Fran Pulver, MD - PM&R Laurie Bell, PT - Physical Therapy Steven Severyn, MD, MBA, MSS Anesthesia Gregg Weidner, MD - Anesthesia

Transcription

1 Fran Pulver, MD - PM&R Laurie Bell, PT - Physical Therapy Steven Severyn, MD, MBA, MSS Anesthesia Gregg Weidner, MD - Anesthesia

2 Case Presentation-Lumbar Sprain/Strain Patient is 42 years old Had sudden low back pain with lifting boxes Pain is sharp and localized to the back. It is made worse with movement and not different with sitting or standing. There is only sharp stabbing, back pain, 5/10. No numbness or tingling or weakness Exam-normal except for tenderness in low back and some pain with movement

3 Lumbar sprain/strain Most common cause of acute low back pain Sprains and strains imply stretching or tearing of the tissue involved, either muscles (strain) or ligaments (sprain). Result from overuse or an acute injury Present with focal back pain with restricted motion. PULVER

4 Lumbar sprain/strain The pain of less severe lumbar sprains and strains typically lasts about 5 to 10 days. 90% of lumbar sprain/strains resolve regardless of kind of treatment in 6-12 weeks. If symptoms do not improve within this period of time, consider other diagnosis ICD lumbar sprain, 846 lumbosacral sprain PULVER

5 Low Back Pain: Physical Therapy Perspective Laurie Bell, PT Patient education Exercise/Modalities Length of treatment BELL

6 Lumbar Sprain: patient education Provide assurance to patients and advise them to remain active Avoid bed rest as a means of pain control Activity modification as needed Teach safe body mechanics Continue working if possible BELL

7 Lumbar Sprain: therapeutic exercise/modalities Ice if acute x 1-3 days Then heat if preferred: superficial heat,deep heat, ultra sound Electric stimulation to lessen pain and/or decrease muscle spasm BELL

8 Lumbar Sprain: length of treatment Assess for directional preference Stretching to improve ROM and muscle flexibility Core strengthening to improve spinal stability Functional exercise to return patient to all normal activities Length of treatment: average 6-10 visits BELL

9 Medications for Treatment of Lumbosacral Strain Steven A. Severyn, MD, MBA, MSS

10 Low Back Pain: Acute, Sub-acute, Chronic Pain, muscle tension, or stiffness with or without leg pain Acute: Sub-acute: Chronic: < 6 weeks 6 weeks to 3 months > 3 months Chronic condition occurs in 5-10% of patients with low back pain but is associated with majority of health care expense and socioeconomic costs SEVERYN

11 Lumbar Strain Muscles Rotatores lumborum longus/brevis muscles (segmental) Interspinalis lumborum muscles (segmental) Intertransversarius muscles (segmental) Multifidus Erector spinae Quadratus lumbotum Fascia Thoracolumbar (anterior, middle, and posterior layers) Ligaments Zygoapophyseal (facet) joint capsules (segmental) Interspinous (segmental) Supraspinous Iliolumbar Sacroiliac (partially segmental) Sarotuberous Sacrococcygeal (lateral and posterior) SEVERYN

12 SEVERYN

13 SEVERYN

14 Medications Acetaminophen NSAID Muscle relaxant Methocarbamol (Robaxin) Cyclobenzaprine (Flexeril) Tizanidine (Zanaflex) Metaxalone (Skelaxin) Carisoprodol (Soma) Tramadol (Ultram) Tricyclic antidepressant Nortriptyline (Pamelor) Amitriptyline (Elavil) SEVERYN

15 Medications Neuromodulators Gabapentin (Neurontin) Pregabalin (Lyrica) Corticosteroid (5 day course of oral medication) Narcotic analgesics (7-10 day course) Hydrocodone/APAP (Vicodin, Lortab, Norco) Oxycodone/APAP (Percocet) Local anesthetic injection Local steroid injection SEVERYN

16 Multi-modal Treatment Physical therapy (active, passive) Behaviorial therapy Massage Spinal manipulation Traction Accupuncture Prevention (conditioning) SEVERYN

17 Sprains and Strains Medical Management NSAIDS Muscle relaxants Anti-Convulsants Analgesics Topical Agents TENS Modalities WEIDNER

18 Sprains and Strains Interventional Techniques Ethyl Chloride or VapoCoolant Sprays Lidoderm Patches Trigger Point injections Acupuncture/ Dry Needling Joint Injections WEIDNER

19 Discussion and Questions