Compression Fracture T11, T12, L1 16 months Post

[danielphysio]

Hi,I have currently been seeing a client who is 16 months post compression fracture of T11,T12,L1. She is 19yrs old, former sprint champion wanting to return to physical activity as she is de-conditioned. She fractured her spine after jumping off a 16m high cliff into water and landed awkwardly on her side. Her # was treated conservatively however no brace was used. She has been to see numerous physios before and I think she may be a little non-compliant with her exercises as she feels they do not do anything. She is still currently experiencing some back pain. I am hoping it is not a chronic type pain but still caused due to structural issues. Do you think this is possible? Should I refer for an X-ray or MRI to check healing and structure?I have done numerous amounts of research but cannot find anything specific with regards to treating someone with compression fracture let alone someone who is 16 months post. I am thinking I will focus on building TA/mult strength and progress to bird-dog, pilates exercises and sling strengthening (post-long, post oblique, ant oblique slings), followed by gym type exercises (following the principles of Paul Wrights Better Back Program. Also I will include some cardiovascular exercise, I'm thinking Bike or cross-trainer. Then if she handles that well I will let her gradually introduce jogging into her exercise program. Do you think this is a suitable rehab program, am I missing something critical?Any guidance or suggestion on what the best method of treatment is for someone like this would be very much appreciated. She is motivated to return to full function and get back into shape.Thank you

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[danielphysio]

Also, when she walks there is an audible clunk coming from the left hip or lower back which is quite worrisome for the client. Any ideas what could cause such an audible clunking noise?

[toddchaney]

You can check the below mentioned link:
Spinal Compression Fracture Treatments: Medication, Surgery, and More
Hope it helps.

[romygeorge]

Also, when she walks there is an audible clunk coming from the left hip or lower back which is quite worrisome for the client. Any ideas what could cause such an audible clunking noise?

I reckon the audible click could be from "hip snapping syndrome". Might be from slipping of iliopsoas over the lesser trochanter or tight IT band or gluteus maximus. It might be also due to acetabular tears or loose bodies in the joint. What movements bring on the clicking? Is it when hip is moving into flexion from extension? eg. climbing stairs? Or is it during pivoting movements?

Regarding the pain, one would expect she should have healed from her injuries considering the normal physiological healing time frame, but the pain resolution can take more time. I feel trying pool therapy and core stability exercises on a gymnastic ball would be useful as well.

Cheers

Romy

[KevinDeakins]

Sometimes a chiropractor can also help so, suggesting you one of the best chiropractic clinic. For further details visit Chiropractic clinic Centreville, VA.

[danielphysio]

Hi Romy,
Thanks for your reply, sorry it has taken me a while to reply, didn't realise someone had replied to my post.

The snapping occurs as you said, when the hip is moving from full range extension into the onset of hip flexion during the gait cycle.
Would you suggest stretching and manual therapy techniques for releasing iliopsoas and ITB? Plus strengthening of glute max/med?

Thank you
Daniel

[romygeorge]

Hi Daniel,

Thanks for your response. It appears that either the Gluteus maximus or IT band or both could be tight. You may need to single out the tight structures first and like you pointed out stretching would be a good option. However, I would also be interested to see if there are any biomechanical factors or foot wear factors contributing to the tightness. Also the client needs to be reassured especially if the clicking is painless/asymptomatic.

[kennethckyuen]

Hi Romy,

I would probably have an X-ray for her spine to check if the # sites are healed up yet. In my point of view, the # sites link to the iliopsoas too. If you find that the clicking sound is from the iliopsoas, I would also do some mobilization and soft tissue release to the spine too. That's why I need an X-ray.

The T11-L1 area requires movements during walking. I believe if the mobility is restored, she could walk better and hopefully she could resume running again.

Core exercise and gait pattern training together is important to her as I think there would probably a change in gait after the injury.

Hope this could provide you some ideas!

Good day!