These are a few things I would do when my patients visit me with LBP.
Pain History
Where the pain was, what type of pain it was, any pins and needles (P+N), any numbness (N), intermittent/constant and the VAS.
Aggravating factors: Sitting, standing, driving, sports etc
Relieving factors: Meds, massage, rest etc
24 hours pattern: Better, same or worse
Interpretation:
Area = Reinforces my hypothesis of what needs to be treated
Dull ache = Muscular related
Sharp or shooting = Nerve related
P+N and/or N = Nerve related
Intermittent = Something is aggravating it
Constant = Rare and might be a red flag
VAS: Insights to my patient’s pain threshold and tolerance
Aggravating factors: Guides my HEP
Relieving factors: Guides my passive treatment, allows me to assume what my patient finds beneficial
24 hours pattern: AM better or PM worse – Fatigue
AM worse – Joint related or sleep related
Palpation
- to determine the patient’s sensitivity to pain/touch stimuli.
- I don’t check how “tight” their muscles are through palpation.
Interpretation:
Guides the amount of pressure I can apply on my patient during manual therapy
SFMA
I only concentrate on MSE, MSF and ODS for the lower back.
Interpretation:
Joint related, motor control dysfunction or true mobility issue.
Mostly motor control dysfunction
Interventions
Dull ache management: IASTM, STM, taping or any other electrotherapy modalities
Sharp, shooting, P+N and/or N management: Nerve mobilisation and/or IASTM/STM along the nerve pathway
24 hours pattern: PM worse – Resistance exercise, or pacing
AM worse – Change pillows/bed and some mobility exs in bed
MSE dysfunction can be treated with repeated extension in lying (REIL)/ Mckenzie exs.
MSF dysfunction can be managed with Active SLR with band assistance, sciatic nerve mobs or by activating the anterior chain.
ODS dysfunction can be improved with REIL, cat and camel exs, Lx manip, knee or ankle mobilisation.
Thanks for reading! Drop me a comment if you have any questions!
