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( Optimal management depends on accurate diagnosis
( 3 distinct groups of LBP caused by :
( Red Flags ( < 2%) :
tumor, infections, fractures, serious medical disease
( Nerve Root Compression (<10%)
( Non Specific / Mechanical (85(85--90%)
( Psychosocial factors (yellow flags)
Fear Avoidance Behaviour & anxiety

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( ðntersegmental muscles:
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( Lumbar muscles:
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reduced ratio of
extenson - flexor strength & endurance
2.  : Poor balance control
3. 
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ROM Pain-Disability?
The quality of motion is more important
4. , (EMG) of back muscles decline
inchronic LBP
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( Active therapy for subacute & Chronic LBP

( Cognitive & Behavioral Approach
( Stabilization exercise
( Strengthening
( Motivation : to gradually resume normal activity
( Patient Reactivation :
Start from the acute to chronic phase is a fundamental
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3.Biochemical principles
( Pain & tissue healing are related to metabolic &
nutritional status
( Macrophages are in high concentration with disc
herniation

The recovery is dependent on diffusion for

its nutrition.
nutrition.
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4.Psychological principles
‡ Patients who worry & fear of their pain will have
chronic problem
‡ Fear/ stress increase muscle tension
exacerbate pain

 
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Early exercise increase satisfaction and function while
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controversial, Mc Kenzie
exercise is recommended for acute LBP.
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Early Behavioral Modification
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ðs a functional rehabilitation progam
 To restore lumbar function & movement
 To influence the behavioral pattern

Based on :
 The severity of pain & deconditioning
 Psychological profile
 Social needs
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ã Addressed to the motor control problems

ã ðmproving the mechanical supports
ý deep muscle contraction exercises
To relieve Pain
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( Coordination
( Mobility
( Muscle endurance exercise
( Stretching
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ù Exercise :
 The DBC device guide patients movement:
‡ Plane
‡ Targeted
‡ Controlled & physiologically correct patterns
ù Cognitive & behavioral support
ù Supporting elements : - relaxation & functional exercise
- psychological & work place intervention
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One course: 12 sessions
( 1st session: baseline evaluation

( 2nd ²11th session: - individual treatment

- progress check
- treatment in group
( 12th session: outcome evaluation

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( ðnflammatory
( Post
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( Post
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( Nerve root compression

( Narrowing of spinal canal

( Pelvic and low back pain

( Spondylolisthesis/ -lysis

( Non
Non--specific pain
 
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Whiplash--Associated
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( Non
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( Shoulder dislocation
( Shoulder instability

( ðmpingement and rotator cuff

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( AC separation

( Shoulder arthritis

( Frozen shoulder
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Average Average Average
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-Baseline (pain during last 6 wks) 55,2 52,6 54,2

-Outcome (pain during last 6 wks) 27,9 27,2 30,7

-Outcome (pain on outcome day) 20,8 21,0 22,2

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Average Average Average

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-Baseline (trouble during last 6 wks) 53,3 49,7 52,8

-Outcome (trouble during last 6 wks) 27,1 26,8 30,0

-Outcome (trouble on outcome day) 19,6 20,6 21,9

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( LBP ý Chronic Symptoms & Disability.
( Correlation specific performance of LBP patients. Reduced iso- iso-
kinetic strength, spinal motion, back musc
muscle fatigueability,
decrease endurance, delayed reaction time & poor balance
control.
( The main goal of treatment has shifted from treatment of pain to
treatment at activity intolerance to restore function.
( Active therapy involving such exercise, cognitive-
cognitive-behavioral
approach, stabilization & strengthening effective for sub-
sub-acute &
chronic LBP.
( With DBC treatment, pain & trouble/impairment are
significantly reduced in back, neck & shoulder problems