|

 
 |





  



ë

  











 





 
 

!
 "  

|
#
 
 Aims and objectives
( By the end of this intensive 2 days course, students
should be able to understand and demonstrate:
( 1: Improve knowledge of applied surface Anatomy
and applied biomechanics of the lumbar spine.
( 2: Improve comprehensive lumbar spine
Assessment and treatment skills.
( 3: Identification of the contraindications/precautions
to treatment.
( 4: Improve Clinical Reasoning Skills for low back
pain management.
( 5: Understand current theories and concepts in low
back pain management.
ëumbar Spine Anatomy/ Surface
Anatomy (S Akhter / M Khan)

( ëumbar spine

( Palpation Points

( Group Practice
Subjective Assessment (S Akhter / M Khan)

( PC: Main problem.

( HPC: when, how and how it has been treated. ?
Investigations. Previous treatments. (Doctors and
physiotherapy).
( PMH: DM, BP, Breathing problems, fractures,
osteoporosis, Tommy operations etc.
( DH: Anticoagulants, steroids plus all other medication.
( SH: Work, family and how much back pain impact on
ADë or work.
( Expectations from physio: what pt expect is it realistic.
( Sport/Hobbies: life style active or sedentary ? Need
education.
( Does pain affect sporting activities
Subjective Assessment (S Akhter / M Khan)

( $%&#'(

( How many pains (P1, P2, P3 etc) ? Radiating.

( If more than one pain: Does these have relation like one pain come of
before other.
( Type: Constant or intermittent, Deep or superficial, achy, burning, stabbing ,
cramping.
( Aggravating factors like Walking, sitting and standing or any activity ?
Sporting.
( Easing factors: like heat and pain killers and any activity like postural relief.
( 24 hour pattern: morning pain and stiffness ease off as the day progress ?
Arthritis.
( Night pain: Is it affect sleep ? How many times wake up from sleep.
( Irritability and nature: How long it take to go away neural pains are highly
irritable.
( Any pins and needles or parasthesia: Constant or intermittent ? Dermatomal
reference.
Subjective Assessment (S Akhter / M Khan)

( Practical Session / Group Practice

( Group 1: 55 yrs old male. ëabour, 2 weeks

history of back pain radiating to left leg.

( Group 2: 39 yrs old female. Work in

clothes store. 6 months history of ëBP. No
radiation.
*bjective Assessment (S Akhter / M Khan)

(  
  

( 
)*%
( 
)*%
(   )
(  
(   
( *+ ,
( 
 #
*bjective Assessment (S Akhter / M Khan)

( Ë


-

( Ë



Treatment Technique A (S Akhter / M Khan)

( 
 #
( 
 .  Ë'/Ë''/Ë'''/Ë'0Ë0
( Ë'
( Small amplitude movement at the beginning range of motion
( Used for pain control and spasm limit movements early in R*M
( Ë''
( ëarge amplitude movement at the midrange of joint play
( Used for pain control, spasm, reduction which inhibit movement
( Ë'''
( ëarge amplitude movement at the end-range of joint play
( Reduce Stiffness
( Ë'0
( Small amplitude movement at the end-range of joint play
( Reduce stiffness
( Ë0
( Manipulation of high velocity and low amplitude to the anatomical end point of a joint
Grade 1, Grade 2, Grade 2, Grade 4
(S Akhter / M Khan)
 Exercise Therapy (S Akhter / M Khan)

( Usually 2 types of exercises in the literature.

( General exercises like Walking, cycling, running,
swimming and aerobic exercises.
( Core stability Exercises.
( Both types of exercises are equally effective.
( Manual therapy with exercise therapy is more
effective than manual therapy or exercise
therapy alone.
 C*RE STABIëITY EXERCISES (S Akhter / M Khan)

Practical
 CYRIAX 3 CNINICAë M*DEëS
Clinical model 1
History:
Central or unilateral pain (not referred below knee.
Gradual onset
Patient can not recall exact mode and time of onset.
Precipitated by period of prolong flexion e.g. sitting.
Examination:
Pain side flexion toward pain full side
No neurological signs.
Treatment:
Sub acute level of pain
Mechanical traction is treatment of choice provided no contraindications.
Try Manipulation may or may not work.
 CYRIAX 3 CNINICAë M*DEëS
Clinical model 2
History:
Central or unilateral pain (not referred below knee.
Sudden onset
Patient can recall exact mode and time of onset.
Examination:
Pain side flexion away from pain full side
No neurological signs.
Treatment:
Sub acute level of pain
Manipulation is treatment of choice provided no contraindications.
 CYRIAX 3 CNINICAë M*DEëS
Clinical model 3
History:
Central or unilateral pain back or buttock pain.
Posteriolateral disc lesion with gradual onset leg pain.
Sudden or gradual onset.
History of increasing, worsening episodes.
Patient may or may not recall exact mode and time of onset.
Parasthesia present.
Examination:
Root signs may be present i.e. sensory changes, muscle weakness, absent or
reduced reflexes, consistent with nerve root involvement.
Treatment:
Pain relief.
Careful manipulation if neurological signs are minimal or stable and no
contraindications.
Traction.
 C*NTRA INDICATI*NS T* MANIPUëATI*N

( General:
( Absence or withdrawal of patient consent.
( Anticoagulant therapy blood clotting disorders.
( Inflammatory arthritis.
( ëong term steroids.
( *steoporosis
( Upper motor neuron lesions, e.g spinal cord
compression, past CVA,TIA.
( Hyper acute pain.
( Recent trauma suspected fracture or major soft
tissue damage.
( Serious pathology past history of tumour.
(
 C*NTRA INDICATI*NS T* MANIPUëATI*N

ëumber spine:
( Cauda equine syndrome (S4 symptoms and
signs, bladder and bowel dysfunction).
( Bilateral sciatica, bilateral SëR limitation,
bilateral neurological signs.
( Severe progressive neurological signs.
( Spinal stenosis.
( First presentation under 20y or 50 yrs.
( Children and adolescents.
( Pregnancy.
( Psychological component (yellow flags).
 PRACTICAë 3 TREATMENT TECHNIQUES

1-DISTRACTI*N TECHNIQUE

2- PEëVIS R*TATI*N F*RWARD.

3-PEëVIS R*TATI*N BACKWARD.

Questions Time/ *pen session
(S Akhter / M Khan)

( Questions