Manual Therapy Techniques Reinforced

Hi crew,

This week I’d like to share with you a summary of one of the patients on my musculoskeletal placement because I think this experience may help reinforce some of the assessment and manual therapy techniques we’ve practiced in labs. This mid twenty year old patient presented with moderate to severe left side mid and low back pain that had been progressively getting worse after feeling the onset of pain following a wrestling incident. In addition to the back pain, the patient reported of intermittent sharp pain down the back of the left leg to the knee and numbness in the toes and sole of the foot. Immediately I’m thinking neurological testing is required here and the patient had a fair amount of pain and irritability so my objective assessment had to be modified. Basically focused on observation, essential active movements, neuro testing, NTPT’s, palpation, PAIVMs and PIIVMs. The findings were no real pattern with AROM, altered sensation in the L5 dermatome in the lower limb, positive SLR with DF, normal PIIVMs. The finding that completed the picture for diagnosis was the hypomobility and reproduction of her low back, leg pain and numbness in her left foot with unilateral AP of the L4-5, L5-S1 passive accessories.

To be able to clinically observe the reproduction of a patient’s symptoms with PAIVMs and correlate those segments to the results from the neurological testing was a first for me and really reinforced the ideas that were presented in the labs.

The initial treatment focused on relieving the patient’s pain so that sitting at work would be manageable. STM for the overactive erector spinae and QL followed by mobilisation of the L4-L5, L5-S1 levels at a grade 2 minus for 30 secs x 3. As subsequent sets of mobs were applied the patient reported of a decrease in leg and back complaints during the 30 secs and reassessment revealed a slight increase in lumbar extension. Home exercises for supine trunk rotation and advice for posture at work finished the session.

The patient reported at the appointment 2 days later that sitting at work and sleeping was more comfortable since treatment. The mid back pain and muscle tension had decreased and the complaints had centralised to the low back region with a decrease in left leg pain and foot numbness.

This experience has definitely shown me the impact we can have with some of our manual techniques and consolidated the ideas on which our treatments are based. It’s important that we practice on each other but we have to continually feel pathological structures and tissues so learning the difference between normal and pathological will becomes more apparent. The outcome of this case has shown me that we just need to keep seeing as many patients as possible. So I hope that if you don’t feel comfortable with your manual skills at the moment, no worries as you’ve been taught the skills you need and you can make a difference for your patients. Have a great long weekend.

Gareth