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

Fran Pulver, MD Fran Pulver, MD -

• PM&R

PM&R Laurie Bell, PT Laurie Bell, PT -

• Physical Therapy

Physical Therapy Steven Severyn, MD, MBA, MSS Steven Severyn, MD, MBA, MSS – – Anesthesia Anesthesia Gregg Weidner, MD Gregg Weidner, MD -

• Anesthesia

Anesthesia

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
• f 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

• Patient education
• Exercise/Modalities
• Length of treatment

BELL

Low Back Pain: Physical Therapy Perspective – Laurie Bell, PT

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