LSS management

• Management of LSS:

  • triage for red flags
  • stage and SIN
  • neurogenic claudication of LSS is usually high pain so high severity and moderate to high irritability
  • pts history can determine mechanism of pain
  • LSS that refers to lower limb will generally be neuropathic pain, especially if we have clear signs of neurogenic claudication
  • pts could have positive neuro symptoms (hyperactivity of the NS) such as radicular pain such as sharp shooting, burning pain with paraesthesia
  • could have negative neuro symptoms (hypoactivity of NS) such as loss of sensation and muscle power - showing radiculopathy

  
• Management of LSS:

  • Primary Hypothesis: Stenosis (?bilateral symptoms)
  • Secondary Hypothesis/differentials: Spondylosis / OA, rule out CES and other sinister pathologies, with or without radicular pain or radiculopathy
  • pain can be managed by altering activities and spacing out their activities, so that they can do more
  • educate patients about the progressive nature
• Problem List - Pain:

  • Suggested techniques: manual therapy techniques such as PAVIMS / SNAGS, Radicular, Easing positions, Pacing
• Problem List - Stiffness:

  • manual therapy into resistance, stretching, ROM exes, active exercises
• Problem List - Muscle weakness / Balance / Gait Disturbances:

  • Consider if peripheral muscle weakness is secondary to radiculopathy or just from disuse
  • Suggested techniques:
  • Consider manual therapy techniques to offload nerve / nerve root if appropriate - if its from radiculopathy
  • Stretching addressing muscle imbalances - if its from disuse
  • Balance / Gait Re-Education
  • Monitor
• Problem List - Low Muscle Endurance:

  • Build muscle endurance
• Problem List - Return to work / function / sport:

  • Gradually build capacity, strength and return to function