Transcript Lumbar Manipulation MK - Fearon Physical Therapy

MK Case Study
Patient Profile
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22 year old man: bartender/student
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LBP onset 2 weeks ago (15 days)
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Spread to R gluteal pain 10 days ago
History
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Onset AM after flag football game
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Gradual onset with return to work (bartender)
Denies pain during game
Previous Hx of ruptured Left RF
No Rx
No Meds
No radiography
Aggravating …………Easing
immediate with standing
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Sitting relieves 5”, immediate
return with return to stand
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Standing > 1/2 hr
spreads to gluteal pain
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Sit 15” to relieve
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Running immediate
increase in LBP
stopped activity
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Cannot run
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Must lay down 30” to relieve
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Able to sit if on L ischium only
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Prolonged sitting (>30)
increases LBP
Observation
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Stands WB primarily L LE
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Slight L shift (contralateral)
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Corrected SB R Upper Lumbar
Objective
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Flexion:
deviates L, poor unrolling of lordosis
limit finger tips to mid tibia
No change in LB SM
Correction of deviation some increase in pain
improves range
Objective
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Extension:
0-5 degrees
deviates to L
Increases his comparable LBP
correction increases c/o pain more
Objective
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SB R 0-5 degrees
-increased his LB pain
- flattened curve
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SB L 0-15 degrees
- painless
Palpation
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Hypomobility into extension L4 & L5
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*Stiff & painful with central PA @ L4> L5
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**Stiff & painful with R unilateral @ L4
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Slight decrease pain with R unilateral @L5
Objective
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Neurological: clear DTR, Myotome,
Sensation
Special Test -
Pain scale
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Patient: @ rest “4/10”
Standing > 30”: 8/10
Sitting > 3”: 3/10
Running: 0/10
stopped activity
Lifting: 1/10
Hip Mobility
R
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Flexion
Extension
XR
IR
ABD
ADD
140
15
60
40
45
20
L
140
20
60
45
50
20
PSFS
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Standing: 2
Sitting: 4
Running: 0
Lifting: 2
TOTAL =8 8/4 activities = 2
ODI & FABQ
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Oswestry Score: 20 = 40%
FABQW: 19
FABQPA: 39
CPR
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No Sm distal to knee
< 16 days
FABQW = 19
Hypomobility 4/5, 5/1 extension
Hip IR >35
CPR
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No Sm distal to knee
15 days
FABQW < 19
Hypomobility 4/5, 5/1 extension
Hip IR >35 both sides
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Woahh ! 5/5 Positive Likelihood Ratio: infinite
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Trial Treatment
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Supine LS V GPM in RSB
Post
 painless in standing
 Extension: 10 degrees, decreased
deviation, painfree
Treatment 2
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Pain: 3/10 at rest in standing
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Extension: 10 degrees, then pain dev L
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SB R 10 degrees, P+
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Repeat V
Treatment 3
Pre-Rx
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Painscale: 1/10 rest
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Extension: 15 degrees no deviation, no pain
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SBR 15-20 degrees P-
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Rx
-Active extension/active exercise
Initial
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Pain Scale:
PSFS:
Oswestry:
FABQ:
6
2
20
19
Re-test
1
8
5
6
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