Hierin vind u het uitgewerkte BOK van casus 1, alleen het onderdeel ''lage rugpijn''. Alle bijbehorende theorie en praktijk zijn samengevoegd (kleine 330 pagina's).
Jaar 2 – Periode 7
Lage rugpijn (a)specifiek – Casus 1
Jolijn Brummelkamp
Auteur: Jolijn Brummelkamp
Plaats: Haarlem
Datum: Periode 7
Fysiotherapie, Hogeschool Leiden
Lage rugpijn (a)specifiek – Casus 1 Jolijn Brummelkamp
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Lage rugpijn (a)specifiek – Casus 1 Jolijn Brummelkamp
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Inhoudsopgave
INHOUDSOPGAVE ........................................................................................................................ 3
ANATOMIE BIJ DE LAGE RUG (A)SPECIFIEK ................................................................................... 7
ANATOMIE LAGE RUG, ANATOMIE VAN DE LUMBALE REGIO EN DE TLO ........................................................ 13
ANATOMIE VAN DE ONDERRUGSPIEREN .................................................................................................. 17
PATHOLOGIE BIJ LAGE RUGPIJN (A)SPECIFIEK ............................................................................. 19
INCIDENTIE/ PREVALENTIE VAN RUGPIJN ................................................................................................. 20
ISCHIALGIE ........................................................................................................................................ 22
LUMBOSACRAAL RADICULAIR SYNDROOM (LSRS) ..................................................................................... 23
POSTOPERATIEF LUMBOSACRAAL RADICULAIR SYNDROOM ......................................................................... 29
KANAALSTENOSE ................................................................................................................................ 31
POSTOPERATIEF KANAALSTENOSE .......................................................................................................... 35
RECESSUS LATERALIS SYNDROOM .......................................................................................................... 36
FACETGEWRICHTARTROSE / SPONDYLARTROSE ........................................................................................ 37
M BECHTEREW ................................................................................................................................... 39
ARTRITIDEN (=MEERVOUD ARTITIS) ....................................................................................................... 44
(SPONDYLO)DISCITIS ........................................................................................................................... 48
SCOLIOSE .......................................................................................................................................... 50
SPONDYLOSE (OF SPONDYLARTROSE) ..................................................................................................... 58
SPONDYLOLISTHESIS ............................................................................................................................ 62
M.PIRIFORMISSYNDROOM .................................................................................................................... 67
LUMBALE INSTABILITEIT / LAGE RUG INSTABILITEIT ................................................................................... 69
ZWANGERSCHAP GERELATEERDE BEKKENPIJN........................................................................................... 71
SACRO-ILIACAAL GEWRICHT (SI-KLACHTEN) ............................................................................................. 75
DISCOGENE RUGKLACHTEN ................................................................................................................... 77
TRAUMATA ....................................................................................................................................... 79
DTF EN SCREENING LAGE RUGPIJN (A)SPECIFIEK ......................................................................... 80
RICHTLIJN HC1.2 ............................................................................................................................... 81
RODE VLAGGEN .................................................................................................................................. 82
Lage rugpijn ............................................................................................................................................................ 82
Rode vlaggen: enkel-voet, knie, bekken-heup, pols-hand, elleboog, thoracale wervelkolom, thorax, schouder,
nek: ......................................................................................................................................................................... 83
Rode vlaggen regio lage rug ................................................................................................................................... 83
Rode vlaggen tijdens de zwangerschap .................................................................................................................. 84
Rode vlaggen na de bevalling ................................................................................................................................. 84
COMMUNICATIE MET ANDERE ZORGVERLENERS ....................................................................................... 86
IN KAART BRENGEN GEZONDHEIDSPROBLEEM BIJ LAGE RUGPIJN (A)SPECIFIEK .......................... 87
PATHOLOGIE...................................................................................................................................... 88
ANAMNESE, OOK GERICHT OP ARBEID .................................................................................................... 88
Normale anamnese ................................................................................................................................................ 88
Anamnese volgens de richtlijn lage rugklachten .................................................................................................... 89
Anamnese gericht op arbeid .................................................................................................................................. 90
PIJNANALYSE (BIJ CHRONISCHE PIJN) ...................................................................................................... 91
LICHAMELIJK ONDERZOEK..................................................................................................................... 92
VT 1.6 – Onderzoek (lumbale) wervelkolom .............................................................................. 92
Inspectie van functies (lumbale flexie in stand) ..................................................................................................... 95
Teweegbrengen van een articulaire beweging ...................................................................................................... 96
Testen van de volgende reflexen: ........................................................................................................................ 102
Lage rugpijn (a)specifiek – Casus 1 Jolijn Brummelkamp
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Testen van pijn- en tastzin (Dermatomen) ........................................................................................................... 103
Testen van spierkracht ......................................................................................................................................... 104
Testen van zenuwlengten (specifieke testen) ...................................................................................................... 107
Testen van druk- of compressiepijn (specifieke testen) ....................................................................................... 108
Slump test (specifieke testen) .............................................................................................................................. 108
Testen en meten van musculaire (actieve) stabiliteit .......................................................................................... 109
VT 2.6 – Therapie bekken en klachten SI-gewricht .................................................................. 114
De cluster van der Wurff ...................................................................................................................................... 115
De cluster van Laslett ........................................................................................................................................... 121
Mobiliteitstesten .................................................................................................................................................. 122
De Active Straight Leg Raise ................................................................................................................................. 123
IN KAART BRENGEN VAN BELEMMERENDE FACTOREN VOOR HERSTEL BIJ LAGE RUGPIJN ......... 124
ANALYSE ......................................................................................................................................... 125
PERSOON EN PERSOONSFACTOREN IN RELATIE TOT LAGE RUGPIJN ............................................................. 125
PROGNOSTISCHE EN RISICOFACTOREN BIJ LAGE RUGPIJN .......................................................................... 125
PATIËNTPROFIELEN ........................................................................................................................... 126
AAN ARBEID GERELATEERDE PERSOONSFACTOREN .................................................................................. 128
Persoonsfactoren ................................................................................................................................................. 128
Zo zijn er ook Aan arbeid gerelateerde persoonsfactoren ................................................................................... 128
VT 3.4 – Anamnese gericht op arbeid en persoonsfactoren (periode 6) .................................. 129
ARBEIDSOMSTANDIGHEDEN (MODEL VAN DIJK, VIER A’S) ........................................................................ 135
Model van Van Dijk .............................................................................................................................................. 135
Saltsa-rapport ....................................................................................................................................................... 139
Saltsa EN model van Dijk ...................................................................................................................................... 144
FUNCTIE BEDRIJFSGENEESKUNDIGE ...................................................................................................... 148
ARBEIDSFYSIOTHERAPIE ..................................................................................................................... 148
COPING .......................................................................................................................................... 149
INTERN VS. EXTERN ATTRIBUEREN ........................................................................................................ 151
STRESS EN AROUSAL .......................................................................................................................... 152
SENSITISATIE .................................................................................................................................... 156
NEUROFYSIOLOGIE............................................................................................................................ 157
VERMIJDINGSLEREN .......................................................................................................................... 164
BEWEGINGSANGST ........................................................................................................................... 164
OPERANTE CONDITIONERING .............................................................................................................. 165
GEVOLGENMODEL ............................................................................................................................ 167
SOMATISATIE ................................................................................................................................... 168
CATASTROFEREN .............................................................................................................................. 168
ZIEKTEPERCEPTIES ............................................................................................................................. 169
COMMON SENSE MODEL (CSM) OF SELF-REGULATION VAN LEVENTHAL ................................................... 169
INFORMEREN/ADVISEREN LAGE RUGPIJN, POSTOPERATIEF LUMBOSACRAAL RADICULAIR
SYNDROOM EN ZWANGERSCHAP .............................................................................................. 170
PROGNOSE ...................................................................................................................................... 171
ALGEHELE BELASTBAARHEID ............................................................................................................... 171
PREVENTIE VAN LAGE RUGPIJN ............................................................................................................ 171
ADEQUAAT BEGELEIDEN: ADVISEREN M.B.T. HOUDING EN BEWEGING ........................................................ 172
Fysieke belasting .................................................................................................................................................. 173
Tillen ..................................................................................................................................................................... 173
Dragen .................................................................................................................................................................. 174
Duwen .................................................................................................................................................................. 175
Trekken ................................................................................................................................................................. 175
Trillen en schokken ............................................................................................................................................... 176
Statische werkhoudingen: Lang staan / zitten in dezelfde houding ..................................................................... 177
Repeterende bewegingen .................................................................................................................................... 178
Lage rugpijn (a)specifiek – Casus 1 Jolijn Brummelkamp
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THERAPIE BIJ LAGE RUGPIJN, POSTOPERATIEF LUMBOSACRAAL RADICULAIR SYNDROOM EN
ZWANGERSCHAP ....................................................................................................................... 180
THERAPIE BIJ RUGPIJN + OEFENEN EN STUREN ....................................................................................... 181
VT 2.5 – Therapie Specifieke lage rugpijn ................................................................................ 181
Verbeteren van de segmentale beweeglijkheid van de (lumbale) wervelkolom ................................................. 183
Houdings- en bewegingsadviezen en oefeningen ................................................................................................ 184
McKenzie protocol................................................................................................................................................ 185
Verbeteren mobiliteit zenuwweefsel (neurodynamica)....................................................................................... 187
Verbeteren van de spierlengte/spiertonus van de musculatuur onderste extremiteit ....................................... 188
Verbeteren spierfunctie buikspieren (dwars en schuine) en rugspieren ............................................................. 201
Handhaven houding evt. met hulpmiddelen (stabilizer) ...................................................................................... 206
STABILISERENDE OEFENINGEN LAGE RUG ............................................................................................... 207
MOTOR CONTROL IMPAIRMENT (MCI) ................................................................................................ 212
Motor control therapie ........................................................................................................................................ 213
GEBRUIK STABILIZER .......................................................................................................................... 214
Handleiding Stabilizer ........................................................................................................................................... 214
GRADED ACTIVITY BIJ LRP .................................................................................................................. 218
ALTERNATIEVE BEWEGINGSSTRATEGIEEN .............................................................................................. 224
BEHANDELDOELEN (SMART, MET BEHULP VAN KLINIMETRIE) .................................................................. 224
ZELFMANAGEMENT BIJ LAGE RUGPIJN .................................................................................................. 224
ONDERBOUWING EFFECTIVITEIT INTERVENTIES....................................................................................... 224
ERGONOMISCH RUG GEBRUIK, WERKHOUDING FYSIOTHERAPEUT .............................................................. 224
BIOMECHANICA VAN HET TILLEN EN ZITTEN ........................................................................................... 225
TIL- EN ZITINSTRUCTIE, ADL INSTRUCTIE GEBRUIK LAGE RUG .................................................................... 225
VERGROTEN ALGEHELE BELASTBAARHEID .............................................................................................. 226
MASSAGE THERAPIE .......................................................................................................................... 227
Intermitterend drukken ........................................................................................................................................ 229
Huidtechnieken .................................................................................................................................................... 230
Effleurages ............................................................................................................................................................ 231
Pétrissages ............................................................................................................................................................ 232
ALTERNATIEVE THERAPIEËN BIJ LAGE RUGPIJN (MINDFULLNESS, YOGA, PILATES) .......................................... 233
Mindfullness ......................................................................................................................................................... 233
Yoga ...................................................................................................................................................................... 234
Pilates ................................................................................................................................................................... 235
Yoga en Pilates ..................................................................................................................................................... 236
THERAPIE BIJ ZWANGERSCHAP ............................................................................................................ 237
VT 2.6 – Therapie bekken en klachten SI-gewricht .................................................................. 237
Pijnverlichting door mobilisatie (nutatie en contra-nutatie) ................................................................................ 238
Abnormaal persen afleren .................................................................................................................................... 240
Stabilisatie- en coördinatie training ..................................................................................................................... 248
Opbouwen belastbaarheid en Conditietraining ................................................................................................... 254
SPB LESSEN................................................................................................................................ 273
SPB 1.7 – DIAGNOSTIEK BIJ EEN PATIËNT MET LAGE RUGPIJN ................................................................... 273
Diagnostisch proces lage rugklachten ..................................................................................... 273
Lage rugpijn (a)specifiek – Casus 1 Jolijn Brummelkamp
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De screening + Anamnese .................................................................................................................................... 273
Diagnostische testen ............................................................................................................................................ 274
SPB 2.7 – FYSIOTHERAPIE BIJ EEN PATIËNT MET POSTOPERATIEF LUMBOSACRAAL RADICULAIR SYNDROOM ...... 278
Diagnostisch proces ................................................................................................................. 281
Opening: ............................................................................................................................................................... 281
Onderzoek (duurt max 5 minuten): ...................................................................................................................... 282
Evalueren:............................................................................................................................................................. 282
Therapeutisch proces ............................................................................................................... 283
Behandelplan: ...................................................................................................................................................... 283
Behandeling:......................................................................................................................................................... 284
Afronding .............................................................................................................................................................. 285
RICHTLIJN LAGE RUG ................................................................................................................. 286
DFT: .............................................................................................................................................. 287
DIAGNOSTISCH PROCES: .................................................................................................................... 287
THERAPEUTISCH PROCES: ................................................................................................................... 289
STOPPEN MET BEHANDELING: ............................................................................................................. 290
RICHTLIJN ZWANGERSCHAP GERELATEERDE BEKKENPIJN .......................................................... 291
DFT: .............................................................................................................................................. 292
DIAGNOSTISCH PROCES: .................................................................................................................... 293
THERAPEUTISCH PROCES .................................................................................................................... 294
CGO – CASUS 1 .......................................................................................................................... 295
BOEK: ONDERZOEK VAN HET BEWEGINGSAPPARAAT – H12 DE LUMBOSACRALE WERVELKOLOM
.................................................................................................................................................. 303
12.5.1 Specifieke rugaandoeningen ........................................................................................ 312
12.5.2 Aspecifieke lage-rugklachten ....................................................................................... 317
HERNIA ..................................................................................................................................... 323
HET ONTSTAAN VAN EEN HERNIA EN DE VERSCHILLENDE FASES à DISCUSHERNIA ........................................ 323
DIAGNOSTISCH PROCES HERNIA ........................................................................................................... 324
RICHTLIJN IN HET ALGEMEEN: ................................................................................................... 325
Lage rugpijn (a)specifiek – Casus 1 Jolijn Brummelkamp
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Anatomie bij de lage rug (a)specifiek
Anatomie lage rug, Anatomie van de lumbale regio en de TLO
Anatomie van de onderrugspieren
Bewegingsrichtingen van de wervelkolom:
• Cervicale wervelkolom
o Flexie (kin op de borst) à sagitaal vlak, transversaal/frontale as.
o Extensie à sagitaal vlak, transversaal/frontale as.
o Lateroflexie (links, rechts, zwaaien à in frontale vlak, sagitale as)
o Laterorotatie (links/rechts, nee schudden àin transversale/frontale vlak,
longituninale as)
o Knikken (test voor C0-C1-C2)
• Thoracale en lumbale wervelkolom
o Flexie (met vingers de grond proberen te raken)
o Extensie (let op compensatie van flexie in knie en heup)
o Lateroflexie (hand laten afglijden aan de laterale kant van het been)
o Rotatie (zittend testen)
Atlanto-occipital joint (C0-C1): 5 /10 / 5
Atlanto-axial joint complex (C1-C2) 5/10 40-45 /
Intracervicale region (C2-C7) 35 /70 45 35
Os occipitalis à achterhoofd waar de eerste wervel aan vast zit.
Beweeglijkheid van thoracaal is minder door de ribben en de booggewrichten
Lage rugpijn (a)specifiek – Casus 1 Jolijn Brummelkamp
Lumbale wervelkolom:
§ goede ventraal/dorsaalflexie
§ geringe tot redelijke lateroflexie
§ nauwelijks tot geen rotatie
Algemene aspecten:
§ Hoogte = Wervels + tussenwervelschijven
Zorgt voor stabiliteit en beweeglijkheid
o Tussenwervelschijven bestaan vooral uit water à
hierdoor worden mensen in de loop der jaren steeds
kleiner, water hoeveelheid neemt af
§ Algemene bouw wervel >>>>>>>>>>>>>>
o Lumbaal cortalis
o Thoracaal transversus
o 4 gewrichtsuitsteksels proc.articularis à 2 superior en 2 inferior
§ Bestaat uit functionele eenheden
Functionele eenheid bevat intervertebraal gewricht:
§ = tussenwervelschijf + booggewrichten + ligamenten
§ Bewegingsmogelijkheden:
o Flexie/extensie
o Lateroflexie
o Axiale rotatie
§ Elke bewegingsmogelijkheid gaat gepaard met gekoppelde bewegingen
§ Discus
o Beperkte vervorming door belasting
o Buitenste ringà annulus fibrosis à collageen bindweefsel,
verdeelt de krachten gelijkmatig
o Binnenste ring à nucleus pulposus à losse vezels soort gel
(gelei-achtig), werkt ADL als schokdemper en houdt de 2
wervels gescheiden.
Ø De nucleus pulposus wordt omgeven door de annulus fibrosus
§ Corpus
o Foramen intervertebrae
o Proc. Spinosus
o Facetgewrichten (art. Zygapophysialis OF booggewricht)
§ Proc. Articularis superior/inferior
§ facetgewrichten: zijn synoviale gewrichten tussen de processus articularis
superiores en inferiors van twee opeenvolgende wervels. Zorgen voor beweging
tussen de wervels.
§ Remming beweging door ligamenten
Varieert per functionele eenheid
Lage rugpijn (a)specifiek – Casus 1 Jolijn Brummelkamp
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