AUSTI N LEPPER & KERI ELLE WI LLI AMS

TOURO UNI VERSI TY NEVADA

Back Pain and
Spinal Disorders
What is Back Pain & Spinal Disorders?
Symptoms of a medical
condition, not a diagnosis
Possible medical conditions:
Mechanical
Injuries
Acquired conditions and
diseases
Infections and tumors
Stress , depression, anxiety,
and insomnia

Retrieved from: http://spine.osu.edu/content/about-us/motivation-mission
Medical Conditions
Mechanical
The way in which the spine moves or the way you feel
when you move your spine in specific ways
Ex. Intervertebral disc degeneration
Discs located between the vertebrae of the spine
begin to break down as age progresses
Wearing down of the facet joints
Ex. Spasms, muscle tension, ruptured discs (herniated
discs)

Medical Conditions
Injuries
Sprains
Twisting or lifting
improperly
Fractures
Osteoporosis
Accidents and falls

Retrieved from: http://www.lollylegs.com/injuries/hamstring_injuries.aspx
Medical Conditions
Acquired conditions and diseases
Scoliosis
Arthritis
Spondylolisthesis
Osteoarthritis
Rheumatoid arthritis
Spinal stenosis
Osteoporosis
Pregnancy
Kidney stones
Endometriosis
Firbromyalgia
Retrieved from: www.basicspine.com
Medical Conditions (less common)
Infections and tumors
Osteomyelitis
Cancer
Stress, depression,
anxiety, and insomnia
Role in severity of pain

Retrieved from: www.orthopediatrics.com
INTERVENTION
STRATEGY #1
Yoga
In 2004 the Centers for
Disease Control and
Prevention estimated that
up to 62% of U.S. adults had
used some form of
complimentary and
alternative medicine in the
previous year, including
yoga, most often to treat
problems such as back pain,
colds, neck problems, joint
stiffness and anxiety or
depression.
(Forbes, 2014)

Retrieved from: www.ventureyogastudio.com
Yoga

According to the AOTA, Occupational therapy
practitioners can show clients how to redirect their pain
so that it interferes less in their daily lives. Relaxation
and visualization activities cognitively redirect pain.
Because of chronic pain, clients are often physically
deconditioned, and the practitioner will work on gentle
exercises to increase clients strength and stamina. They
might also use such activities as self-hypnosis,
meditation, and yoga, all of which can be effective ways of
coping with pain.

(AOTA, 2013)

Domains of OTPF

Performance skills
Motor skills
Process skills
Areas of occupation
Leisure
Social participation
Client factors
Body functions
Retrieved from: http://sunyogaway.com/?page_id=27

Promotes health and wellness

yoga is about practicing with awareness of
physical sensations, breathing, emotions, and
thoughts from moment to moment with
unconditional acceptance. If yoga is practiced
regularly you will notice many benefits to your
physical and mental health. (University of
Missouri, 2014)
Increase your musculoskeletal flexibility,
strength, and balance
Increase relaxation and awareness

Prevention of disease and disability

Ex. Arthritis
Increase muscle strength
Improve flexibility
Promote balance
Increase energy
Decrease bodily aches and pain
Decrease negative feelings
Improve posture

Retrieved from: www.yogajournal.com
Quality of Life

Yoga increases quality of life and spinal flexibility better
than physical therapy exercises. (Wattamwar & Nadkarni,
2013)
Reduces stress
Deep breathing
Ease migraines
Sleep better
Increases endurance
Manage fatigue


Retrieved from: www.everydayhealth.com

Occupational Engagement

Aspects or techniques of yoga can be transferred over into
daily occupations
Rest and Sleep
Social participation
Leisure
Work



Retrieved from: http://www.huffingtonpost.com/2013/06/30/yoga-for-sleep_n_3505226.html
Details
What OT needs to
know to implement
Anatomical focus
Abdomen
Back
Neck
Therapeutic focus
Back pain
Anxiety
Fatigue
Osteoporosis


Yoga poses
Seated & twists
Standing
Core
Backbends
Arm balances
Forward bends
Inversions
Restorative
Meditation
Pranayama
Mudra & bandha

Details
Materials & Tools
Mat
Clothing
Towel
Blocks & straps
Power cords
No slip socks
Bolster
Water

http://www.gaiam.com/yoga-props-accessories/

Retrieved from: www.asia.ru
Details
Specific training or certification
Yoga certification
Registered Yoga Teacher (RYT) 200 yoga
alliance
200 hour training program
Must come from the same school and
multiple trainings cannot be
combined
Teaching hours are not required
https://www.yogaalliance.org/Creden
tialing/Credentials_for_Teachers

Retrieved from: www.yogaalliance.org

Practical Considerations
Context
Home
Community
Outdoors
Time
Typically 1 hour to 1.5 hours
Reimbursement
Self-pay
Billed as OT
Purposeful or preparatory
activity
Retrieved from: gebarbieri.wordpress.com

Training and Education
Client/caregiver involvement
Active therapeutic exercise
Listen to their body
Know their limitations
Videos and literature
Continue after discharge
Community classes
At home practice
Tools or education needed
Safety

Retrieved from: www.youngyogamaster.com
Precautions/Contradictions
Safe environment
Movement limitations
Knowing your bodys limits and listening to your body
Asthma
Back injury
Heart problems
Knee injury
Low blood pressure


Retrieved from: www.myyogaonline.com
Literature Review
Study 1- Effects of conventional occupational therapy
and yoga in chronic low back Pain
Conventional occupational therapy and yoga is more effective than
conventional occupational therapy alone by improving the back
extensor strength, spinal range of motion, and the social life of the
patient. (Wattamwar & Nadkarni, 2013)
Study 2- Therapy Students Recommendations of
Physical Activity for Managing Persistent Low Back
Pain in Older Adults
When a client does not have proper management, persistent pain is
disabling, which then reduces independence and overall quality of
life for older adults, therefore health care professionals should
promote a physically active lifestyle that includes remaining active in
work, participating in exercise and activities, and avoiding bed rest.
(Ryan, Schofield, & Martin 2013)
PEOP Model
Person
Client centered
Environment
Home
Lifestyle
Caregivers
Occupational
Performance
Abilities
Deficits


Additional Resources
Therapist
http://www.yogaot.com/
Therapeutic yoga workshops
Variety of treatments for different populations
http://www.yogajournal.com/poses/finder/browse_index
Client and Caregiver
Youtube.com
http://www.doyogawithme.com/
http://www.yogajournal.com/practice/home_practice


12 Yoga Poses for Back Pain
Retrieved from: www.healthxwellness.com
INTERVENTION
STRATEGY #2
Self-management of Physical Agent
Modalities (PAMs)

procedures and
interventions that are
systematically applied to
modify specific client factors
when neurological,
musculoskeletal, or skin
conditions are present that may
be limiting occupational
performance (AOTA, 2014,
S78)



Retrieved from: www.clinicalresources.com
Domains of OTPF

Client Factors
Body functions
Body structures
Performance
Skills
Motor skills
Process skills

Retrieved from: www.orthobalancept.com

Promotes Health and Wellness
Increases function
Prepares muscles for movement
while engaging clients
occupational performance
Pain management (acute or
chronic)
Less severe side effects than
medications
Pain relief during occupational-
based treatment



Retrieved from: www.everydayhealth.com

Prevention of Disease and Disability
Modulate or decrease pain
Modify tissue healing
Increase tissue extensibility
Modify skin and scar tissue
Decrease edema or inflammation
Increases circulation
Maintain or increases ROM
Decrease muscle spasms or spasticity
Prevent disuse atrophy
Strengthening

Quality of Life

Improves functional mobility
Clients can safely use PAMs at
home
Substitutes as an orthoses
PAMs do not cause sedation
Ex. Patients can safely drive while
receiving the benefits of PAMs
Retrieved from: www.everydayhealth.com


Occupational Engagement

PAMs should be used as an adjunctive measure in
preparation or in conjunction with functional
activities or occupations (AOTA, 2013)
Can be used concurrently during purposeful activity
or during occupational engagement
Support occupational performance while allowing
the client to engage in ADLs
Ex.
Fluidotherapy
Electrical stimulation- NMES

Details
What OTs need to know to implement
Types of modalities
Cryotherapy (cold packs, ice massage)
Paraffin baths
Moist hot packs
Fluidotherapy
Whirlpool
Contrast baths
Ultrasound
Electrical stimulation
Rationale behind each modality
Heat vs. cold
When NOT to use each modality

Retrieved from: www.ezultrasound.com
Details
Materials & Tools
Each PAM requires
different materials or
tools
Ex. Moist Hot Pack
Hot pack
Hydrocollator
Hot water
Towels
Hot pack sleeve
Fastener

Retrieved from: www.allergromedical.com
Details
Specific training or
certification
Physical Agent Modalities
Practitioner Credentialing
Agency (PAMPCA)
http://www.pampca.org/
Course fee of $595
12 learning modules plus
two-day workshop

Retrieved from: www.physiohealth.com

Practical Considerations
Context
Clinic
Home
Time
Varies depending on
which PAM
Typically around 10-15
min.
Reimbursement
Billed as a preparatory
activity
Depends on the insurance



Retrieved from: www.hometipsworld.com

Training and Education
Client/caregiver involvement
Understand rationale behind each modality
When a specific PAM should be used
When a specific PAM should NOT be used
Know the warning signs of when to stop the treatment
Continue after discontinuation
Home use
Tools or education needed
Safety and precautions


Retrieved from: www.gla-rehab.com
Precautions/Contradictions
Cardiac conditions
Pregnancy
Epilepsy
Malignancy
Peripheral vascular disease
Decreased sensation
Undiagnosed pain
Not over the carotid sinus
Varies depending on PAMs
Retrieved from: www.nailsmag.com
Literature Review
Study 3- The Challenge of
Chronic Low Back Pain
The combination of self-
management tools, such as
heat and ice massage, in
conjunction with the use of
modalities, such as
ultrasound and electrical
stimulation, help a client
manage their chronic lower
back pain.

Retrieved from: www.acefitness.org
Biomechanical Frame of Reference
Functional motion
Movement required to
perform occupations
ROM
Strength
Endurance
Retrieved from: www.medexaminer.net
Additional Resources
Therapist
Physical Agent Modalities:
Theory and Application
for the Occupational
Therapist
Client and caregiver
http://www.pinterest.com/gee
na68/crafts-hot-and-cold-
pack-ideas/
Retrieved from: www.amazon.com
References
American Occupational Therapy Association. (2014). Occupational therapy practice framework:
Domain and process (3rd ed.). American Journal of Occupational Therapy, 68(Suppl.
1), S1-S48. http://dx.doi.org/10.5014/ajot.2014.682006
Bracciano, A.G. (2000). Physical Agent Modalities: Theory and Application for
the Occupational Therapist. Thorofare, NJ: SLACK, Inc
Kennedy-Spaien, E. (2013). The Challenge of Chronic Low Back
Pain. Rehab Management: The Interdisciplinary Journal Of
Rehabilitation, 26(6), 46-51.
Ryan, C. G., Schofield, P., & Martin, D. J. (2013). Therapy Students'
Recommendations of Physical Activity for Managing Persistent Low
Back Pain in Older Adults. Journal Of Aging & Physical Activity, 21(3), 309-
318.
Wattamwar, R. B., & Nadkarni, K. (2013). Effect of conventional occupational therapy
and yoga in chronic low back Pain. Indian Journal Of Occupational
Therapy, 45(3), 13-20.
Van der Giessen, R. N., Speksnijder, C. M., & Helders, P. M. (2012). The effectiveness of
graded activity in patients with non-specific low-back pain: a systematic
review. Disability & Rehabilitation, 34(13), 1070-1076.