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Utilizing Clinical Practice Guidelines for Treatment of Low Back Pain: Summary
• U.S. Department of Health and Human Services (HHS): ○ Include balance training ○ Aerobic activities (moderate intensity) 3×/week for 30- to 45-min bouts ○ Also include muscle strengthening 2×/week Postoperative LBP Exercise: • Note: Weak evidence (C) • General exercise training • Surgeries in the literature search: ○ Lumbar discectomy ○ Spinal fusion ○ Decompressive surgery: ■ Laminectomy ■ Hemilaminectomy ■ Laminotomy Key Points for Exercise: • Many exercise training interventions potentially reduce pain and disability • Not possible to recommend any one type of exercise • No clear evidence of one exercise/approach when exercise protocols are directly compared • Progressive exercise training recommended in older adults with LBP to reduce pain and disability 2. MANUAL AND OTHER DIRECTED THERAPIES Thrust and nonthrust joint mobilization: Continuum of skilled passive movement applied at varying speeds and amplitudes within or at the end range of motion of a joint. Thrust procedures are those provided with low amplitude and high velocity. • Soft tissue mobilization : Skilled passive movement of soft tissue, including fascia, muscles, and ligaments, to reduce pain or improve range of motion. Techniques include myofascial release, trigger point therapy, strain/counterstrain, and so on • Massage : Techniques using the hands to promote relaxation of underlying muscle • Dry needling : Intervention that uses a thin filiform needle to penetrate the skin and stimulate underlying myofascial trigger points and muscular and connective tissues for the management of pain and movement impairments • Traction : Intervention that uses manually or mechanically applied forces with the intention of
EXERCISE TERMINOLOGY TABLE Term Definition Trunk muscle
To restore or improve the strength, endurance, or power of trunk muscles or muscle groups To target specific deep trunk muscles (e.g., transversus abdominis, multifidus) using co-contraction to alter or restore control or coordination of the lumbopelvic region • To alter, restore, or retrain control of functional movements and tasks, with feedback on movement patterns ○ Movement control
strengthening and endurance exercise
Specific trunk muscle activation exercises
Movement control exercise
exercises often involve activation of weak trunk musculature and inhibition of overactive muscles
to restore efficiency and coordination and include functional movements/ tasks General exercise To restore or improve overall
strength or endurance of the major muscle groups of the upper/lower extremities and trunk, including exercises for flexibility/mobility and aerobic/ conditioning exercises direction to achieve a reduction of symptoms
Trunk mobility exercise
Aerobic exercise To restore or enhance the capacity or efficiency of the cardiovascular system Multimodal exercise Combines two or more of the interventions described previously
stretching and distracting the spine: ○ Meta-analysis by Vanti et al. (2021): ■ Mechanical traction to treat lumbar radiculopathy
■ Effective short term for pain and disability ■ Long-term effectiveness not conclusive ○ Meta-analysis by Cheng et al. (2019): ■ Mechanical traction compared to sham or no traction ■ Subjects diagnosed with lumbar disc herniation
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