New Hampshire Musculoskeletal Institute Fall Conference September 10 th, 2016 Slide 1. Slide 2. Slide 3

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1 Slide 1 A Functionally Applied Collaborative Approach to Evaluation and Treatment of the Lumbar Spine Slide 2 Slide 3

2 Slide 4 Slide 5 Slide 6

3 Slide 7 Slide 8 Slide 9

4 Slide 10 Reliability of a treatment-based classification system for subgrouping people with low back pain. Slide 11 Slide 12

5 Slide 13 Slide 14 The Optimum Spine Spine (Phila Pa 1976) Jul-Aug;11(6): Gracovetsky S, Farfan H Slide 15 The Hip Bone is Connected to the Foot Bone...: The hip to foot relationship in energy transfer and conservation. By Erl Pettman, MCSP, MCPA, FCAMT.

6 Slide 16 Slide 17 Slide 18

7 Slide 19 Slide 20 Slide 21

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9 Slide 25 s/ Slide 26 Slide 27

10 Slide 28 Slide 29 Slide 30

11 Slide 31 Slide 32 Slide 33

12 Slide 34 Slide 35 Slide 36

13 Slide 37 Recent research states there needs to be refinement in the stabilization and mobilization category, but agreement is improving. (2003 vs. 2013) Slide 38 Slide 39 McGill (2002)

14 Slide 40 Fritz JM Hebert JJ Spine J. Koppenhaver SL Teyhen DS Walker BF Slide 41 Slide 42

15 Slide 43 Slide 44 Once you have back pain, you will ALWAYS have back pain. Slide 45

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23 Slide 67 Slide 68 Slide 69 Acta Obstet Gynecol Scand.

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28 References 1. Allbrook D. 1957, Movements of the lumbar spinal column. J Bone Joint Surg Br. May;39 B(2): Binkley, J., et al. (1995). "Interrater reliability of lumbar accessory motion mobility testing." Phys Ther 75(9): ; discussion Blumenfeld, H. (2011). Neuroanatomy Through Clinical Cases, Second Edition, Sinauer Associates, Inc. 4. Bogduk, N. (1997). Clinical anatomy of the lumbar spine and sacrum. New York, Churchill Livingstone. 5. Boden SD et al. Abnormal magnetic resonance scans of the lumbar spine in asymptomatic subjects: A prospective investigation. J Bone Joint Surg Am 1990; 72A: Boswell, M. V., et al. (2005). "Interventional techniques in the management of chronic spinal pain: evidence based practice guidelines." Pain physician 8(1): Boyling, J. D., et al. (1994). Grieve's modern manual therapy : the vertebral column. Edinburgh ; New York, Churchill Livingstone. 8. Breum, Reliability and concurrent validity of the BROM II for measuring lumbar mobility; J Manipulative Physiol Ther.1995 Oct;18(8): Brinckmann, P. (1986). "Injury of the annulus fibrosus and disc protrusions. An in vitro investigation on human lumbar discs." Spine (Phila Pa 1976) 11(2): Buckwaler, Henry and Alan AAOS Instructional Course Lectures, Volume Articular Cartilage and Osteoarthritis. 11. Bullock Saxton JE1, Janda V, Bullock MI; The influence of ankle sprain injury on muscle activation during hip extension. Int J Sports Med Aug;15(6): Butler, D. S. and M. A. Jones (1991). Mobilisation of the nervous system. Melbourne; New York, Churchill Livingstone. 13. Charlin, B., et al. (2007). "Scripts and clinical reasoning." Med Educ 41(12): Cleland, J. (2007). Orthopaedic Clinical Examination: An Evidence Based Approach for Physical Therapists. Philadelphia, PA, Saunders Elsevier. 15. Cook C, H., E (2012). Orthopedic Physical Examination Tests: An Evidence Based Approach, Prentice Hall. 16. Cook, C., et al. (2005). "Subjective and objective descriptors of clinical lumbar spine instability: A Delphi study." ManTher. 17. Crock, H. V., et al. (1988). Vascular anatomy related to the intervertebral disc. Boca Raton, CRC Press. 18. Croft, P. R., et al. (1998). "Outcome of low back pain in general practice: a prospective study." BMJ 316(7141): Cyriax, J. H. (1982). Textbook of orthopaedic medicine: volume 1 Diagnosis of soft tissue Lesions. London,, Bailliáere, Tindall & Cassell. 20. Damen, L., et al. (2002). "The prognostic value of asymmetric laxity of the sacroiliac joints in pregnancy related pelvic pain." Spine (Phila Pa 1976) 27(24): Delitto, A., et al. (1995). "A Treatment Based Classification Approach to Low Back Syndrome: Identifying and Staging Patients for Conservative Treatment." Physical Therapy 75(6): Denis, F. (1983). "The three column spine and its significance in the classification of acute thoracolumbar spinal injuries." Spine (Phila Pa 1976) 8(8): Deyo, R. A., et al. (2009). "Overtreating chronic back pain: time to back off?" J Am Board Fam Med 22(1): Deyo, R. A. and S. K. Mirza (2009). "The case for restraint in spinal surgery: does quality management have a role to play?" Eur Spine J 18 Suppl 3: Di Iorio, D., et al. (2000). "A survey of primary care physician practice patterns and adherence to acute low back problem guidelines." Arch Fam Med 9(10): Downey, B. J., et al. (1999). "Manipulative physiotherapists can reliably palpate nominated lumbar spinal levels." Man Ther 4(3):

29 27. Dreyfuss, P., et al. (1996). "The value of medical history and physical examination in diagnosing sacroiliac joint pain." Spine (Phila Pa 1976) 21(22): Dutton, J. A., et al. (2000). "SPECT in the management of patients with back pain and spondylolysis." Clin Nucl Med 25(2): Farfan, H. F. and S. Gracovetsky (1984). "The nature of instability." Spine 9(7): Ferreira, P. H., et al. (2013). "The therapeutic alliance between clinicians and patients predicts outcome in chronic low back pain." Phys Ther 93(4): Feuerstein, M., et al. (2004). "National trends in non operative care for nonspecific back pain." Spine J 4(1): Flynn, T. W., et al. (2002). "A Clinical Predication Rule for Classifying Patients with Low Back Pain Who Demonstrate Short Term Improvement with Spinal Manipulation." Spine 27(24): Fortin, JD. Falco, FJ. The Fortin finger test: an indicator of sacroiliac pain. Am J Orthop 26: Fritz, J. M., et al. (2005). "Lumbar spine segmental mobility assessment: an examination of validity for determining intervention strategies in patients with low back pain." Arch Phys Med Rehabil 86(9): Fritz, J. M., et al. (2007). "Subgrouping patients with low back pain: evolution of a classification approach to physical therapy." J Orthop Sports Phys Ther 37(6): Fukui, S., et al. (1997). "Distribution of referred pain from the lumbar zygapophyseal joints and dorsal rami." Clin J Pain 13(4): Fukui, S. and S. Nosaka (2002). "Pain patterns originating from the sacroiliac joints." J Anesth 16(3): Gawande, A. The checklist manifesto: how to get things right New York : Metropolitan Books, Ghosh, P. (1988). The Biology of the intervertebral disc, CRC Press. 40. Goodman, C. C. and T. E. K. Snyder (2000). Differential diagnosis in physical therapy. Philadelphia, Saunders. 41. Goodman, C. C., et al. (2003). Pathology : implications for the physical therapist. Philadelphia, Saunders. 42. Gregersen, G. G. and D. B. Lucas (1967). "An in vivo study of the axial rotation of the human thoracolumbar spine." JBone Joint Surg Am 49(2): Hart, L. G., et al. (1995). "Physician office visits for low back pain: frequency, clinical evaluation, and treatment patterns from a US national survey." Spine 20: Hebert JJ1, Koppenhaver SL, Teyhen DS, Walker BF, Fritz JM. Increased reliability and validity of the MLT to assess lumbar multifidus function at the L4-5 level. Spine J Oct Hicks, G. E., et al. (2003). "Interrater reliability of clinical examination measures for identification of lumbar segmental instability." Arch Phys Med Rehabil 84(12): Hicks et al; Preliminary Development of a clinical prediction rule for determining which patients with LBP will respond to a stabilization exercise program. Arch Phys Med Rehab 2005;86; Hides J, Stokes M, Saide M, Jull G, Cooper D. Evidence of lumbar multifidus muscle wasting ipsilateral to symptomsin patients with acute/subacute low back pain. Spine 1994;19(2): Hodges, P. W. and C. A. Richardson (1996). "Inefficient muscular stabilization of the lumbar spine associated with low back pain. A motor control evaluation of transversus abdominis." Spine 21(22): Horneij, E., et al. (2002). "Clinical tests on impairment level related to low back pain: a study of test reliability." J Rehabil Med 34(4): Huijbregts, P. (2002). "Spinal Motion Palpation: A review of Reliability Studies." JMMT 10(1): Jackson, J. L. and R. Browning (2005). "Impact of national low back pain guidelines on clinical practice." South Med J 98(2): Jarvik, J. G., et al. (2003). "Rapid magnetic resonance imaging vs radiographs for patients with low back pain: a randomized controlled trial." JAMA 289(21):

30 53. Kalichman, L., et al. (2008). "Facet joint osteoarthritis and low back pain in the community based population." Spine (Phila Pa 1976) 33(23): Kapandji, I. A. (1974). The physiology of the joints: annotated diagrams of the mechanics of the human joints. Vol 3 The trunk and the vertebral column. Edinburgh, E. & S. Livingstone. 55. Keating, J. C., Jr., et al. (1990). "Interexaminer reliability of eight evaluative dimensions of lumbar segmental abnormality." J Manipulative Physiol Ther 13(8): Kendall, F., et al. (1993). Muscles Testing and Function. 4th Ed. with Posture and Pain. Baltimore, MD, Williams and Wilkins. 57. Kent, P. and J. L. Keating (2005). "Classification in nonspecific low back pain: what methods do primary care physicians currently use?" Spine 30(12): Kirkaldy Willis, W. H. and H. F. Farfan (1982). "Instability of the lumbar spine." Clin Orthop Relat Res(165): Kobayashi S1, Yoshizawa H, Yamada S.Pathology of lumbar nerve root compression. Part 1: Intraradicular inflammatory changes induced by mechanical compression. J Orthop Res Jan;22(1): Kobayashi, S., et al. (2007). "Motor neuron involvement in experimental lumbar nerve root compression: a light and electron microscopic study." Spine (Phila Pa 1976) 32(6): Korr, I. M. (1981). "The spinal cord as organizer of disease processes: IV. Axonal transport and neurotrophic function in relation to somatic dysfunction." J Am Osteopath Assoc 80(7): Laslett M, Aprill CN, McDonald B, Young SB. Diagnosis of sacroiliac joint pain: Validity of individual provocation tests and composites of tests. Man Ther 2005;10: Laslett, M. (2008). "Evidence based diagnosis and treatment of the painful sacroiliac joint." J Man Manip Ther 16(3): Leboeuf Yde, C., et al. (2002). "Motion palpation findings and self reported low back pain in a population based study sample." J Manipulative Physiol Ther 25(2): Lilius,G., Laasonen EM, Myllynen P, Harilainen A, Gronlund G, Lumbar facet joint syndrome, Helsinki university hospital, vol 71B, No. 4, August 1989, (Level of evidence: 1B) 66. Love, R. M. and R. R. Brodeur (1987). "Inter and intra examiner reliability of motion palpation for the thoracolumbar spine." J Manipulative Physiol Ther 10(1): Macedo et al; Predicting response to motor control exercises and graded activity for patients with low back pain: preplanned secondary analysis of a randomized controlled trial. Phys Ther. 2014; 94: Manchikanti L1, Pampati V, Boswell MV, Smith HS, Hirsch JA. Analysis of the growth of epidural injections and costs in the Medicare population: a comparative evaluation of 1997, 2002, and 2006 data. Pain Physician May-Jun;13(3): Maher, C. G., et al. (1998). "An investigation of the reliability and validity of posteroanterior spinal stiffness judgments made using a reference based protocol." Phys Ther 78(8): Maigne, J. Y., et al. (1996). "Results of sacroiliac joint double block and value of sacroiliac pain provocation tests in 54 patients with low back pain." Spine (Phila Pa 1976) 21(16): Maitland, G. D. and B. C. Edwards (1986). Vertebral manipulation. London ; Boston, Butterworths. 72. McGuirk, B., et al. (2001). "Safety, efficacy, and cost effectiveness of evidence based guidelines for the management of acute low back pain in primary care." Spine (Phila Pa 1976) 26(23): McKenzie, R. (1981). The lumbar spine. Mechanical Diagnosis and therapy. Waikanae, Spinal Productions. 74. McGill, Stuart Strength and Conditioning Journal: Core Training: Evidence Translating to Better Performance and Injury Prevention. June Volume 32 - Issue 3 - pp Meadows, J. T. S. (1999). Orthopedic differential diagnosis in physical therapy : a case study approach. New York, 76. Mooney, V. (2004). "Manual therapy and exercise therapy in patients with chronic low back pain: a randomized, controlled trial with 1 year follow up." Spine (Phila Pa 1976) 29(1): 107; author reply Nachemson, A. L. (1981). "Disc pressure measurements." Spine 6(1):

31 78. O'Sullivan, P. B. (2000). "Lumbar segmental 'instability': clinical presentation and specific stabilizing exercise management." Man Ther 5(1): Page, P. Assessment and Treatment of Muscle Imbalance: The Janda Approach (2010) 80. Panjabi, M. M., et al. (1984). "Effects of Disc Injury on Mechanical Behavior of the Human Spine." Spine 9(7): Paris, S. (1985). "Physical Signs of Instability." Spine 10(3). 82. Pearcy, M. J. and S. B. Tibrewal (1984). "Axial rotation and lateral bending in the normal lumbar spine measured by three dimensional radiography." Spine 9: Pettman, E. (2006). Manipulative Thrust Techniques. Abbotsford, BC, Aphema 84. Sahrmann, S. Diagnosis and Treatment of Movement Impairment Syndromes (2001) 85. Salter, R. B. (1994). "The physiologic basis of continuous passive motion for articular cartilage healing and regeneration." Hand Clin 10(2): Saur PM; Spine 1996; 21(11): Lumbar range of motion: reliability and validity of the inclinometer technique in the clinical measurement of trunk flexibility. 87. Schmidt, H. G. and R. M. Rikers (2007). "How expertise develops in medicine: knowledge encapsulation and illness script formation." Med Educ 41(12): Sherrington (1947) Integrative action of the nervous system 89. Shumway Cook (2001) Motor Control: Translating Research into Clinical Practice; LLW 90. Siemonsma, P. C., et al. (2013). "Cognitive treatment of illness perceptions in patients with chronic low back pain: a randomized controlled trial." Phys Ther 93(4): Standring, S. (2008). Gray's Anatomy, 40th Edition The Anatomical Basis of Clinical Practice, Churchill Livingstone. 92. Stankovic, R. and O. Johnell (1990). "Conservative treatment of acute low back pain. A prospective randomized trial: 93. McKenzie method of treatment versus patient education in "mini back school"." Spine 15(2): Stankovic, R. and O. Johnell (1995). "Conservative treatment of acute low back pain. A 5 year follow up study of two methods of treatment." Spine 20(4): Strender, L. E., et al. (1997). "Interexaminer reliability in physical examination of patients with low back pain." Spine (Phila Pa 1976) 22(7): Sugioka, T., et al. (2008). "Predictive value of self reported patient information for the identification of lumbar spinal stenosis." Fam Pract 25(4): Tanz, S. S. (1953). "Motion of the lumbar spine; a roentgenologic study." Am J Roentgenol Radium Ther Nucl Med 69(3): Tesh, K. M., et al. (1987). "The abdominal muscles and vertebral stability." Spine (Phila Pa 1976) 12(5): Twomey, L. T. and J. R. Taylor (2000). Physical therapy of the low back. New York, Churchill Livingstone 100. van der Wurff P, Hagmeijer RH, Meyne W. Clinical tests of the sacroiliac joint: A systematic methodological review.part 1: Reliability. Man Ther 2000;5: van Trijffel, E., et al. (2010). "The role and position of passive intervertebral motion assessment within clinical reasoning and decision making in manual physical therapy: a qualitative interview study." J Man Manip Ther 18(2): van Tulder, M. W., et al. (2004). "Quality of primary care guidelines for acute low back pain." Spine 29(17): E Virgin, W. J. (1951). "Experimental investigations into the physical properties of the intervertebral disc." J Bone Joint Surg (Br) 33B: Vleeming, A., et al. (1996). "The function of the long dorsal sacroiliac ligament: its implication for understanding low back pain." Spine (Phila Pa 1976) 21(5): Vollestad, N. K. (1997). "Measurement of human muscle fatigue." J Neurosci Methods 74(2): Waddell, G. (1987). "1987 Volvo award in clinical sciences. A new clinical model for the treatment of low back pain." Spine (Phila Pa 1976) 12(7): White, A. A. and M. M. Panjabi (1990). Clinical biomechanics of the spine. Philadelphia, Lippincott.

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