i am treating an athlete who is suffering from thoracic/lumbar paraspinal spasms. She has had this on and off for almost a year now and they decrease in frequency and intensity when she is in the off season and have picked right back up. we have done studies to find underlying issues and there don't seem to be any. I have tried E-stim, US, Phonophoresis, massage, ice massage, heat, ice... you name it...we've tried it. Just wondering if anyone had any suggestions??? anything is GREATLY appreciated it! THANKS
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Joined: February 14, 2003
From: Madison WI USA
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How about more information on symptom behavior patterns, findings from evaluation, medical history, etc. That would make it easier for me to make some suggestions on things to try. There is likely an underlying reason, muscles dont just start spasming because they feel like it.
ok first of all...i know that muscles don't spasm for no reason...i was simply saying that the tests we had run (MRI and xray) hadn't shown anything with the exception of a decreased curve in her lumbar spine which we are currently trying to treat with chiropractic care. but here's the more information: D1 college basketball player who was forced into hyperextension while rebounding in practice about 10 months ago. obvious palpable spasms immediately. spasms decreased after 2-3 days and athlete was allowed to return to play. during the game 4 days later, she was undercut and fell directly onto her butt without being able to brace herself or catch herself at all and back then spasmed again. she has never had a back injury before and never even complained of back pain or tightness since i first started working with her about 2 yrs ago. during the off-season, she took some time off and felt considerably better but still had some spasming from time to time though not as severe. like i said earlier...spasms have never really stopped...just decreased when she wasn't as active. we have tried just about everything i can think of including kinesiotape now which made no difference. no scoliosis, no palpable defect, (-) SLR, no neurological symptoms. just obvious palpable spasms along the paraspinal muscles on both sides. they are not constant but they increase if she has been sitting for awhile or playing basketball (running and scrimmaging). there doesn't seem to be a pattern to when the muscles spasm or for how long but she frequently has to get massaged with trigger point release during practice just to be comfortable. this hasn't really stopped her from playing or practicing but is extremely uncomfortable for her at times. i'm just looking for any suggestions that anyone has because we've tried practically everything and nothing really seems to help.
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First, why chiropractice care for something that may have been present prior to her injury?Also, no data suggest that chiropractic care can change the curve in the lumbar spine. Is there a PT on staff comfortable with manipulation?
Also, your post above makes it sound as though you threw the kitchen sink at the patient. As is commonly true, I think your best bet is to try to see if this person fits in a treatment-based sub-group, such as manipulation, lumbar stabilization, directional preference exercises or traction. If they fit, use the intervention, try to control as many other variables as possible, and assess the patient's response.
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Jess Brown, PT Board Certified in Orthopaedic Physical Therapy
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From: Madison WI USA
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Missync, Treating it with "chiropractic care" is about as vague as saying treating it with "physical therapy". Keep in mind, this is not attacking you, just looking for clarification of what you said, as we dont have much else to go on. If you are here to learn, understand that what you say will be dissected towards this learning end, not towards a personal attack. (or at least hopefully not!)
I would concur with Jess' thoughs regarding throwing everything but the kitchen sink at her. However, when someone says they have tried everything, there is still probability that they did not try the right thing, or perhaps the right thing at the right time, or perhaps not enough of the right thing. Could you be specific as to what you have tried, leaving out the unhelpful modalities you listed above.
This is someone who rested from the aggravating stressors over an off season, got somewhat better, but when subjected to the same stressors after the break, had return of symptoms. If the MRI and films showed no hint of bony pathology, and showed no potential for disc herniation, Bone scan could show a bony issue when the others might not, such as a spondyloysis. Assuming all is structurally well, one must turn to the performance of the muscles and their ability handle the dynamic tasks associated with basketball. This would lead the therapist towards aggressive strengthening, and lots of it. It should include multifidi strengthening, abdominal strengthening in useful positions (sitting abs strengthening and sit ups are fairly useless in my opinion), relative plyometrics and the whole 9 yards of basketball related movements, in a progressive fashion.
And finally, if there was a forceful landing on the buttock, I imagine you addressed pelvic manipulation to un-do what could have been an upslip. I am not one who feels the treatment of the SI joint is often necessary, UNLESS there is a clear cut fall onto a buttock, something that could plausibly cause an instant obliquity.
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As the chiro on the board, was there an indication to treat the lumbar spine besides lack of lordosis? How was the lordosis issue determined? As shill has mentioned eval the pelvis if all is well tell the chiro to ignore the lumbar spine and restore mobility ( should be short length of tx ) to the t/l transitional area then careful core activation all should be good.
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