LBP only in the AM

[nsbirak]

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.

[Jackson]

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

[TexasOrtho]

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?

[zimney3pt]

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.

[nsbirak]

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

[Jackson]

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