LBP

hi yall
had this patient today which made me think

33 yr old...runner..c/o LBP muscular L5 level from 3 months...tender on palpation
-On assessment...pain on flexion, mobil spin process..full rom, no pain...no neuro signes...
-Grade 4 lumb extensors...grade 5 abd...otherwise 5 throughout...
-ALso has flat feet..using no orthotics currently

Rx
Advised on flexion to prevent etc..lifting etc
hamstring stretches, knee to chest, rotational stretches in supine lying with knees bent
Strengthening lumbar extensors in prone with 10 sec hold at end of rom.
To continue wearing orthotics for flat feet on running etc.
Heat application 2 times per day..15 mins

What do u think on this treatment, anything else I should test, and anything u would add in Rx.
;)
Thanks guys...much appreciated.

physioo,
Take a look @ the study provided through this link www.apta.org/Foundation/news/spinal_manipulation# (click on the link at the end of the 2nd paragraph). This is an excellent study & is consistent with most other current research. Your patient sounds like they may fit the criteria. LOL

Release psoas, stabilize against lumbar extension by training abs so that when running his hip extends and not his lumbar spine instead. Is pain unilateral or central, may have an imbalance and resultant vertebral/discal shear forces with rotation of the pelvis during toe-off during stance phase.

Basically you need to see him run, not just fresh but when he is tired. I would hypothesize that he has reduced hip extension and also poor eccentric dorsiflexion due to the foot issues. Shoes such as the Nike Air Pegasus, which had a higher than average heel to toe angle make assist in the same way a heal raise would.

Overall his presentation seems pretty standard. Mobile spinous process could however indicate a spondylolithesis or pars fracture. Has he been involved in any rotation activities e.g. bowling in cricket?

:smokin