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  1. #1
    chaitanyamohansuri
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    treatment protocol for LBA (Low Back Ache)

    Must have Kinesiology Taping DVD
    can u all suggest me a treatment protocol for low back ache without sciatica and with sciatica

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    Acute Pain

    Defined as onset within 0-6 weeks
    90% of patients with low back pain
    Only 10-20% can be given precise patho-anatomical diagnosis

    Chronic Pain

    Pain with onset > 3 months
    5% of patients with low back pain
    85% of costs due to loss of work and compensation
    50% have clear structural diagnosis made for cause of their back pain

    A brief outline of treatment will be as under:

    Acute LBP

    Bed rest
    functional in 6.6 days compared to 11.8 days for those kept ambulatory 1
    2 days of bedrest are as effective as 7 days and results in 45% less time away from work 2
    more beneficial in Wikipedia reference-linkradiculopathy
    Analgesics
    Muscle relaxants: controversial
    Aerobic exercise
    Weight loss
    Stop smoking

    Chronic LBP

    Back exercises
    Williams/flexion exercises: better tolerated
    Extension exercises: may be more efficacious
    Physical Therapy
    Ultrasound
    Diathermy
    TENS
    Exercise instruction
    Traction
    Bracing- controversial, not clearly efficacious, may weaken back/abdominal musculature
    Facet injection: probably not effective
    Epidural Steroid Injection for radiculopathy
    controversial
    66% with sx < 6 months show improvement
    33% with sx > 12 months show improvement
    Narcotics in chronic LBP are best avoided
    Antidepressants in low doses may be beneficial

    Important neurologic deficits (ie. foot drop) best treated surgically
    Long-term functional outcome unaffected if surgery delayed up to 12 weeks


    Surgery:
    Indications

    Progressive or severe neurologic deficit
    Persistent neuromotor deficit despite 4-6 weeks conservative therapy
    Persistent radiculopathy, sensory deficit or reflex loss after 4-6 weeks
    conservative therapy with +SLR, consistent clinical findings and favorable
    psychosocial circumstances (no depression, substance abuse or
    somatization disorder)


    Outcome


    Acute LBP

    Resolution of pain (without sciatica) in 6 weeks with nonspecific treatment in 75-90%
    60% will have a recurrence within one year

    > 50% with sciatica recover in 6 weeks

    Chronic LBP:

    Successful rehabilitation (%) vs. length of symptoms

    Summary Points

    Back pain seen in up to 90% of population
    Only 20-50% of cases have a clear patho-anatomic etiology identified
    75-90% of those with acute back pain will have resolution of pain within 6 weeks
    Know the "red flags"

    Weight loss
    fever
    age > 50
    Adenopathy
    History of cancer, TB, IV drug abuse
    Neurological symptoms
    uni/bilateral
    urinary retention
    saddle anesthesia
    Writhing in pain
    (visceral/vascular)
    Unrelenting pain at rest
    (infection/ malignancy)


  3. #3
    chaitanyamohansuri
    Guest

    re

    thank sir for the benificial information.
    i would like to know the intensities as well as the duration for each modality u mentioned earlier. if not thn can u let me know the criteion for selecting the modalities coz giving all modalities will not b fine.


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    Re: treatment protocol for LBA (Low Back Ache)

    if patient is with radiating LBA u should go for neural mobilization


  5. #5
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    Re: treatment protocol for LBA (Low Back Ache)

    Hi sdkashif,

    you mention 50% of chronic back pain have a structural diagnosis to explain their pain..what is the source for this statistic?

    As for the OP, physiotherapy is not a receipe profession. Conduct your assessment and make a diagnosis. Treat the problems you find, not just the symptoms that are reported.

    Also, If your patient takes longer than 6 weeks to get better, it is more likely that they got better on their own (natural recovery).

    Lastly, there are seemingly god manual therapy courses in India that are VERY cheap - 3000 rupees is ~150USD i think for a 2 or 3 day course. That is good value. If they do what they say and teach you MT, then it is worth the money.



 

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