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40 yr old Male NSLBP (Person (Professional Socialisation (Pain management…
40 yr old Male NSLBP
Person
Dialoguism
middle aged man. Martial Arts for 20 yrs. 2 little girls and wife. keen keto and paleo diet experimenter. down to earth and keen to get back to activity as quickly as possible. wishes to have a ring fight again but wife won't let him.
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Science
Pattern recogniton
Seen a range of NSLBP patients with varying hypothesised causations. As well as undertaking PJs back tutorials and attempting to apply these to patients.
Hypo-deductive reasoning
Session 1: AROM flex to toes (pain in Lx spine on return) ext pain at end of range (full range) L lat flex knee crease pain R low back R lat flex knee crease pain L low back. Thoracic ROM R 40 L 55 Strength Hip Abd R 18.2 L 20 Add R 20 L 22.0 ext R 38.3 L 44.5. Balance on SL foam - unable/ balance on single leg eyes closed R = 8s L = 4s. Calf Strength SL R = L Terminated at 42 reps. K2W R = 16cm L = 12cm. Rx Lx Spine mobs // flex toes pain worse, ext less pain. STR ES + QL // flex a lot less pain, ext still no pain. Glute bridge activation ex // nil pain felt good afterwards > prescribed HEP glute bridge 50-100reps a day.
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Session 2: STT glute med // improved flex + ext dramatically after weekend flare up. Ex hip thruster 60kg 3 x 10, jefferson curl 2 x 12 6kg // improved pain flex + L flex both sides. GHE 3 x12. Prescribed HEP hip thruster + jefferson and return to gym.
Increase self efficacy of exercise and encourage good movement patterns. Demonstrate strength of back and potential benefits of movement for pain relief and preventing reoccurrence.
Next session look to progress strength. Add in Deadlift and assess kicking biomechanics and facilitate return to sport.
Should we rather target abdominals (ab crunch) as he favours flexion based movement. Directional preference?
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EBP
https://www-sciencedirect-com.ezproxy1.library.usyd.edu.au/science/article/pii/S1356689X05001104 "pain disorders are predominantly mechanically induced and patients typically present with mal-adaptive primary physical and secondary cognitive compensations for their disorders that become a mechanism for ongoing pain. Restoration of the painful impaired movement is critical for the resolution of the disorder."
AND THE BASIS OF OUR INTERVENTION: "The aim of the intervention is to desensitize the nervous system by restoring normal movement, reducing the fear of movement into pain and associated muscle guarding. This is facilitated by graded movement exposure into the painful range in a relaxed and normal manner based on the individual patient presentation. The cognitive strategies of reducing fear and changing beliefs regarding pain is augmented by manual therapy ‘treatment’ to restore the movement impairment (articular mobilisation/manipulation and soft tissue techniques)."
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