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How to manage: Physiotherapy Non-operative and Post-operative BACK REHABILITATION.

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Presentation on theme: "How to manage: Physiotherapy Non-operative and Post-operative BACK REHABILITATION."— Presentation transcript:

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2 How to manage: Physiotherapy Non-operative and Post-operative BACK REHABILITATION

3 REHABILITATION PRINCIPLE Assess any Abnormality and treat to correct the Abnormality

4 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

5 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

6 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

7 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

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

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

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

11 CORE STABILITY Transversus Abdominis

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

13 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

14 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

15 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

16 STABILISATION EXERCISES Isometric Abdominals in Supine

17 STABILISATION EXERCISES Side Lying + Gluteus Medius

18 STABILISATION EXERCISES Supine Bridge

19 STABILISATION EXERCISES Abdominal Curl

20 STABILISATION EXERCISES 4 Point Kneel

21 STABILISATION EXERCISES Prone Plank

22 STABILISATION EXERCISES Side Plank

23 STABILISATION EXERCISES Standing Lunges

24 STABILISATION EXERCISES Step ups

25 STABILISATION EXERCISES Gym Ball Seated

26 STABILISATION EXERCISES Balance Disc

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

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

29 POST-OPERATIVE DISCHARGE DISCECTOMY : DAY 0-1 LAMINECTOMY : DAY 1-3 FUSION : DAY 3/4

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

31 6 WEEK POST-OPERATIVE REVIEW OSWESTRY PROGRESSIVE BACK CARE INVOLVE GYM / WORKPLACE SELF MANAGED PLAN

32 CONDITIONING NON-OP AND POST-OP GENERAL AEROBIC FITNESS POSTURAL CORRECTION MINUTE PERIODS WEIGHT LOSS POSITIVE RATHER THAN PURELY CLINICAL SETTING NORMALISE SETTING : TAI CHI, PILATES, YOGA, GYM CLASSES, SWIM FOCUS ON SELF MANAGEMENT

33 MULTI MODAL ROLE UNDERSTANDING RELATIONSHIP EARLY ACTIVITY EARLY EXERCISE EARLY MOBILITY MANAGEMENT ROLE SHIFT ONUS OF RESPONSIBILITY SELF MANAGEMENT


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