Quick Case: Management of Lumbar Flareup Via Text Message | Modern Manual Therapy Blog

Quick Case: Management of Lumbar Flareup Via Text Message


One of the reasons why I recommend MDT so much is that it enables you to treat the patient without touching them, plus educates them on self assessment and treatment. Everything they need to get better and stay better.



My first online consult, which is on the OMPT Channel, had a recent flareup of lumbar pain and contacted me via text message. He said he may need an appointment and it was quite severe. Here is the conversation posted with his permission that went on for about 4-5 days.

Day 1

AK: Hey doc E I hope all is well, and you had a happy Father's Day. I have been feeling incredible btw! However I just went to kneel down and begin exercising, and I felt an acute pain directly In the center of my L4-L5. Even the slightest flexion delivers a sharp feeling of pain. Do I rest this, or work it out? My instinct says rest. During the day I picked my wife up off the ground (100 lbs) but I did not feel any pain during this. But that is the only thing out of the ordinary that I did recently. I have not had an acute sharp pain like this in years. My, pain until it went away was always dull. I would be down for a google session, but I'm sure by the time we chat it will go away. :) Any advice? 8:42 PM

Me: Yes 9:11 PM
Me: Double down on extension in standing 9:11 PM
Me: Next time you pick up anything out of the ordinary extend a set or so 9:12 PM
AK: Double down, got it . I'll let you know when I hit blackjack :) Thank you 9:13 PM
Me: Keep me updated 10:39 PM
Me: Good luck! You'll be fine 10:39 PM

Day 2

AK: Thanks for the vote of confidence. It really helps. Update: 1) pain went from a 10 to a 9 with a good nights sleep. 2) I had to take Advil today (which I rarely do, and pain decreased to a 8) My body is still on high alert and it is somewhat difficult to walk. 3) walking with a decreased lumbar lordosis seems to take some pressure off. 4) I am performing 20 reps of standing extensions every half hour. After I finish each set my entire body stays on Super high alert for 1 minute, then the pain subsides after 1 minute, to somewhat decreased pain symptoms. On my way to feeling better. Thank you 1:07 PM
Me: You can also lie prone on elbows do you're non weight bearing and in slight lordosis for 5 to 10 minutes 1:08 PM
AK: Oh good, I've been doing that. Tyvm 1:12 PM
Me: Great job! Also try diaphragmatic breathing at the end of prone press ups locking elbows 1:13 PM
AK: Will do, - the breathing exercises you taught me (slight hold on both ends) really helps, especially with chi gong, and for pain.  1:26 PM
Me: Awesome! 1:26 PM
AK: :) 1:26 PM

Day 3

AK: Today's update: Pain down to a 5/6. Slight flexion still causing discomfort. Walking has become easier. -keeping up with 30 extensions per hour 10:33 AM
Me: Great! 10:52 AM
AK: Btw- after I foam roll tfl and adductors, there seems to be much less restriction when I initiate standing extensions 4:46 PM
Me: Good find 4:57 PM

Day 4

AK: upon waking up - pain was a 3-4. Mid day pain level down to a 0-2 2:49 PM
AK: Thank you again for your help 2:49 PM
Me: Np, it was all you 2:51 PM
AK: Ur the best 2:51 PM
Me: Thanks I'm going to write this up for my blog 2:59 PM
AK: Awesome 3:08 PM

Since the series of 6-7 online consults last year, he had quite a bit of education in modern pain science, and self evaluation and treatment via MDT principles. It did not help that his father is a prominent radiologist who told him his chronic thoracic pain was caused by disc issues. Despite it being intermittent over the years, the analogy that really decreased the threat was asking him if he ever skinned his knee. He said multiple times. I asked if he went on and one about his chronically skinned knee despite it no longer hurting. That brought on a "I never thought about it that way."

Since then, AK has gone back to golf, yoga, and regular exercise and also being able to work pain free after having years of cervical, thoracic and lumbar pain. Other than PRI, and using modern pain science, I am not sure of other methods/systems that allow for treatment via google hangouts, and even more limiting, text messages.

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Keeping it Eclectic...

2 comments:

  1. Jakob Svit JensenJune 25, 2014 at 4:10 PM

    Hi Dr E.
    Can you tell some more about how you use these online consultations? which program you use for it, duration of consultation, price etc.
    In Denmark we are not using this tool much yet but I can see great opportunities in working like that.
    Thank you for a great blog.
    Jakob Jensen
    Physiotherapist
    Cert MDT
    Denmark

    ReplyDelete
  2. Hi Jakob, I use Google hangouts which is free and works like Skype but records and automatically upload to YouTube. I make it private and that serves as my record of the "visit"

    ReplyDelete