Fran Pulver, MD - - PM&R PM&R Fran Pulver, MD Laurie - PowerPoint PPT Presentation

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

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

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

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-9 847.2 lumbar sprain, 846 lumbosacral sprain PULVER

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

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

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

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

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

Low Back Pain: Acute, Sub-acute, Chronic  Pain, muscle tension, or stiffness with or without leg pain  Acute: < 6 weeks  Sub-acute: 6 weeks to 3 months  Chronic: > 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

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

SEVERYN

SEVERYN

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

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

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

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

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

Discussion and Questions