Lower back pain in 24 year old rugby player

[wutti]

These are all really good posts, i am impressed!! and i can only aggree with most of the written stuff. however, concerning to the stiffness of pa glides, if he has a hyperlordisis in lumbar spine, the facett joints are locked anyway, because of increased shear/pressure on joints. the ab´s might be overstretched, so strengthing of all abdominals would be important.
Most important: check his Gym programm, make sure he is strengthing all muscle groups the right way, not only six pack etc., deep muscle groups and main stabilizers!!! also make sure that the hip joints have the appropiate ROM in all directions, because if not he compensates with lumbar spine.
the same for thoracic spine ROM. If stiff, his numbness of forearm may result of compensation of cervical spine.
good luck!!

[alophysio]

Hi Wutti,

I agree wholeheartedly - there are so many aspects of his treatment that i would include. However, Cat indicated that she was a fairly new physio so i didn't want to confuse matters by adding an SIJ examination that she probably has never done before.

Also, there are so many possibilities as to why someone may have increased L/S extension from the foot through to her head. I had a patient once who didn't tell me about her chronic ankle injury "because it didn't hurt". But she had decreased DF in her ankle so it changed her posture into a sway back posture...etc

For Cat: I would still try the above first. If it is not working, then start moving away from the area. This works as a general rule.

For example, I had a patient yesterday come in to see me for her intermittent medial knee pain. The area of pain was just medial to the medial border of the patella. No mechanism of injury. All ligament tests were negative. All meniscal tests were negative. ROM was normal and pain free. Walking up one step gave her the pain as did sit-to-stand. Palpation of the knee was negative as were mobes of the tib-fem, tib-fib and patellofem joints.

To me, the knee wasn't the perpetrator of the pain, it was merely the victim. There was no good reason why the knee was causing the pain. So i went to examine her hip - problems with control and imbalance of muscles. I checked her SIJ = problems with load bearing on the ipsilateral side.

Simple solution was to treat the hip and SIJ and within 10 mins of walking in, she was significantly better with a home programme of stretches for the hip and we will start core-stability work next treatment.

The moral of the story is - if it looks like a duck and it walks like a duck - it probably is a duck. If it doesn't, look for something else!

Thanks again Wutti for the encouragement and comments!

[wutti]

hi alophysio!!

your are right with not bothering with to much stuff at the beginning. my experience is thet espacially amateur athletes are often doing the *same* things wrong. no appropriate cool down and stretching after exercise. so often muscular imbalance is the main cause of skeleteal problems. but its right that any joint instability might cause problems in *far away* areas. however, i think cat will manage the problem with all these good comments.
good luck for that!!

[cafra23]

UPDATE!

Sorry it has taken me so long to get back to you, but I thought you would like to hear how things have been going with this guy.

Thank you so much for all your helpful ideas and suggestions - they have been invaluable. Having a wide variety of treatment options available helped build my confidence in my own abilities and as a result, my patients confidence and belief in helping himself.

I used Mulligans techniques to increase lumbar flexion ROM, taught pilates type exercises (partly based on those you suggested and partly on those I have learnt myself at classes) with incorporated upper and lower limb movements. I also went with him to see him in the gym, where it became apparent (despite my lack of experience in this area), that his techniques were poor and he was putting a lot of stress though his LS. With the assistance of one of the experienced Personal Trainers we were able to work on this and develop a more suitable gym programme.

As well as this, I found that he had been spending a lot of time during the day sitting slumped in a fork lift which had been aggravating his symptoms - simply using a rolled up towel helped with this.

Overall, he has reported a 90% improvement with his symptoms, and importantly has incorporated the "pilates" exercises into to his x3 weekly gym sessions.

Sorry for waffling on, but I am so pleased with the results I just wanted to let you know! Thanks again for all your advice and time, you are incredibly kind.

Many Thanks,

Catherine.

[alophysio]

Hi Cat,

Excellent work. Thanks for the feedback.

Hope everything else is going well. This patient should be one of your "success stories" that you should bring up whenever you want to feel better (believe me, sometimes you need to remember that you help a lot of people - the old one bad comment to 10 compliments rule!).

THanks again for the feedback