Hey all, hope week 2 is treating you all well!.
This blog is kind of a continuation from last week in that one of my non-english speaking patients is causing me a bit of grief. My patient is a young man (24) who presented with low back pain with pain radiating into the left buttock, thigh and calf (lateral pain). From what i could gather it looked as if he had an opening up/stretch pattern so gave him exercises into extension and did PAVMS at the affected segments.
My problem with this patient is that his symptoms keep changing and he is not consistent with what he's telling me, and as a consequence, I don't know what i should be treating. Sometimes it appears to be an opening up pattern but half way through the Ax/Rx it may change to a closing down pattern of restriction. Is it possible to have both??? I have a feeling that he might be telling me what he thinks I want to hear because functionally, he is quite able, or maybe he doesn't know how to differentiate between pain, ache, or stretch (and I have asked on many occasions!).
Example of my frustration: Lx flexion ROM is decreased and on assessment it may increase Pb and on another re-assessment it may increase a different pain altogether. Nothing is consistent!!! His neurodynamic tests are variable - before treatment he could get SLR to 80 degrees (60 with DF) with increased Pb and Pc (not Pt) and after treatment he got to 60 SLR (45 with DF) and said it felt better and only Pc!!! I could be completely overlooking somehting but if Rx was effective, shouldn't his SLR increase and pain should centralise????
When i speak to my supervisor he gives me a look of "are you assessing this man properly? because what you telling me doesn't make sense" and as a result I feel quite stupid. I'm making sure everything is done by the book Ax/Rx wise but feel like I'm getting nowhere! Can anyone help?
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1 comment:
Hey Fan,
One thing that my last prac taught me is to treat based on diagnosis. What is this gentlemans diagnosis? is it a slipped disc or is it a facet jt problem? Have you assesed combined movements? If it is a facet jt problem they usually show up more consistently with combined movements. If it is a disc or a facet you can get an irregular pattern which means that it will show a sign of opening and or closing. Also in terms of the leg pain, have you assesed piriformis length? have you tried releasing it? I was amazed at how much a simple release can have a large effect on leg pain. I had a very hard time with complex patients like the one that you are treating. The best thing is to be 100% sure of the diagnosis and then treat based on that. If you want to discuss this pt in more detail give me a call and maybe we can work through it together.
Shadi
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