Case of the Week 8-6-12: Acute Lumbar Pain Update | Modern Manual Therapy Blog - Manual Therapy, Videos, Neurodynamics, Podcasts, Research Reviews

Case of the Week 8-6-12: Acute Lumbar Pain Update

Here is an update on the COTW from last week, the acute lumbar pain with lateral shift.

Part 1 of this ongoing case is here.

Visit 4: The first visit of this week was cancelled as she was called into work to train a new employee. She presented on Wednesday of this week with mod lateral shift to the right, and severe loss of extension, slightly increased Sx to 5/10 on average. I concentrated on shift correction, and was able to push her close to end range. I told her to give up extensions and just concentrate on SGIS to the left against a wall ALL DAY. Luckily, she is off this week and the next.

Visit 5: She presented with 4/10 pain at worst, minimal shift, with mod loss of SGIS to the left. Shift corrections were performed and she was much less blocked, with less pain. I performed manual shift correction for about 20 minutes and we were both sweating! I was glad I didn't workout arms the night before! I was able to progress finally to what I think was her end range in SGIS left (remember she could previously backward bend like in the Matrix). I then added extension in SGIS, which was severely blocked and painful. After several sets of this she was finally not shifted any longer and able to hold the shift correction while walking for 1-2 minutes. I then performed left psoas and QL release which were moderately restricted compared to WNL on the right. This also decreased her pain to 2-3/10

Visit 6: The patient presented with 2/10 pain with minimal shift, less than the day before, but still unable to maintain upright posture after walking > 20 feet or so. Sitting was more comfortable for her. I did more shift corrections and progressed to end range holds with her doing deep breaths. SAGs, they're not just for press-ups anymore! I don't know why I never thought of that, but they helped her obtain further end range, and enabled her to get into more SGIS for her self correction. She left being able to walk for 4-5 minutes without shifting again.

Next week is her last week off! She is going to hammer away at her shift corrections, try some prolonged right sidelying with her upper body on the over pillows for sustained correction for 20-30 minutes. Her goal is to get back to running by the middle of next week. I told her it is absolutely obtainable as long as she remains shift free and her extension returns close to normal for at least 48 hours straight.

I was overly optimistic about her getting better in 2-3 visits as it was acute. The shift is making it take a bit longer than I expected!

Update 8-6-12 Visit 7: The patient had 6 oz of wine and a full body massage prior to PT. She was mildly shifted and her drive did not bother her. SGIS was full, but extension in standing still had mod loss. IASTM was performed to L > R paraspinals and L psoas was release. REIS was now mild loss, this improved further with PT OP. Instructed on REIS and REIL performed all day.

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