Low Back Pain: Goal Setting and Treatment Plan

Pain & Injury on February 11th, 2011 No Comments

The first step in treating low back pain (LBP) is to determine if the client has been given a specific diagnosis, this should be based upon both a thorough physical examination and  specialized diagnostic testing. The important thing here is to make sure that a serious disease entity has been ruled out and not the cause or mimicker of the (LBP). A common diagnosis often given to clients is called Non-specific (LBP) meaning there is no identified anatomical reason for your back pain. It is then important to conduct a comprehensive health history, postural assessment and range of motion evaluation to determine the mechanisms of injury, contributing factors and functional limitations. Health history, palpation examination, pain scale scores, and (LBP) disability indexes can help identify the level of severity, stage of inflammation and impact on the clients quality of life.  There are three recognized levels of (LBP): Acute, Recurrent and Chronic. The level of severity and stage of inflammation will direct and dictate the treatment techniques selection with the following goals in mind:

1)   Decrease swelling and inflammation

2)   Decrease muscle spasm, muscle contracture and muscle adaptation

3)   Decrease passive and active pain

4)   Restore range of motion and overall function

5)   Reduce scar tissue formation and help realign scar tissue

6)   Decrease depression, anxiety and somatization

7)   Improve core strength and muscle endurance

8) Correct postural dysfunction

Acute (LBP) treatment would include Lymphatic Drainage opening the main lymphatic ducts and lymph nodes then draining the low back region into the inguinal lymph nodes. Strain Counterstrain can be applied to the Quadratus Lumborum, Psoas, Iliacus, Erector Spinae, and the Gluteal muscles. Gentle circulatory massage can be applied to the entire back, gluteal muscles and hamstrings.

Recurrent (LBP) treatment would include Myofascial Release to the entire back, gluteal muscles, hamstrings and Iliopsoas. Cross fiber friction can be applied to the Erector Spinae, Quadratus Lumborum, Multifidi, Gluteals and Hamstrings. Strain Counterstrain can be applied to the Iliacus and Psoas.

Chronic (LBP) treatment would include Trigger Point Release Techniques, Cyriax Cross Fiber Friction and Post Isometric Relaxation directed at the Erector Spinae, Quadratus Lumborum, Gluteals, Hamstrings, Iliopsoas and Multifidi. In addition Cyriax Cross Fiber Friction can be applied to the following ligaments – Iliolumbar, Sacroiliac and Sacrotuberous.

The interesting aspect about setting goals and designing a treatment plan is that none of this really matters if you don’t know how to accurately locate and palpate all of these muscles and ligaments.

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