The case study of the Low Back pain: Assessment and Treatment Report - Essay Example

? The case study of the Low Back pain: Assessment and Treatment Report Patient details: The of the patient is Gavinder Brar. The patient is a 26 year old male. He is well built and participates in sports activities. However, he reports experiencing lower back pain in the last 2 years. Subject information Gavinder was referred to the office following increasing right lumbosacral back pain. Patient’s states pain began as intermittent approximately two years ago though this has increased in the prior months. Previous physiotherapy has been ineffective and he states that the pain has not warranted the need for analgesics. The patient is very active, well-built and appropriately proportioned. He has not ceased from his usual activities which include football and weightlifting, though he has noticed that some of his activities seem to precipitate and aggravate the condition. He complains of initial stiffness in the mornings, and some instances of shooting pain in the leg though not commonly. The injury is of unknown origin. Objective Assessment The assessments that were used for the problem included the active and the passive assessments. Active movement assessment is appropriate in the sense that in enables one to effectively tell the problems underlying the limbs. For instance, patient is asked to move the limbs in certain direction while inquiring about the patients’ feeling for each movement. Painful movement for certain direction, as well as painless movement for other direction will say a lot about the underlying complication (Chiradejnant, Maher, Latimer, Stepkovitch 2003). There are various issues that could be ascertained from the active movement assessments which could lead one to an informed inference, including those pertaining to coordination, pain and muscle strengths. Besides, patients can conduct an evaluation on motion to see whether to ascertain whether the problems are caused by the eccentric and concentric muscle activities. In each case of movement, the therapists are required to make note of whether the pain is involved. On the other hand, passive movement is essential to the case because it focuses on assessing the tissues that are not contractile, which are now not involved in the motion. In this assessment, the therapist simply moves the dysfunction part about the joints and this test is suited for the assessment of restriction, binding and the crepitus. In this assessment, it is also imperative that the therapists make not of the pains that are involved for every movement because this will also go a long way in informing the references (Raj 2008). Specifically, the slump test was considered to be most appropriate movement tests because it has proven to be the most appropriate approach for evaluating the patients with higher and lower extremity complaints (Gaitland 2005). Conventionally, the test is focussed at identifying or ruling out the tensions between neuromeningeal tracts. The only inherent limitation is that it leaves the allowance for the multiple interpretations but it has on the overall been rated to be effective for the clinical use. Another effective test is the straight leg raise. This has been widely cited as an appropriate method for testing nerve irritations, for example, that resulting from the disc prolapsed (Koury, Scarpel, 1994). Besides, the manual resistive tests, also referred to isometric tests, are often conducted to confirm the findings obtained for the active and passive movement assessments (Julie, Robichaud and Keith, 2002). Possible Diagnostic One of the possible diagnostic of the lower back pain is the degeneration of the intervertebral disks. Disk height may be altered and also affect the mechanics involving the resting of the spinal column (Raj,2008). Other structures are then affected including muscle tissue and ligaments. Intervertebral discs lie between vertebral bodies which as a connectors. They must transmit constant loads of pressure which comes from the weight of the body and spinal column. The outer rings of these discs are covered thick and fibrous material known as cartilage, which is the annulus fibrosis. In the center lies the nucleus pulposus which contain the collagin and elastin fibers. It is outside of this center where the annulus is located. As one ages the boundary between the two tends to become less distinct (Cedars Sinai 2013). The annulus lamellae bind together and their action is thought to behave as sensors and communicators that indicate mechanical strain along and within tissue. Disc degeneration in this case and the annular tears most likely a result of the effects of mechanicals loads which can induce degenerative changes. As A CT scan has not yet been completed classification of the annular tears cannot be made at this time. Other possible diagnostics include inflamed muscles, as well as other complications associated with the joints, bones, nerves and muscles, and other spine structures (Hurwitz, Morgnenstern, Harber, Kominki and Adams, 2002). There are various factors that are pivotal in enabling the discrimination of the appropriate diagnostic from the rest. For example, this is dependent upon whether the pain has occurred suddenly or it chronic; whether the pain is continuous or intermittent; or whether it is limited to one region or spreads to other regions. The pain at the low back could be rated as a dull ache, piercing, sharp or even a burning sensation which could spread to other areas such as the hands, arms, feet or even the legs (Foster, Thompson, Baxter and Allen 1999). Differentiation test for the diagnostic The complete neurological examination on the lower limbs was carried out. The differentiation test was informed by the fact that the extension of the ER resulted in the increase of the pains while these was non-indicative. During the time of examination, the patient condition was described to be tending towards the swayback. The AROM flex to the ankle was found to increase the pull across the Lx. The exterior ER increased the pain in the right R Lx. There were no complications that were associated with LSF while the exercise was accompanied by increased pain in the RSF. SLR was found to increase ham pain while pal L5S1 was found to increase pain on the right hand only. This led to the inference that the victim possessed lordosis. Recommended treatment After the movements for the assessment processes have been identified, the next step is to come up with the choice of treatments. The choice of treatment is often dependent on various aspects including the severity of the pains, the irritability and the stiffness of the body organs towards the movements. The nature aspect has to do with how intense issue underlying the complication such as whether it is mechanical or inflammatory. The severity aspect has to with the intensity at which it could be considered to be serious or less serious. Irritability aspect pertains to the levels of pain that is associated with the movements, as well as how long it takes for the pain to ease (Sprague, 1983). In regard to these, the following treatments were recommended. The treatment that was recommended for the first session was the passive accessory right and unilateral grade iii. The victim was massaged for about three minutes and asked to undertake some exercises. The exercises recommended include the activation of the transverses abdominis muscles, knee rolling and the stretching of the hamstrings. Passive accessory right and unilateral grade iii modalities are employed in the treatment of the lower back problems. Various systematic reviews have found substantial evidence in the support of these techniques. These reviews encompass those that that have conducted the investigations on the passive joint mobilizations’ effects on the vertebral column joints (Simmonds, Kumar & Lecheit 1995). The exercises are crucial in the sense that they increase they increase the rate at which blood and nutrients flow into the structures that support the back problem healing processes. In addition, the exercises are well placed to remove eliminate the stiffness at the joint and which is often associated with pain causation (Osce Skills 2013). In the case of lordosis, physical exercises are meant to displace the dislocated backbones back to their original position (Hurley, McDonough, Baxter, Dempster and Moore 2005). What makes these exercises suitable is the fact that they are not associated back pains. Patient’s Progress During the time of examination, the patient condition was described to be tending towards the swayback. The AROM flex to the ankle was found to increase the pull across the Lx. The exterior ER increased the pain in the right R Lx. There were no complications that were associated with LSF while the exercise was accompanied by increased pain in the RSF. SLR was found to increase ham pain while pal L5S1 was found to increase pain on the right hand only. In the subsequent assessment, the flexing was not accompanied by pain while the ext pain remained to be rated as end range and reduced with activation of the glut. Thus, the patient’s progress was considered to be positive. In the third assessment, the patient was found to exhibit subjective improvement symptoms. However, O/E signs were found to have increased and these were attributed to poor exercising. In the final assessment, the patient was found to be fully recovered and even resumed playing football. In this regard, the diagnosis and modality approach was appropriate. References Cedars, S (2013). Swayback (Lordosis). Retrieved from http://www.cedars-sinai.edu/Patients/Health-Conditions/Swayback-Lordosis.aspx. Last accessed 12th May 2013. Chiradejnant A, Maher, G, Latimer J, Stepkovitch N. (2003). Efficacy of "therapist-selected" versus "randomly selected" mobilisation techniques for the treatment of low back pain: A randomised controlled trial. Australian Journal of Physiotherapy 49:233-241. Gaitland D. (2005) Maitland's Vertebral Manipulation. Philadelphia, PA. Elsevier. 2005. Foster, E, Thompson K, Baxter D, Allen J. (1999). 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Lower Limb Neurological Examination. Retrived from http://www.osceskills.com/e-learning/subjects/lower-limb-neurological-examination/. Last accessed 12th May 2013. Raj, P. (2008), 'Intervertebral disc: anatomy-physiology-pathophysiology-treatment', Pain Practice, 8, 1, pp. 18-44, CINAHL Plus with Full Text, EBSCOhost, viewed 12 May 2013. Simmonds, M, Kumar S, & Lecheit, E. (1995). Use of a Spinal Model to Quantify the Forces and Motion That Occur During Therapists' Tests of Spinal Motion. Physical Therapy 75(3)212-222. Sprague, B. (1983) The Acute Cervical Joint Lock. Physical Therapy.63 (9):1439-1444. Read More