Spinal stenosis and disc protrusion

[Ozy]

sdkashif, thank you, I will check neural tension tests in ten days - when she'll be back from her trip

jwilso, yes, there are non-organic signs (or yellow flags).

I will let you know what happened on our next appointment.
Regards!

[asha]

I think you have been a bit confused & in your hurry to bring about pain relief doing a lot of things. On day one you may sometimes not get a movement preference. you have prescribed as home programme all movements, how can you do a clinical analysis.

She came to me yesterday - I gave her a postural education, a mobilisation of spine, cervical traction and McKenzie exercise for the neck - retraction and all directions.

You seem to have got no movement preference & you seem to have gone ahead with progression of forces in the mckenzie approach.

p.s. I did mobilization (also a part of McKenzie approach), traction
and one muscle energy technique for the neck.

during movement testing, of the cervical spine have you isolated the upper c spine & the lower c spine? If you systematically go through with the mckenzie assessment techniques, I think you will find the solution to your problem. If it comes up as an mechanically inconclusive, then go ahead with with other systematic approach. Iam mckenzie trained too & I have seen worse patients that this coming out. Be systamatic & you'll sure find a way out.
In the lumbar spine what is her position or movement preference? If she finds prone better, she may nor be able to try out REIL due to her cervical spine. have you then tried bilateral knee bending in prone ? You may have to wait to reduce the pain in the cervical to start with the lumbar. well it all actually depends on your assessment. Nothing like a good assesment.there's a whole lot of info that you have not mentioned.when the patient comes back to you, be level headed & start on a fresh page. If you are mckenzie trained, this should be an easy job.

[Ozy]

Asha,
I agree with you, I was in a hurry!
She came to me as a patient with lumbar problem, and I was surprised that she has also neck problem.
I didn't have enough time during assessment, and I have spent to much time on the LS, but she told me that the neck pain is something that she can handle right know (she was used to feel lumbar and legs pain)...
Why I gave her "retraction and all directions"?
I never did that before!
But I didn't find the right movement direction, because she was stiff and everything was painful to her (with great deal of yellow flag sign).
So I wanted to "relax" her to move in all directions - to see that nothing will happen if she moves her neck, if you can understand what I am saying?

Another problem, she didn't do any of the instructions that I gave to her (except the cervical role for the night - and then she had better sleep).
I think she will need different approach, because she doesn't want to change herself: the way off seating, and to integrate exercise (retraction or EIL or EIS) in her daily routine.
We just can do much for that kind of patients with McKenzie method...
Off course, everything would be different if I was able to find the right movement at first visit - which is partially impossible for chronic conditions.
On the other hand Asha, you may have different opinion?

[asha]

Well i do agree with you ozy. we can't do anything much if the patient does not do what is being asked as a home programme. Its not always that we get the right direction on day one. Especially if there are too many things happening at the spine, it may take roughly 5-6 sessions. But the patient must adhere to our instructions.