Rehabilitation

Conservative Management of a 31 Year Old Male With Left Sided Low Back and Leg Pain

By Frank M. Painter|November 11, 2012|Chiropractic Care, McKenzie, Rehabilitation, Spinal Manipulation|

Conservative Management of a 31 Year Old Male With Left Sided Low Back and Leg Pain: A Case Report

SOURCE: J Can Chiropr Assoc. 2012 (Sep); 56 (3): 225-232

Emily R. Howell, BPHE(Hons), DC, FCCPOR(C)

Ashbridge’s Health Centre,
1522 Queen St. East,
Toronto, ON M4L 1E3.
dremilyhowell@hotmail.com

OBJECTIVE: This case study reported the conservative management of a patient presenting with left sided low back and leg pain diagnosed as a left sided L5-S1 disc prolapse/herniation.

CLINICAL FEATURES: A 31-year-old male recreational worker presented with left sided low back and leg pain for the previous 3-4 months that was exacerbated by prolonged sitting.

INTERVENTION AND OUTCOME: The plan of management included interferential current, soft tissue trigger point and myofascial therapy, lateral recumbent manual low velocity, low amplitude traction mobilizations and pelvic blocking as necessary. Home care included heat, icing, neural mobilizations, repeated extension exercises, stretching, core muscle strengthening, as well as the avoidance of prolonged sitting and using a low back support in his work chair. The patient responded well after the first visit and his leg and back pain were almost completely resolved by the third visit.

SUMMARY: Conservative chiropractic care appears to reduce pain and improve mobility in this case of a L5-S1 disc herniation. Active rehabilitative treatment strategies are recommended before surgical referral.

Recent Studies Have Also Shown That:

Back Surgery Fails 74% of the Time

From the FULL TEXT Article

Introduction:

Low back pain has been reported as the chief complaint for 23.6% of patients presenting to chiropractic offices. [1] Disc herniations that lead to nerve-root compromise account for less than 15% of chronic low back pain cases. [2] Over 95% of lumbar disc herniations occur at L4–5 or L5-S1 levels, and only 2% of herniations require surgery, 4% have compression fractures, 0.7% have spinal malignant neoplasms, 0.3% have ankylosing spondylitis and 0.1% have spinal infections. [2, 3]

Leg pain is estimated to be found in 25–57% of all low back pain cases and accounts for large costs, disability, chronicity and severity. [4, 5, 6] Many conservative treatments have been shown to be effective in the management of this condition and are favorable to pursue before considering any surgical interventions, such as: modalities, soft tissue therapy, spinal manipulations or mobilizations, pelvic blocking, McKenzie/end-range loading exercises, lumbar stabilization exercises and neural mobilizations, patient education, reassurance, short-term use of acetaminophen, and nonsteroidal antiinflammatory drugs. [2, 3, 7–24] The purpose of this case report is to describe the successful management of a patient with low back and leg pain.

Discussion:

There are more articles like this @ our:

Low Back Pain and Chiropractic Page and the:

Chiropractic and Sciatica Page

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A Basic Rehabilitative Template

By Frank M. Painter|May 24, 2012|Chiropractic Care, Clinical Decision-making, Diagnosis, Evaluation & Management, Evidence-based Medicine, Nutrition, Physical Therapy, Rehabilitation|

A Basic Rehabilitative Template

The Chiro.Org Blog

Clinical Monograph 1

By R. C. Schafer, DC, PhD, FICC

INTRODUCTION

Injuries can be classified into 13 types: abrasions, contusions, strains, ruptures, sprains, subluxations, dislocations, fractures, incisions, lacerations, penetrations, perforations, and punctures. This paper will not detail the management of burns or injuries requiring referral for operative correction, suturing, or restricted chemotherapy.

Objectives

Except for the most minor injuries, traumatized neuromusculoskeletal tissues are benefited by alert restorative procedures. The more serious the injury, the more prolonged is and the greater the need for professionally guided rehabilitation. The first step in rehabilitation is to explain to the patient that rehabilitation is just as important as the initial care of the injury. The goal is not only to restore the injured part to normal activity or as near normal as possible in the shortest possible time but also to prevent posttraumatic deterioration. It is an individualized process that requires patient dedication. The author recognizes that it is easier to write about comprehensive planning than to motivate some patients to follow prescriptions after pain has subsided.

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Chiropractic Rehabilitation

Most authorities would agree with Harrelson when he lists the goals of rehabilitation as:

decreased pain;
decreased inflammatory response to trauma;
return of full pain-free active joint ROM;
decreased effusion;
return of muscle strength, power, and endurance; and
regain of full asymptomatic functional activities at the preinjury level (or better).

(more…)

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Lower Back Trauma (Lumbar Spine and Pelvis)

By Frank M. Painter|May 20, 2012|Chiropractic Care, Chronic Pain, Evidence-based Medicine, Low Back Pain, Orthopedic Tests, Rehabilitation, Spinal Manipulation|

Lower Back Trauma (Lumbar Spine and Pelvis)

The Chiro.Org Blog

Clinical Monograph 24

By R. C. Schafer, DC, PhD, FICC

Although it may be easier to teach anatomy by dividing the body into arbitrary parts, a misinterpretation can be created. For instance, we find clinically that the lumbar spine, sacrum, ilia, pubic bones, and hips work as a functional unit. Any disorder of one part immediately affects the function of the other parts. We should also keep in mind that an axial kinematic chain of weight-supporting segments extends from the occipital base to the soles of the feet.

Because the number of professional papers concerning the cause and diagnosis of low-back pain is voluminous, emphasis herein is placed on points that the author believes are important but not often emphasized in popular literature.

BACKGROUND

A wide assortment of muscle, tendon, ligament, bone, nerve, and vascular injuries in this area is witnessed during posttrauma care. As with other areas of the body, the first step in the posttrauma examination process is knowing the mechanism of injury if possible. Evaluation can be rapid and accurate with this knowledge.

Low-back disability rapidly demotivates productivity and athletic participation. The mechanism of injury is usually intrinsic rather than extrinsic. The cause can often be through overbending, a heavy steady lift, or a sudden release –all which primarily involve the muscles. IVD disorders are more often, but not exclusively, attributed to extrinsic blows and intrinsic wrenches. An accurate and complete history is invariably necessary to offer the best management and counsel.

Initial Assessment

A player injured on the field or a worker injured in the shop should never be moved until emergency assessment is completed. Once severe injury has been eliminated, transfer to a backboard can be made and further evaluation conducted at an aid station.

Neurologic Levels

Neurologic assessment should be made as soon as logical. Muscle tonus (flaccidity, rigidity, spasticity) by passive movements is determined. Voluntary power of each suspected group of muscles against resistance is tested, and the force is compared bilaterally. Check pupil size, ability to follow finger motion, and reaction to light. Cremasteric (L1–L2), patellar (L2–L4), gluteal (L4–S1), suprapatellar, Achilles (L5–S2), plantar (S1–S2), and anal (S5–Cx1) reflexes are evaluated. Patellar and ankle clonuses are noted. Coordination and sensation by gait, heel-to-knee and foot-to-buttock tests, and Romberg’s station test are checked. These are typical minimal evaluations.

Initial Assessment

Tenderness. Tenderness is frequently found at the apices of spinal curves and not infrequently where one curve merges with another. Tenderness about spinous or transverse processes is usually of low intensity and suggests articular stress. Tenderness noted at the points of nerve exit from the spine and continuing in the pathway of the peripheral division of the nerves is a valuable aid in spinal analysis pointing to a foraminal lesion. However, the lack of tenderness is not a clear indication of lack of spinal dysfunction. Tenderness is a subjective symptom influenced by many individual structural, functional, and psychologic factors that can make it an unreliable sign. An area for clues sometimes overlooked is the presence and symmetry of lower-extremity pulses.

Keep in mind that lumbopelvic tenderness as well as pain can be referred from pelvic and lower abdominal viscera.

LUMBAR SUBLUXATION SYNDROMES

Functional revolts associated with subluxation syndromes can manifest as abnormalities in sensory interpretations and/or motor activities. These disturbances may be through one of two primary mechanisms: direct nerve disorders or be of a reflex nature.

Nerve Root Insults

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Rehabilitation Monograph Page

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The First Domino: Chiropractic Before Spinal Surgery for Chronic Low Back Pain

By Frank M. Painter|May 17, 2012|Chiropractic Care, Evidence-based Medicine, Guidelines, Health Care Reform, Low Back Pain, Rehabilitation|

The First Domino:
Chiropractic Before Spinal Surgery for Chronic Low Back Pain

The Chiro.Org Blog

SOURCE: Dynamic Chiropractic

By Peter W. Crownfield

University of Pittsburgh Medical Center Health Plan mandates conservative care before even considering surgery for chronic Low Back Pain cases.

The University of Pittsburgh Medical Center (UPMC) Health Plan, a health maintenance organization affiliated with the university’s School of Medicine, has adopted landmark guidelines for the management of chronic low back pain.

As of Jan. 1, 2012, candidates for spine surgery must receive “prior authorization to determine medical necessity,” which includes verification that the patient has “tried and failed a 3-month course of conservative management that included physical therapy, chiropractic therapy, and medication.”

Surgery candidates also must be graduates of the plan’s LBP health coaching program. The program features a Web-based decision-making tool designed to help plan members “understand the pros and cons of surgery and high-tech radiology.” It is the first reported implementation of such a policy by a health care plan.

Putting a Clamp on the Soaring Rates of Spine Surgery

According to the December 2011 issue of the UPMC Health Plan Physician Partner Update, which informed participating providers of the new guidelines and the rationale for their implementation, “We feel strongly that this clinical initiative will improve the quality of care for members who are considering low back surgery, and that it will facilitate their involvement in the decision-making process.”

The update also noted, “Surgical procedures for low back surgery performed without prior authorization will not be reimbursed at either the specialist or the hospital level.” (more…)

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Posttraumatic Subluxation-Fixation Implications: Etiology, Effects, and Common Coincidental Factors

By Frank M. Painter|May 17, 2012|Chiropractic Care, Diagnosis, Rehabilitation, Spinal Manipulation, Subluxation|

Posttraumatic Subluxation-Fixation Implications:
Etiology, Effects, and Common Coincidental Factors

The Chiro.Org Blog

Clinical Monograph 5

By R. C. Schafer, DC, PhD, FICC

INTRODUCTION

The kinetic aspects of spinal biomechanics are an important consideration in traumatology since the totality of function is essentially the sum of its individual components. However, although reminders are frequently given, the multitude of causes and effects of an articular subluxation complex (spinal or extraspinal) will not be detailed here that is primarily directed to chiropractic clinicians and advanced students who are well acquainted with standard hypotheses. For a detailed description, the reader is referred to:

Basic Principles of Chiropractic:
The Neuroscience Foundation of Clinical Practice
Arlington, Virginia, American Chiropractic Association, 1990.

Basic Implications

The biomechanical efficiency of any one of the 25 vertebral motor units, from atlas to sacrum, can be described as that condition (individually and collectively) in which each gravitationally dependent segment above is free to seek its normal resting position in relation to its supporting structure below, is free to move efficiently through its normal ranges of motion, and is free to return to its normal resting position after movement. The degree of fixed derangement (subluxation-fixation) of a bony segment within its articular bed and normal range of motion may be an effect in the range of microtrauma to macroscopic damage. Regardless, it is always attended by some degree of mobility dysfunction; neurologic insult; and overstress of the muscles, tendons, and ligaments involved and their respective mechanoreceptors.

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What is The Chiropractic Subluxation?

Once produced, the lesion becomes a focus of sustained pathologic irritation in which a barrage of impulses streams into the spinal cord where internuncial neurons receive and relay them to motor pathways. The contraction that provoked the subluxation initially is thereby reinforced, thus perpetuating both the subluxation and the pathologic process engendered. Sensory reflex phenomena can also be involved, and they frequently are. The nerve impulse creates a multitude of cellular reactions and responses besides those of even the most intricate, subtle, and variable sensations and motor activities. Once this is appreciated, we must add the complexities of trophic effects, neuroendocrine interrelations, biochemical affinities, proprioceptive buildup, summation increments, facilitation patterns, the input of the ascending and descending reticular activating mechanisms, genetic neurologic diatheses, synaptic overlaps, demoralization and disintegration of synaptic thresholds, the neurologic spread and buildup, reflex instability, predisposition to sensorial aberrations, undue cerebrovisceral or viscerocerebral interactions, psychosomatic overtones, and those many phenomena that science is only beginning to understand or are beyond our present understanding. This underscores that the quality and sometimes quantity of nerve function relates directly or indirectly to practically every bodily function and contributes significantly to the beginning of physiologic dysfunction and the development of pathologic processes.

Structural Imbalance (more…)

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Shoulder Girdle Trauma

By Frank M. Painter|May 16, 2012|Chiropractic Care, Diagnosis, Evaluation & Management, Rehabilitation, Shoulder, Spinal Manipulation, Sports|

Shoulder Girdle Trauma

The Chiro.Org Blog

Clinical Monograph 16

By R. C. Schafer, DC, PhD, FICC

The articulations of the scapula, clavicle, and the humerus function as a biomechanical unit. Only when certain multiple segments are completely fixed can these parts possibly function independently in mechanical roles. Forces generated from or on one of the three segments influence the other two segments. Thus, they will be described here as a functional unit. Please underscore this point in your mind as you read this paper.

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Enjoy the rest of Dr. Schafer’s Monographs at:

Rehabilitation Monograph Page

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