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dmshaw9
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Three Levels of Classification
- First Level: Is the patient appropriate for PT? (3 choices: PT only, consultation and PT, or referral)
- Second Level: What is the severity of the disability?
- Third Level: What syndrome is the patient?
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First Level Classification: Red Flags
- Potential Indicators of Serious Pathology:
- Cauda Equina
- Tumor
- Fracture
- Infection
- What to Look For:
- Pain precipitated by significant trauma
- Pain that worsens at night or that is not relieved by any position
- Bilateral radiculopathy
- Numbness or paresthesia in the perianal region
- Change in bladder/bowel function
- Unexplained significant lower limb weakness
- Progressive neurological deficit
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Cauda Equina Syndrome
- Requires immediate referral to physician
- Cauda equina: collection of intramural nerve roots beginning at the end of the SC
- Patient Presentation:
- Saddle paresthesia
- Severe radicular pain
- Severe or progressive neurological deficits (LE sensation, reflex, or strength loss)
- Alteration in bladder or bowel function
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Second Level Classification: Stage 1
- Stage 1: Acute
- Basic functions limited (i.e. sit, stand, walk)
- Oswestry range 40-60
- Treatment:
- Pain modulation
- Therex: flex, ext, lat shift
- Manipulation
- Traction
- Immobilization/stabilization
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Second Level Classification: Stage 2
- Stage 2: Sub-Acute
- Limited IADL's
- Oswestry 20-40
- Treatment = improve impairments (flexibility, strengthen, body mechanics, cardiovascular)
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Second Level Classification: Stage 3
- Stage 3: Chronic
- Limited ability to perform sustained activities
- Treatment: simulate work/recreational activity
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Stage 1 Syndromes
- Specific Exercise: Lateral Shift, Extension, Flexion
- Mobilization
- Traction
- Immobilization/Stabilization
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Specific Exercise: Lateral Shift
- History: sudden onset, severe pain
- Presentation: frontal plane deformity, sidebending asymmetrical, often neurological signs
- Treatment: shift correction --> extension syndrome
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Specific Exercise: Extension Synrome
- History: prefer standing and walking
- Presentation: neurological component, repeated extension --> centralize/improve, repeated flexion --> peripheralize/worsen
- Treatment: avoid flexion postures, extension exercises (McKenzie)
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Specific Exercise: Flexion Syndrome
- History: preference for sitting, worse w/ walking & standing
- Presentation: neurological component, repeated flexion --> centralize/improve, repeated extension --> peripheralize/worsen
- Treatment: flexion exercises, unloading techniques in extension
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Mobilization
- History: mild-moderate pain
- Presentation: symptoms localized to lumbar region (no radicular symptoms), NO change w/ repeated movement testing
- Treatment: limited ext --> ext mob, limited flex --> flex mob, SI mob
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Traction
- History: no positional preference
- Presentation: radicular symptoms, worse w/ repeated movement testing
- Treatment: 2 types of traction (mechanical and positional)
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Immobilization/Stabilization
- History: frequent episodes, pain w/ sustained posture
- Presentation: aberrant movement patterns, positive segmental stability test, greater SLR ROM
- Treatment: stabilization (avoid extreme ROM, stabilization exercises, external support, surgical management)
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