7/18/2019 Athletic Low Back Pain v2

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DISCLAIMER: This handout is meant to be used as a general guide only. If you have specic questions, please discuss them with your provider.

Athletic Low Back Pain OverviewTHREE CATAGORIES OF BACK PAIN

FLEXIONDiagnostic Tool Reset ReloadMedical Management Reinforce Discharge Focus

• MRI • Rest in acute phase,unload spine,consider corset,avoid sitting andexion orientedactivities

• Multifdus taping

• MSF quality focus  TPDN  - LM, RF, posterior chain

- Breathing• Local motor control

training• LM Emphasis

• SLD symmetry• YBT/FMS

• NSAID• Steriod Dose Pack• Consider 1-2 day

complete rest• Referral for epidural

injection

• Lifts• SLD symmetry• TGU symmetry

EXTENSIONDiagnostic Tool Reset ReloadMedical Management Reinforce Discharge Focus

• MRI

• CT post brace period

• Activity modifcation

avoiding loaded weighttraining (squats) andquad dominate activities

• Avoid stomach sleepingand prolonged standing

• Hip and Thoracic

extension Focus:• TPDN  - abdominals

- RF- Iilacus- Psoas

  - Latissimus- Thoracic spine

  - Breathing  - Control of HTS• Local motor control

training TrA focus

• Lunge symmetry

• YBT/FMS

• Rest/brace if acute

lesion with goal of fullhealing. Obtain CT scanat 8 weeks

• To tolerance if chroniclesion

• NSAID are notrecommended as theyimpede bone regeneration

• Can inject anestheticnext to pars (no steroid)and/or consider facetinjection

• Healing is goal in acutelesion with much higher

rate seen in unilateral

• Flexion progression

focus• Chops• TGU symmetry• Maintain exion rolling to

manage HTS

SIJDDiagnostic Tool Reset ReloadMedical Management Reinforce Discharge Focus

• Rule out extension lesionand + test cluster

• 3/5 provocative tests  - Distraction  - Thigh thrust  - Gaenslen  - Sacral thrust

  - Compression

• Avoid excessivereciprocal movements

• Consider SI Belt

• SIJ mobilization• TPDN  - Soleus (possible referral)  - Abdominals  - QL, TFL, LM• Local motor control;

focus on TrA/PF

• YBT/FMS• Consider SIJ injection(must be underuoroscopy)

• Flexion progressionfocus on symmetry;

 Chops, TGU and carefulprogression to SLD andlunges

LUMBAR SPINE: ATHLETIC LOW BACK PAIN: Kyle Kiesel, PT, PhD, ATC, Todd Arnold, MD