Q&A Time! | Modern Manual Therapy Blog

Q&A Time!

Today's Q&A is a case from one of my former fellows.

Dr. Chris Capilli writes:  I have a patient who had a fused L/S 10 years ago, told not to go to PT so she did not. Last year she had a discectomy after a fall.  Long story short, she has a number of limitations including a forward flexed posturing with her gait limited heel strike, etc...  Patient is 47 year and now after 9 visits is doing much better she is able to teach all day without pain, but still cannot walk 3 blocks without having to stop.  She gets great relief with the STM to bilateral Iliopsoas and QL, I have showed her the standing stretch and she does it often but they are almost structurally shortened due to 10 years of being life this, anything that you can suggest ???  Like I said she has made great strides in her treatment, kicking herself that she did not come after the initial surgery, as am I.  I know this might just be her plateau but I don't want to give up on her as of yet..thanks for your help.


The subject of his email was: You're still my mentor... awww... thanks Chris!


Ok, now with only this having to go on, and knowing Chris's approach, here are some strategies that will hopefully progress her a bit further.


Treatments

  • IASTM to the ITB, rectus femoris, lumbar paraspinals, thoracic paraspinals
  • thoracic mobilization
  • IASTM to around gastrocs
  • JM to talocrural and subtalar joints, it's not no pain, no problem!
  • femoral slump neurodynamics
  • hip mobs particularly focusing on IR and anterior glide/prone knee bend

Corrective Exercise

  • The forward flexed posture most certainly means her stride length is also decreased and thus has lengthened hamstrings and inhibited gluts
    • focus on bridges with driving her heel down and knees forward, really kicks in the posterior!
    • she should absolutely not feel these in her back
    • get her doing mini dead lifts to focus on working on the muscles that will get her upright
  • much of her feelings of "tightness" are likely due to a weak or inhibited core, this would cause her areas around it to "tighten" up
  • progressively grade her walking, slow it down, focus on quality
  • have her take several smaller walks a day and work up to increasing either frequency, intensity, or duration, every 2-3 days

Hope this helps, keep us updated!

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