Joined: March 12, 2004
Wow! I haven't been to these forums in ages and it's good to be back.
I have a friend that I saw tonight that presents with an apparent lumbar shift (not sure if this is the exact terminology). In standing, he has an obvious convexity to the right with his t-spine to the left of his 'center' (not directly above his l-spine). Marked tension in his right paraspinals, LLD on the right (right LE became longer from supine -> longsitting), unable to flex forward without leaning to the left, and marked pain lower lumbar on the right. No radicular c/o were mentioned and sensation intact. He does have a hx of mechanical LBP that isn't helped by his being a truck driver. He's about 5'11" & 165 pounds. Pain with P-A testing of entire l-spine, but mostly L4-5.
As an outpatient PT, I wish I saw more of this so that I'd have a better 'handle' on treating it. Can any of you offer me treatment ideas/rationales/EBM based on this presentation? If there's any more information you need, please let me know.
Joined: October 9, 2001
From: Pittsburgh, PA USA
Hey Chris, welcome back.....why ya been slacking off here?????
To me, a shift is usually a sign of a derangement..something that the body is shifting away from. The fact that he deviates when flexing supports that even more.
One does not have to have radicular symptoms when presenting with a shift. When I had mine (2 HNPs), I did not have the radicular issues for over a week. How long has this guy had symptoms?
I know I have read somewhere research regarding the shift, and correction of, but just can't remember what and where....I'm sure it's buried in my site somewhere....you're a member, so do some digging!
I work on correcting the shift, as long as there are no symptom reproductions with the exercise. Many times, the shift corrects with daily correction, and the problem resolves pretty quickly. Check neural tension, myotomal strength, and fix the physical deficits you find.
John M. Duffy, PT Board Certified Orthopaedic Clinical Specialist www.PTupdate.com