails/25.jpg)
Trunk Curl• Keep one leg straight and
one bent– Helps maintain neutral
curve of low back– Do not flatten low back to
floor• Lift shoulders from floor• Rotate at rib cage• Shoulders should not
come up any more than six inches
![Page 26: Current Concepts of Low Back Pain - Creighton … Concepts of Low Back Pain Terry L. Grindstaff, PhD, PT, ... Management • Mobility of ... Key Concepts • The number one](https://reader033.vdocuments.us/reader033/viewer/2022052516/5ab818e27f8b9ad3038c6e28/html5/thumbnails/26.jpg)
Bridging• Raise hips off of
ground• Maintain neutral spine• Do not hyperextend
back• Keep knees, hips,
and shoulder in straight line
![Page 27: Current Concepts of Low Back Pain - Creighton … Concepts of Low Back Pain Terry L. Grindstaff, PhD, PT, ... Management • Mobility of ... Key Concepts • The number one](https://reader033.vdocuments.us/reader033/viewer/2022052516/5ab818e27f8b9ad3038c6e28/html5/thumbnails/27.jpg)
Balance• Single Limb Stance
– Stand on one leg• Hold counter if needed
– 30 seconds– Progress to eyes
closed
![Page 28: Current Concepts of Low Back Pain - Creighton … Concepts of Low Back Pain Terry L. Grindstaff, PhD, PT, ... Management • Mobility of ... Key Concepts • The number one](https://reader033.vdocuments.us/reader033/viewer/2022052516/5ab818e27f8b9ad3038c6e28/html5/thumbnails/28.jpg)
General Exercise Progression• Slow Fast• Stable Unstable• Eyes Open Eyes
Closed• Normal Respiratory
Rate Elevated Respiratory Rate
![Page 29: Current Concepts of Low Back Pain - Creighton … Concepts of Low Back Pain Terry L. Grindstaff, PhD, PT, ... Management • Mobility of ... Key Concepts • The number one](https://reader033.vdocuments.us/reader033/viewer/2022052516/5ab818e27f8b9ad3038c6e28/html5/thumbnails/29.jpg)
Key Concepts• The number one predictor of future injury
is a previous injury• Most core stabilizing muscles are slow
twitch muscles– They respond better with pause of 3-5 sec at
end range of exercise motion– Maintain slight (10-30% max) abdominal
contraction (bracing) to provide optimal stability during all exercises
![Page 30: Current Concepts of Low Back Pain - Creighton … Concepts of Low Back Pain Terry L. Grindstaff, PhD, PT, ... Management • Mobility of ... Key Concepts • The number one](https://reader033.vdocuments.us/reader033/viewer/2022052516/5ab818e27f8b9ad3038c6e28/html5/thumbnails/30.jpg)
Key Concepts• Exercises should be performed multiple
times per week• Emphasis should be placed on proper
technique and development of endurance, not amount of weight lifted or strength gains
![Page 31: Current Concepts of Low Back Pain - Creighton … Concepts of Low Back Pain Terry L. Grindstaff, PhD, PT, ... Management • Mobility of ... Key Concepts • The number one](https://reader033.vdocuments.us/reader033/viewer/2022052516/5ab818e27f8b9ad3038c6e28/html5/thumbnails/31.jpg)
Resources
• Low Back Pain: Prevention and Management– http://www.moveforwardpt.com/SymptomsCo
nditionsDetail.aspx?cid=d0456c65-7906-4453-b334-d9780612bdd3
– http://www.moveforwardpt.com/asset.axd?id=7531c13f-9696-419a-9c72-6eddb3bea462