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MK Case Study. Patient Profile. 22 year old man: bartender/student LBP onset 2 weeks ago (15 days) Spread to R gluteal pain 10 days ago. History. Onset AM after flag football game Gradual onset with return to work (bartender) Denies pain during game Previous Hx of ruptured Left RF

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MK Case Study

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Mk case study

MK Case Study


Patient profile

Patient Profile

  • 22 year old man: bartender/student

  • LBP onset 2 weeks ago (15 days)

  • Spread to R gluteal pain 10 days ago


History

History

  • Onset AM after flag football game

    • 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

Standing > 1/2 hr spreads to gluteal pain

Running immediate increase in LBP stopped activity

Prolonged sitting (>30) increases LBP

Sitting relieves 5”, immediate return with return to stand

Sit 15” to relieve

Cannot run

Must lay down 30” to relieve

Able to sit if on L ischium only

Aggravating …………Easing


Observation

Observation

  • Stands WB primarily L LE

  • Slight L shift (contralateral)

  • Corrected SB R Upper Lumbar


Objective

Objective

  • 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


Objective1

Objective

  • Extension:

    0-5 degrees

    deviates to L

    Increases his comparable LBP

    correction increases c/o pain more


Objective2

Objective

  • SB R 0-5 degrees

    -increased his LB pain

    - flattened curve

  • SB L 0-15 degrees

    - painless


Palpation

Palpation

  • Hypomobility into extension L4 & L5

  • *Stiff & painful with central PA @ L4> L5

  • **Stiff & painful with R unilateral @ L4

  • Slight decrease pain with R unilateral @L5


Objective3

Objective

  • Neurological: clear DTR, Myotome, Sensation

  • Special Test -


Pain scale

Pain scale

  • Patient: @ rest “4/10”

  • Standing > 30”: 8/10

  • Sitting > 3”: 3/10

  • Running: 0/10 stopped activity

  • Lifting: 1/10


Hip mobility r l

Hip MobilityR L

  • Flexion140140

  • Extension 15 20

  • XR 60 60

  • IR 40 45

  • ABD 45 50

  • ADD 20 20


Mk case study

PSFS

  • Standing: 2

  • Sitting: 4

  • Running: 0

  • Lifting: 2

  • TOTAL =8 8/4 activities = 2


Odi fabq

ODI & FABQ

  • Oswestry Score: 20 = 40%

  • FABQW: 19

  • FABQPA: 39


Mk case study

CPR

  • No Sm distal to knee

  • < 16 days

  • FABQW = 19

  • Hypomobility 4/5, 5/1 extension

  • Hip IR >35


Mk case study

CPR

  • No Sm distal to knee

  • 15 days

  • FABQW < 19

  • Hypomobility 4/5, 5/1 extension

  • Hip IR >35 both sides

  • Woahh ! 5/5 Positive Likelihood Ratio: infinite


Trial treatment

Trial Treatment

  • Supine LS V GPM in RSB

    Post

  • painless in standing

  • Extension: 10 degrees, decreased deviation, painfree


Treatment 2

Treatment 2

  • Pain: 3/10 at rest in standing

  • Extension: 10 degrees, then pain dev L

  • SB R 10 degrees, P+

  • Repeat V


Treatment 3 pre rx

Treatment 3Pre-Rx

  • Painscale: 1/10 rest

  • Extension: 15 degrees no deviation, no pain

  • SBR 15-20 degrees P-

  • Rx

    -Active extension/active exercise


Initial re test

Initial Re-test

  • Pain Scale: 6 1

  • PSFS: 2 8

  • Oswestry:20 5

  • FABQ:19 6


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