MDT
Terms
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Prevalence of LBP
- 50-80% of adult pop will have LBP at some point
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Natural Hx
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reoccurence, episodes and persistent symptoms are common
NH is quite variable
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Risk Factors
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1. Individual and lifestyle, Hx of LBP
2.Physical or biomech, heavy or frequent lifting,whole body vibration, prolonged and frequent bending or twisting, postural stresses
3.Psychosocial
- Lifestyle
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Poor sitting posture and frequent flexing
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Chemical Pain
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Constant
Recent Onset
Cardinal Signs, swelling,redness, heat, tenderness
Lasting aggravation of pain by all movements
No movement abolishes Pain
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Mechanic Pain
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Intermittant pain but,
Constant pain can be changed by certain repeated movements cause lasting reduction, abolition, or centralization.
Mechanical changes improve with the symptoms
- Chronic Pain
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not closely linked to mechanical factors or original tissue dammage
Response may take more time
May not happen at all
there could be psychosocial factors
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Repair Process
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Inflammation-0-5 days
Repair 1st few days for 3 weeks
Remodelling 3-4 weeks onwards
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Matching stage of the condition to management
Week 1-Injury & Inflammation-
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Protect from further damage
Prevent excessive inflam exudate
Reduce Swelling
mid-range movements, isometric contractions
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Matching stage of the condition to management
Weeks 2-4 Repair and Healing
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Gentle tension & loading without lasting Pain (produces pain but no worse after)
Progressive return to normal loads & tension
Pain (does it last, is it local)
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Matching stage of the condition to management
Weeks 5 and onward
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Prevent contractures
Full Range movements
Normal loading and tension to increase strength and flexibility
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Indications for MDT
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Nerve root problems
Mechanical back pain
-mostly aged 20-55
-lumbosacral region, buttocks and thighs
-mechanical nature, patient is generally well
- Contraindications for MDT
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Serious spinal pathology
cauda equina
Cancer, fractures, widespread neurological deficit
cord signs, infections
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Cauda equina
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Loss of anal sphincter tone
urinary retention or overflow incontience
saddle anaesthesia
sciatica
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Possible Ca
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age(>55)
Hx of Ca
unexplained wt. loss
constant,progressive, pain not effected by loading strategies, worse at rest
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Possible other serious spinal pathology
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systematically unwell
widespread neurology
hx of significant trauma
hx of trivial trauma with osteoporotic pts.
sudden and persistent extremes of pain causing pt to freeze
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Inflammatory disorders
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gradual onset
marked morning stiffness and persisting limiation of movements in all directions
peripheral joint involvement
Iritis, psoriasis, colitis
urethral d/c
family hx
- stenosis
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hx of leg symptoms when walking upright
sitting or leaning fwd abolishes pain
loss of ext
sustained extension causes P and relief on flex
age >50
nerve root signs and symptoms
extensive degenerative changes on x-r
- Hip
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exclusion of lumbar spine my mech evaluation
Pain inc with wt. bearing, eased by rest, or worse first few steps after rest
Pain pattern-groin, ant thigh, knee ant shin, lateral thigh, possibly buttock, positive pain provocation tests&
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Symptomatic SIJ
- exclusion of Lumbar spine and Hip