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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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Presentation Transcript
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
  • Flexion 140 140
  • Extension 15 20
  • XR 60 60
  • IR 40 45
  • ABD 45 50
  • ADD 20 20
slide13
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
slide15
CPR
  • No Sm distal to knee
  • < 16 days
  • FABQW = 19
  • Hypomobility 4/5, 5/1 extension
  • Hip IR >35
slide16
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
ad