SomaSimple Discussion Lists  

Go Back   SomaSimple Discussion Lists > Physiotherapy / Physical Therapy / Manual Therapy / Bodywork > Clinical Reasoning
Albums Quiz PubMed Gray's Anatomy Tags Online Journals Statistics

Notices

Clinical Reasoning Typical cases are discussed there. The cases are brought by practioners.

Reply
 
Thread Tools Display Modes
Old 15-08-2011, 06:32 PM   #1
nsbirak
Junior Member
 
Join Date: Feb 2010
Location: Houston
Age: 31
Posts: 24
Thanks: 0
Thanked 0 Times in 0 Posts
Default LBP only in the AM

I have a 47 yr old female patient who had a sudden onset of LBP 2 months ago. She states the pain is worse in the A.M. and eases as the day goes on. She reports it is difficult to walk int he A.M. due to the pain. My evaluation was performed in the evening when she only suffered from a 1/10 pain level and all neurodynamic test were negative. The only position the reproduced her symptoms was prone laying, otherwise she had full pain free lumbar motions. I figure that in the AM her disc height is the highest thus causing her nerves to be tensioned, but she reports she can not find any position in the A.M that would decrease her symptoms. Currently I have performing seated slump nerve glides b/c she did complain of some R posterior hip/leg pain. Any Ideas would be appreciated.
nsbirak is offline   Reply With Quote
Old 15-08-2011, 06:41 PM   #2
Jackson
Senior Member
 
Jackson's Avatar
 
Join Date: Dec 2010
Location: Jackson, TN
Posts: 123
Thanks: 43
Thanked 12 Times in 11 Posts
Default

What happens if you have her extend in prone? If she lies in prone for a longer period of time, what effect does this have?

Nick
__________________
Nick Nordtvedt, PT, DPT, Cert MDT

You will never succeed if you are not prepared to fail.
Jackson is offline   Reply With Quote
Old 15-08-2011, 06:59 PM   #3
TexasOrtho
Arbiter
 
TexasOrtho's Avatar
 
Join Date: Feb 2008
Location: Huffman, TX
Age: 42
Posts: 1,677
Thanks: 963
Thanked 750 Times in 270 Posts
Default

Hi Neal. Good to see you on SS. Do you have any more information on the location of her morning symptoms. (i.e. central, lateral, buttock, etc...) Has she identified anything other than the passage of time that contributes to a resolution of her morning pain?
__________________
Rod Henderson, PT, ScD
It is useless to attempt to reason a man out of a thing he was never reasoned into. — Jonathan Swift
TexasOrtho is offline   Reply With Quote
Old 15-08-2011, 07:00 PM   #4
zimney3pt
life long learner, clinician, and instructor
 
zimney3pt's Avatar
 
Join Date: Dec 2009
Location: Sioux City, IA
Age: 44
Posts: 2,149
Thanks: 262
Thanked 1,165 Times in 408 Posts
Default

Also in the morning most people have lowest HR and BP. Nerves like blood. Decrease in blood flowing can make them more cranky in the morning. Sometimes just increasing general cardio fitness can be helpful along with education of why the nerves may be a bit cranky and what needs to be done to reduce that. Overtime with some attention to movement and increase cardio will often times get better as it is not most likely an issue in the tissues as no specific acute incident and pain improves with position or use so signs of more mechanical in nature. Ideomotion can also be helpful.
__________________
Kory Zimney, PT, DPT

http://koryzimney.blogspot.com

"Study principles not methods, a mind that can grasp principles will create its own methods." - Gill

"All truths are easy to understand once they are discovered; the point is to discover them." - Galileo Galilei
zimney3pt is offline   Reply With Quote
Old 16-08-2011, 03:51 PM   #5
nsbirak
Junior Member
 
Join Date: Feb 2010
Location: Houston
Age: 31
Posts: 24
Thanks: 0
Thanked 0 Times in 0 Posts
Default

Thanks for the responses. See reports after laying prone for approx. 5 minutes her pain levels remain the same. Rod she does reports sensitivity to touch over the anterior region of her R thigh, but the LBP is central. If it was lateral what would that make you think? She states reclined sitting helps decrease her pain in the A.M.

I'm not familiar with ideomotion can you please lead me into the right direction to learn about this technique. I will definitely talk to her about the lack of blood flow int he A.M.

Thanks

Neal
nsbirak is offline   Reply With Quote
Old 16-08-2011, 03:57 PM   #6
Jackson
Senior Member
 
Jackson's Avatar
 
Join Date: Dec 2010
Location: Jackson, TN
Posts: 123
Thanks: 43
Thanked 12 Times in 11 Posts
Default

I'd test more movement. Once you make her pain worse in prone lying, what movement makes it better? If she extends further back in prone lying does she have increased s/s, resolution, or no change?

Nick
__________________
Nick Nordtvedt, PT, DPT, Cert MDT

You will never succeed if you are not prepared to fail.
Jackson is offline   Reply With Quote
Reply

Bookmarks

Thread Tools
Display Modes

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is On
HTML code is Off

Forum Jump

Similar Threads
Thread Thread Starter Forum Replies Last Post
Unexplained LBP nsbirak Clinical Reasoning 33 30-09-2010 04:47 AM
LBP origins? bernard General Discussion 48 26-10-2004 04:02 PM


All times are GMT +2. The time now is 12:02 AM.


Powered by vBulletin® Version 3.8.8
Copyright ©2000 - 2014, vBulletin Solutions, Inc.
SomaSimple © 2004 - 2014