left buttock pain radiating to mid back

[jacinta]

Hi Aussie,

thank you for the advise.
his symptoms is now progressing, pain reducing slowly.

in fact, we started McKenzie's with trunk lat. slide in pr., as well as in frontal plane.
The latter, of course is for his convenience as he has a 9-5 office job.
But this gentleman prefer the earlier exercise as he found it more comfortable.
Flexion exercise is KIV until pain subside.

Very kind of you to remind me of pilates exercise.
I am planning to train his core stability with few ideas that i have:
1. crunches in crook ly with s/bags resistant.
2. 'Aeroplane' with gym-ball: (alternate )UL reaching forward & c/l LL backward.
3. Obliques muscle strengthening - sustain upper trunk twist in crook ly;hands behind head
4. upper trunk extension - hand behind back;

I am not train for pilates rehab. Got the ideas from researching book.
Hope to hear correction/suggestion from any expert out there.

This gentleman started swimming 1/52 as advised.
shall wait and see if his condition improve further.
cheers~

[KiwiDPT]

I only just read this but I would like to add to AussiePhysio's comments. I also use repeated movements with my low back assessments however sometimes I find repeated motions in standing can also increase a patients pain, and confound results. This is usually with the more acute cases. So I always add prone bilateral LE manual traction as an assessment, and prone on elbows. Also sometimes you may have to have them lay over a pillow or two as the extension from laying flat maybe too much.
Just my 2 cents for additional screens I use.

[anthony32]

How is your patient feeling right now. Is he still having pains when he imitates kicking a ball. Is there any other pains or niggles

[jacinta]

Hi Kiwi,

sorry for late reply as I had been away for some time.
Your opinion definately worth much more than 2 cents

I 'experimented' on few patients and had the same finding like you.
Certain patients pain scale increase when prac McKenzie in pr. position, but pain
goes off with pillow support;
while some display totally contradicting symptoms.

Pain elicited might be due to hyperext of lumbar spine,
causing sudden increase of discal pressure, & compression of surrounding structure possibly lead to increase neural tension.
I am yet to find out any evidence regarding this.
Could anyone tell me if thr's any journal or paper that I could refer to?
Please correct me if I am wrong.

once comfort approach is determined, result is more satisfactory with trunk lat. flx added into the component.

Anthony, I am yet to see him since i went off.
Do hope he improve.
thanks.


Jacinta