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Back rehabilitation

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

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  1. Back rehabilitation How to manage: Physiotherapy Non-operative and Post-operative

  2. Rehabilitation Principle • Assess any Abnormality and treat to correct the Abnormality

  3. 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

  4. 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

  5. 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

  6. 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

  7. CORE STABILITY • MUSCULAR CONTROL TO MAINTAIN FUNCTIONAL STABILITY • MUSCULAR CORSET • STABILITY INVOLVES PASSIVE AND ACTIVE STIFFNESS • INSTABILITY WHEN EITHER COMPONENT DISTURBED

  8. CORE STABILITY • GLOBAL : DYNAMIC / PHASIC MUSCLES = ACTIVE TRUNK MOVEMENT • RECTUS ABDOMINIS • EXTERNAL OBLIQUES • ILIOCOSTALIS (THORACIC PART) • LATISSIMUS DORSI • LINK PELVIS TO THORACIC CAGE

  9. CORE STABILITY • LOCAL : POSTURAL / TONIC = INTERSEGMENTAL STABILITY • TRANSVERSUS ABDOMINIS • MULTIFIDIS • PSOAS MAJOR • QUADRATUS LUMBORUM • DIAPHRAGM • ILIOCOSTALIS ( LUMBAR SEGMENT) • INTERNAL OBLIQUE

  10. Core stability • Transversus Abdominis

  11. ASSESSING FUNCTIONAL CORE STABILITY • LUMBAR TORSION TEST • PRONE PLANK • SIDE PLANK • SEATED TORSO FLEXION • PRONE EXTENSOR ENDURANCE TEST • SINGLE LEG SQUAT

  12. 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

  13. 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

  14. 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

  15. Stabilisation exercises • Isometric Abdominals in Supine

  16. Stabilisation exercises • Side Lying + Gluteus Medius

  17. Stabilisation exercises • Supine Bridge

  18. Stabilisation exercises • Abdominal Curl

  19. Stabilisation exercises • 4 Point Kneel

  20. Stabilisation exercises • Prone Plank

  21. Stabilisation exercises • Side Plank

  22. Stabilisation exercises • Standing Lunges

  23. Stabilisation exercises • Step ups

  24. Stabilisation exercises • Gym Ball Seated

  25. STABILISATION EXERCISES • Balance Disc

  26. POST OPERATIVE REHABILITATION • UNDERSTANDING THE SURGERY • REALISTIC GOALS / TIMELINES • PAIN CONTROL • EARLY EXERCISE • EARLY MOBILITY • DISCHARGE WITH REHABILITATION PACKAGE

  27. POST-OPERATIVE EXERCISE • NEUTRAL SPINE • INTERSEGMENTAL STABILITY REGIME • GLOBAL ABDO WORK • ADDRESS SPECIFIC WEAKNESS • MOBILISE DAY 0 OR 1 • AVOID NEURAL STRETCH

  28. POST-OPERATIVE DISCHARGE • DISCECTOMY : DAY 0-1 • LAMINECTOMY : DAY 1-3 • FUSION : DAY 3/4

  29. EARLY POST-OPERATIVE REVIEW • WOUND REVIEW • PAIN ISSUES • ACTIVITY LEVEL • EXERCISE UPGRADE • STABILITY • GYM, BALL, POOL, CARDIO INCREASE

  30. 6 WEEK POST-OPERATIVE REVIEW • OSWESTRY • PROGRESSIVE BACK CARE • INVOLVE GYM / WORKPLACE • SELF MANAGED PLAN

  31. 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

  32. MULTI MODAL ROLE • UNDERSTANDING • RELATIONSHIP • EARLY ACTIVITY • EARLY EXERCISE • EARLY MOBILITY • MANAGEMENT ROLE • SHIFT ONUS OF RESPONSIBILITY • SELF MANAGEMENT

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