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Re: back pain case
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Re: back pain case - August 24, 2006 10:36:00 AM
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Bournephysio
Posts: 585
Joined: April 25, 2002
From: Calgary
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Obviously with the limited information given it is hard to get a complete picture of the situation but here’s my take.
If this guy was 4-5 years older, I think that this would be a clear cut case of too little rehab and sending him back to sports too quickly.
- already has “chronic” back issues
- looks like about 3 weeks of rehab
- appears to be relatively basic stability exercises
- still has some pain with extension
- send him back to football where he is doing explosive loading probably in some degree of extension
Are you still surprised that he got worse? The tissue needs some time to heal and the neuromuscular system needs to be much better trained to support it. You don’t go from slow light loading on a ball straight to heavy explosive loading in a game situation. Considering his age, you would want to be a little more careful but I don’t see any reason not to continue treating this person. I would have no problem mobilizing this guy though it’s not going to cure him.
Doug
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Re: back pain case - August 24, 2006 11:33:00 AM
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nari
Posts: 1568
Joined: November 14, 2003
From: Australia
Status: offline
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Rage
If there is any question of instability (and the thread is full of fears about a slip) then a McK extension would not be entertained as an option.
Of course, if EIL/EIS actually improved the situation, it could be tried. Doesn't sound like it would, but as Doug said, it's hard to evaluate online.
I can't begin to imagine a situation where the doc stops PT, anyway. The only reason that would ever happen here is if imaging showed something drastic happening.
How do you survive under such conditions???
Nari
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Re: back pain case - August 24, 2006 11:54:00 AM
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ragempt
Posts: 111
Joined: August 14, 2006
From: linden, michigan
Status: offline
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well i guess i have to take some blame for not attempting to educate the doctors about an early discharge. i just dont like to ruffle feathers.
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Re: back pain case - August 24, 2006 1:57:00 PM
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ginger
Posts: 658
Joined: February 26, 2005
From: Melbourne Victoria
Status: offline
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Jboy , you will be amongst the first to rejoice, I feel sure , when the "culture" of PT in the US , moves in the direction of primary contact practitioners, as is true in Canada and Australia. Where your methods and opinions are given equal credit with MD's, where you are not concerned about what the insurance company thinks, where people happily pay full price in cash for services that are your speciality, without having to check the doctors orders. Under these circumstances , and where standards are driven by a combination of strong ethical guidelines, a considerable culture of quality and best of all, little or no meddling from sources of opinion to do with scientific or other bias that is not , as it were, on the wavelngth that manual therapy occupies.
When that happens ( if ever ) with your culture Jboy , you will be able to move and grow into your profession with the same freedoms and encouragements that go with the undeniable value of making a difference, unfettered by the fears that appear to be an integral part of your system.
The continuous method is not , as you seem to believe, a pounding, mashing application of random forces. Quite the opposite. If you re-read the detail I offer in the manual therapy section of this forum you may arrive at a different view , of the method , and the likely best effects for this young footballer.
As SJBird , and others have offered, there will be a gain if only in the sense that feedback from paraspinal muscles and other structures , will add to the observations already made. Add usefull things that are not able to gotten any other way. The advantage being , to have the kind of insight that goes with manual therapies , where the application of the safest method , provides a clue to the behaviour of joints and adjacent structures, leading then to methods serving your patient in the optimum way . X-rays dont do this. MRi's and cat scans cant do this , only your sensitive hands can do this. If the "culture" of your PT world is such that even the safest of movement therapies is counselled against in the face of fear of the unknown, then I say you've retreated to the safest , but not the most effective position.
Come out of your foxhole soldier.
_____________________________
Ubi est mea anaticula cumminosa?
The Grand Pediculator
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Re: back pain case - August 25, 2006 3:56:00 AM
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Jeep
Posts: 353
Joined: March 28, 2003
From: USA
Status: offline
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ptjosh-
Can you update us on this patient?
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Re: back pain case - August 25, 2006 4:07:00 AM
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ptjosh
Posts: 9
Joined: July 31, 2006
Status: offline
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I had talked to MD about possiblity of spondy. He was supposed to see MD yesterday. On my schedule for this afternoon.
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