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Electrician Project manager with pain around waist (Person (Professional…
Electrician Project manager with pain around waist
Person
Professional Socialisation
Young active male whole regualrly participates in frisbee and soccer
Has had to take time off of the recreational league he participates in
Has not taken time off of work because of his issue
Is not involved in work cover compensation
Has not gone to see another therapist/health practitioner regarding this issue
No need for referral to another health practitioner
Previous patient at Rouse Hill, check previous PHx notes to identify if this is a recurring issue
Previously seen by Mitch for LBP
Narrative Based Reasoning
Promoted to project manager recently; started spending less time standing and more time sitting at a desk
Sitting for long periods of time makes pain worse, while movement can often ease the pain
Usually active however has stopped playing frisbee and soccer because of this pain
Screen for other psychosocial aspects affecting injury
Does not regularly exercise anymore
Dialoguism
Beliefs about pain: started working as a project manager 2/12 and believes that his sitting and posture contribute to his symptoms
Encourage movement and provide strategies that he can use in the office
Recalls that he noticed during playing soccer one day, however has had trouble reproducing the exact movement that reproduces the pain; describes it as a sudden jolt while twisting
Young active male, enjoys recreational frisbee and soccer; wants to return to sport
Goals: Return to frisbee and soccer
Home: Lives with roommates
Science
Pattern Recognition (Practice based evidence)
Shooting Pain down both legs
Neuro test: dermatomes and myotomes in tact, nil abnormalities
Neural Tension: LLTT positive result, with L>R reproducing shooting pain
Slump Test: Positive, with relief when foot is off dorsiflexion
Previous patient at Rouse hill for LBP due to gluteal weakness and recently began working at a job which requires long periods of sitting
Retest glute strength to see if there is a remission of previous issue
Hip Ext Weak bilaterally <35% BW
Assess AROM of Lx
Prefers extension, dislikes flexion with reproduction of symptoms
Tx: Rotation L=R
Evidence based practice
HEP: Glute Bridges, PNF stretch of Piriformis, STR using trigger ball for obturator internus/piriformis
STR: Release of internal rotators of the hip; piriformis and obturator internus
Retest: improved Hip IR and subjective pain reduction
Education re: movement, injury timeline, strength gains timeline, what to do at work, and the effects of stretching vs release before movement
Hypothetico deductive Reasoning
What lies directly underneath area of pain?
Dysfunction of pelvis
Glute weakness
Single Leg Stance
Trendelenberg Sign
Possible glute med weakness
Internal Rotation Strategy
Tightness of ipsilateral psoas
SIJ
4 SIJ tests: Compression, Distraction, Gaenslen's, Thrust
Lumbar spine
AROM: Flexion, Extension, Lateral Flexion
Hip joint
Left Hip IR>ER, Right Hip IR<ER
Left Hip IR range reduced with restriction
Muscle tighness?
Palpation: Obturator internus and piriformis
Treatment: STM
PHx: Gluteal weakness
Hip Extension weak
Difficulty activating glutes in glute bridging
HHD Testing: Abductor weakness