Burns and Lower Back Pain: Assessment, Recovery, and Treatment
BURNS
Assessment/Classification: Classified according to depth and size of the burn; 1st degree (superficial) &
2nd degree (partial-thickness/burn top 2 layers)-2 to 3 weeks healing time;3rd degree (full-thickness/plus
fatty tissue above muscle) & 4t degree (skin/fat/muscle/bone); slow healing, produce severe scarring, loss
of normal range of motion; patients hand=1% body coverage
Types/causes: Thermal burns-most common type of burns caused by fire, hot liquids, or a hot surface;
chemical burns-direct contact with strong acids, alkaline agents, gases, or other chemicals; Freeze
injuries-frostbite, propane, and freon; Radiation burns-large doses cause damage; Electrical burns-little
external damage, causes extensive internal damage, can continue from point of contact, can continue to
cause damage after the fact; Inalation injury-injury to the respiratory tract caused by smoke inhalation and
carbon monoxide toxicity. Can lead to brain injury or death; 1st&2nd-thermal sources such as hot liquids
or radiation (sunburn); 3rd&4th-fire, flame, or electrical
Adjustment: 85% return to former activities within 6 months; 15% require extensive intermittent
reconstructive or cosmetic surgery for a period of about 2 years
Recovery: skin grafts can be taken from healthy skin of individual; skin is recovered from back & legs from
cadavers (only top 1.5 layers), donor skin is a temp dressing; TransCyte (human fiberglass)-artificial temp
skin covering; not rejected by body, mainly for 2nd degree burns, too expensive & has been gone for 15
yrs, starting to make a comeback temp reg is diff (especially w/3rd degree burn-thermos is burned away)
made by cells from foreskin of babies; RECell-take small graph and scrape cells off tissue, goes into
formula, and sprayed on (not the gun); Meshing is a small graph means putting a graph through a mesher
to slice it like a lettuce plastic wrap w/holes in it; Tilapia skin is also being used in other countries (proteins
and collagen); Pressure garments-23 hrs/day for 1 year, helps with scarring and mobility; Pain is almost
like neuropathic and can last for years; Infections like pseudomonas (past, more deadly) and MRSA
(present, less deadly) can be of concern; Stretching skin is important to keep from contractors; support
groups available-group members provide elp, and give pushes wen peers need it, discussing stares and
comments; Psych is need: that is why the speaker became an MFT
Vocational: Assess ability to perform past jobs or potential future jobs; Cosmetic appearance; Pain
management; Range of motion; Big struggle going back to work, especially with facial burns; “Big
Burn”=complete facial burn
Limitations: Mobility-contractures caused by shortening of tissues or scarring (lower: walking, climbing,
balancing; Upper: reaching, fingering, handling); Cosmetic disfigurement; Tolerance to heat; Aesthetic
appearance; Ability to meet the public; Self-image; Trauma to injured skin and/or joints
BACK
Prevalence: 80% of adults will experience at some point in life; More than 1/4 of adults reported
experiencing in last 3 months; Most common causes of job-related disability and leading contributor of
days missed
Risk factors: 90% of patients experiencing LBP cannot be given a specific diagnosis-never identify the
source; POSTURE is a big factor
Recovery: Those with a high threat meter may not get better with regular physical therapy approaches.
There is a need to reduce threat meter first
Diagnostic approaches: Subjective-pain location, intensity, when it started, any injury; Objective-Strength
testing, neurological testing, posture presentation; Diagnoses are short on physical findings, must rely
mainly on history and level of reported discomfort
Treatment: First choice-strategies to facilitate patient self-management of symptoms, education; Second-
manual therapy, joint immobilization, soft tissue mobilization, joint manipulation, modalities-ice,heat,
electrical stimulation, traction; Last Resort-surgery, second opinions are encouraged, and no benefit to
help w/chronic low back strain; High Threat Meter-fear of pain, threat meter may need to be turned down
first, higher threat meter w/concurrent psych disturbances (especially anxiety and depression)
Prognosis: 90% of those experiencing LBP get better in about 3 months; 78% of those w/a history of LBP
have a relapse; Understanding that pain does not just present itself physically (but also psychologically),
may help w/chronic pain progression