Spinal Stenosis

Clinical practice guidelines for the management of non‐specific low back pain in primary care: an updated overview clinical practice guidelines containing recommendations for non-specific LBP have been issued or updated since last overview in 2010.

Summary of Recommendations for neck intervention (Continued): NECK PAIN WITH HEADACHES Acute: - Clinicians should provide supervised instruction in active mobility exercise. - Clinicians may provide C1-2 self-sustained natural apophyseal glide (self-SNAG) exercise. Sub acute: - Clinicians should provide cervical manipulation and mobilization. - Clinicians may provide C1-2 self-SNAG exercise. Chronic: - Clinicians should provide cervical or cervicothoracic manipulation or mobilizations combined with shoulder girdle and neck stretching, strengthening, and endurance exercise. NECK PAIN WITH RADIATING PAIN Acute: - Clinicians may provide mobilizing and stabilizing exercises, laser, and short-term use of a cervical collar. Chronic: - Clinicians should provide mechanical intermittent cervical traction, combined with other interventions such as stretching and strengthening exercise plus cervical and thoracic mobilization/ manipulation. - Clinicians should provide education and counseling to encourage participation in occupational and exercise activities.

Summary of Recommendations for neck intervention (Continued): NECK PAIN WITH MOVEMENT COORDINATION IMPAIRMENTS (including whiplash-associated disorder [WAD]): Acute: - Clinicians should provide the following: • Education of the patient to Return to normal, non-provocative pre-accident activities as soon as possible. - Minimize use of a cervical collar. - Perform postural and mobility exercises to decrease pain and increase ROM. - Reassurance to the patient that recovery is expected to occur within the first 2 to 3 months. - Clinicians should provide a multimodal intervention approach including manual mobilization techniques plus exercise (eg, strengthening, endurance, flexibility, postural, coordination, aerobic, and functional exercises) for those patients expected to experience a moderate to slow recovery with persistent impairments. - Clinicians may provide the following for patients whose condition is perceived to be at low risk of progressing toward chronicity: • A single session consisting of early advice, exercise instruction, and education • A comprehensive exercise program (including strength and/or endurance with/without coordination exercises) • Transcutaneous electrical nerve stimulation (TENS) - Clinicians should monitor recovery status in an attempt to identify those patients experiencing delayed recovery who may need more intensive rehabilitation and an early pain education program. Chronic: - Clinicians may provide the following: • Patient education and advice focusing on assurance, encouragement, prognosis, and pain management. • Mobilization combined with an individualized, progressive submaximal exercise program including cervicothoracic strengthening, endurance, flexibility, and coordination, using principles of cognitive behavioral therapy. • TENS Read details of the guidelines: https://www. jospt.org/doi/full/10.2519/jospt.2017.0302