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Severe LBP
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Severe LBP - May 15, 2004 5:46:00 PM
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sprite
Posts: 22
Joined: April 21, 2004
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Any ideas? 29 yo male presented to clinic Friday bent at waist (approx 45 degree angle) from severe LBP. Unable to stand upright. When he tried, he swayed side-to-side trying to stand erect. Said initial episode was 11/03 from falling onto R hip/buttock. Pain lasted 1-2 weeks. It returned approx 1.5 weeks ago, almost went away then hit again Tuesday of this week. Pt. has L lateral shift and had increased pain with correction. Tender lower T and L paraspinals. States pain occasionally travels into R thigh. No significat med Hx. No x-rays.
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Re: Severe LBP - May 16, 2004 12:48:00 AM
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Alex Brenner PT MPT OCS
Posts: 1057
Joined: February 29, 2004
From: Kentucky
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Hi Sprite. Essentially you are asking, Do we have any ideas on how to manage acute low back pain? I manage acute low back pain with spinal manipulation and with prescribed therapeutic exercises based on my assessment from a thorough history and physical examination. From your brief history above this gentleman already has 2 out of the five predictors for favorable outcome to spinal manipulation (1=symptoms not distal to the knee and 2=symptoms less than 15 days) according to the recent Rose award research- Flynn et. al. Clinical prediction rule for classifying patients with low back pain who demonstrate short term improvement with spinal manipulation. Spine. 2002;27(4):2835-2843. I bet with a thorough examination you will find he will probably have other predictors which would raise his liklihood to benefit from manipulation. The most recent and best evidence that we have for the treatment of acute low back pain is manipulation.
However, if you are not comfortable with this then search in the archives on this forum for the topic "How do you treat acute low back pain". You will find a good thread there to give you some other ideas.
For the brief history that you provided it seems that this gentleman is having some acute discogenic low back pain without nerve root impingement. After performing a thorough history and examination to rule out any serious pathology I would perform a manipulation probably followed by some extension and side gliding exercises to work into his restricted range of motion and lateral shift.
As always, just my thoughts. Good luck, keep us updated.
ArmyPT, OCS
_____________________________
Alex Brenner, PT, MPT, OCS
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Re: Severe LBP - May 16, 2004 1:54:00 AM
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sprite
Posts: 22
Joined: April 21, 2004
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Thanks for the ideas. Traditionally, I am very comfortable treating LBP. I was lost with this pt. though b/c he was only able to tolerate sitting with forward flexion and slump long sit. How would you manipulate, do side glides or extension exercise when he is not able to stand erect or assume positions other that the one listed above?
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Re: Severe LBP - May 16, 2004 4:31:00 AM
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jma
Posts: 2432
Joined: August 24, 2000
From: NY
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Hello,
Thank you for the reference that you mentioned ArmyPT. I too was looking for something that would help predict and outcome. Should be very interesting to read.
JMA
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Re: Severe LBP - May 16, 2004 7:52:00 AM
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mcap56
Posts: 619
Joined: October 26, 2002
From: New York, NY
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When the McKenzie folks can't shift-correct a patient upright, they will try the correction in varying degrees of flexion. It could be that you could correct the shift in flexion. However, I find it usually isn't worth the tremendous strain that is placed on the therpaists body. Of course you could try belts and other tricks.
You could also try rotation in flexion (self positioning). This is probably similar to the manipulation you would use.
It's hard to make recommendations without having seen the patient. Most of the acute deformities I have seen are either bent over in the sagittal plane which may be due to meniscoid entrapment (they aren't really sure of the cause - but it's an easy one to fix) or laterally shifted in the frontal plane with less flexion than you describe.
One thing is that I wouldn't force the issue too much. These things tend to resolve fairly quickly. His previous episodes have. AFter it does may be the best time to intervene.
What kind of pain control is he getting? Might there be an answer there? LBP is often very undermedicated.
mcap
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Re: Severe LBP - May 16, 2004 8:38:00 AM
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chiroortho
Posts: 655
Joined: February 18, 2004
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What precipitated 2nd episode?
Why no xrays? Fall on butt/hip, severe pain...xrays sound good to me.
Greg
_____________________________
Greg Priest, DC, DABCO
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Re: Severe LBP - May 16, 2004 12:10:00 PM
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sprite
Posts: 22
Joined: April 21, 2004
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2nd episode occured for no apparent reason. Not sure why x-rays were not taken. When pt. went to MD he said he was not as severe (was able to stand erect). MD told him it is muscular and gave mm relaxer, vioxx, and pain med.
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