Management

• Triage:

  • MUST ASK ANYONE WITH ANY BACK PAIN THE SPECIFIC QUESTIONS
  • ask general red flag questions as well
• SINS:

  • if high severity and irritability do less, put pts in positions of ease, low amplitude
  • if low severity and irritability get the pts moving, do more, hih amplitude, can stretch pts in positions of pain
• Pain mechanism:

  • nociceptive - pain only comes on in positions of aggs, goes away when eased
  • neuropathic - more irritable
  • nociplastic - high amount of pain in intermittent pattern so need to get pts moving
• Diagnosis:

  • is it specific or non specific?
  • it is only specific when its a certain/obvious pathology (e.g. radiculopathy or stenosis) in clear pattern
• IF YOU DO MANUAL THERAPY IN YOUR EXAM YOU MUST JUSTIFY IT - PAIN GAIT THEORY ETC
• How to treat a joint:

  • simply move the joint e.g. if they have limited lumbar flexion, put them in lumbar flexion
  • passive accessory movement
• Outcome measure:

  • compare tests before and after
  • VAS score
  • functional tests/capability
  • questionnaires
  • etc