A Vertebral Condition for Mobilizations - Case Study Example

ANALYSIS OF A VERTEBRAL CONDITION FOR MOBILIZATIONS Introduction Looking at the case, it will be important to first consider the likely reasons that may have led to the pain. It is obvious that the patient may be suffering from lower back pain. To begin with, there are a number of issues that may lead to lower back pain injuries among golfers, such like our patient. It is however important that the lower back pain felt, may be as a result of pressure from movements from other body muscles surrounding it, which leads the lower back to do excessive work and typically breaks down. Hence, even before thinking of a solution to the problem, it is better to have an understanding of the various movements or ‘swings’ and the likely impact on its lower back. One likely cause of lower back pain is sprains of the muscles at that point. A sprain is basically a ‘pulled’ muscles. This can typically resolve itself in a period of not less than two weeks but the same should not go over four weeks (Petty & Moore, 2001). This thus means that if the pain is to go over four weeks, then an intervention should be through through and put in place. According to Petty and Moore (2001), symptoms of sprains includes minor ache but sometimes this may lead to a debilitating pain. However, Nordin & Frankel (2003) notes that it is unlikely that the pain which comes as a result of spraining a muscle will be felt far from the location of the muscle. In essence, such a pain tends to be localized. Therefore, the intermittent side in the lumbar region to the left side of lower back may be as a result of muscle sprain. However, such a pain is not expected to spread to the buttock as is the case. The intervertebral disc in the lumbar region helps absorb compressive forces, in the process creating a space for spinal nerves to leave the spinal column (Nordin& Frankel, 2003). In the event excessive compressive pressure is placed on the disc, sometimes tears can occur in the disc. The force of the jelly put on the tears can lead the disc tearing at that point. In some cases, the disc can ruptured at the point of the tear. Disc problems like this makes the disc vulnerable to compression as the player takes various swings in the process of playing, and this results into the pain. Unlike pain caused by muscle sprain, this type of pain can radiate into the buttocks and the legs (Muscolino, 2009) and may be the cause of pain being felt into the buttocks. Thus, to conclude, the two types of pain being felt by this particular player may be as a result of both a muscle sprain in the lower back region and a disc injury. It is thus important to implement a mechanism that address the cause of the pain rather than the pain itself. It should also be noted that the pain felt may be as a result of degenerative arthritis. Rose (2014) observe that overuse can lead to the joints being arthritic.Spine-Health (2014) notes that arthritis causes cartilage, which absorbs pressure and shock that comes due to movement, to breakdown. As a result, the bones rub against each other leading to pain, especially with certain movements, and stiffness, especially in the morning (Rose, 2014). Besides, arthritis lowers the freedom to move, severely compromising the extent to which a player can participate in a game. The cause of these sprains may be several. A golfer’s swing during a game is a likely culprit for these sprains. These swings are likely to rotate the the spine at a great force, leaving the player with little control over his body. This exposes the lower back to a number of injuries including the disc injuries. Besides, Porterfield (1998) notes that disc and facets are loaded with the body weight so as to provide the force during a golf swing. This weight being loaded onto the disc leads to compression. It is also important to mention that the lumbar region is forced to strain so as to provide the necessary force during the swing so as to hit the ball. But again, bending over to pick golf ball and bags or even the clubs as well as carrying the muscles can provide the sprain the lumbar region. With regards to sprain, it is also important to remember that poor body mechanics during the paly may also be a cause of sprain. If a golf club is swung with poor mechanics, the hips, arms and the upper back will not follow smoothly. Muscolino (2009) notes that when this happens, than it means that stress is placed on the lumbar region. This may results into sprains of the muscles and hence the pain. Treatment Plan The main aim of this paper is to suggest appropriate treatment plan for the player so as to help him improve motion and reduce pain. Currently, the condition of the player appears to be in such a state that he will be in so much pain that he cannot paly the nest match. Yet, the player is preparing for a competition which is due in a couple of days, and the plan should include both short term plan as well as long term plans. Warm Ups The most important thing to note is that the player should be asked to consider warming up before playing. Muscolino (2009) notes that one of the key cause of injuries to players is the lack of warm ups, largely caused by the nature of the game. In most cases, exercise before a game may easily be overlooked if the club has no strict policy on the same or even facilities for the same. Palastanga, et al., (2006) observes that warm ups help to alleviate the symptoms of arthritis. This should be done before any round of a golf play. Besides, exercise prepares the muscles to stretch and take in the necessary oxygen to give the muscles required strength (Palastanga, et al 2006). Exercise to stretch hips and low back and prepare them for golf can greatly help this patient. The player can be advised to lie on his back on a flat hard surface to keep the back level. On that position, player can bend both legs at the knees. The hands can be placed just above the the left knee. At this position, the player should bring the left knee towards the head 10 times after which the same should be repeated with the rights knee. The next exercise deals with stretching both the hips and the lower back. This includes that to first bend the knees at an angle of 90 degrees. Fists should then be placed between the knees. The feet should be moved away from each other, then again towards each other in movements that resembles that of a windshield. This can be done once a day and the movement repeated 10 times. Lastly, the player can do the quadruped rocking activity which aims at stretching the entire spine and the hips. This purpose of this exercise is to prepare the back and hips for proper posture, especially considering that during play, players do squat and bend a lot. For this exercise, the player should be on his hands and knees such that the hand fall below the shoulders and the knees below the hips. The belly should then be pulled towards the spine, making sure to maintain a natural curve in the low back. The hips should then be moved backwards until a stretch is felt in the low back and the hips. This should be done at least ten times daily. Mobilizations Mobilizations can be undertaken in the lower back to reduce the pain and increase the movements of the patient. Mobilizations helps to achieve a reduction in pain in a number of ways. Whichever the case Nordin & Frankel (2003) notes that mobilizations interferes with the transfer of inputs from the sensory nerves are affected area to the nocioceptive nerves which communicates with the brain, relieving pain in the process. Mobilizations also helps to increase movement by stretching the fibrous tissues causing what is called ‘creep’(Zusman, 2011). This is important because it allows the tissue to change shape with time as various weights are applied. This change is not permanent and once the load is removed, the tissue can resume its previous shape. As a result of this, the player can participate in the golfing activity with less pain thus enabling more movement. Mobilizations may also help to address the stiffness as the joints are stretched to their normal limits (Zusman, 2011). Option 1- Developed by Mulligan The first treatment mobilization option to be advised will be the Mobilization with Movements (MWMs).This method enables dysfunctions joints to move to their full range with minimum or no pain. Making sure that the direction of the force is perpendicular to normal joint movement, apply the force. Stephens (1995) and Vicenzino & Wright (1995) observes that this method has recorded many successes and it is hoped that even our patient will, be able to reap the benefits. For this technique, the patient lies on his side, facing the therapist, with the knees bent in the direction of the chest. With the arms along the back of the patient, the therapist will sway the hips of the patient towards the left and to the right to produce extensions to the lumbar spine. The therapist should ensure that a sustained force is applied throughout the process so as to isolate flexion. This method is basically applied to ensure that the patient will be in less pain when the joint is put to use. Option 2- Passive Accessory Intervertebral Movement (PAIVM) This is a technique that does not require active participation of the muscles used in movement. McCollam & Cindy (1993) and Powers, et al. (2008) are of the opinion that this method has proved to be effective in reducing the pain in lower back, and increases the range of lumbar extension. To begin the exercise, the patient should first be made to lie down in prone. The therapist then should stand to the patient’s side and place their ulnar surface of the hand on the selected spinous process. This is done with the wrist in full extension. The other hand is placed on top of the hand to reinforce the pressure being applied in the patient. The therapist may apply pressure on either side of the spinous process by leaning and performing rocking movements that provides movements in an oscillatory way on the vertebra. According to McCollam & Cindy (1993), if the patient exhibits little to no movement during the process, the help of the pillow should be sought in raising the spine to an extension so as to produce the necessary tension. On the other hand, in the event that patient cannot take the pain, the pressure can be directed on either side of the spinous process by the help of the thumbs. It is important to take care when mobilization this patient because there is a possibility of arthritis which is a contraindication to forceful mobilization (Powers, et al., 2008). This means that when excessive force is applied, desired results may not be obtained, in fact, the problem may even be made worse and breakages of bones may be experienced. For the longer term action of addressing the issue, the player should be put under arthritis treatment. This should include taking anti-inflammatory drugs to relieve the pain being felt as a result of arthritis. The drugs can to be administered include such tablets such as ibuprofen and aspirin (Vicenzino& Wright, 1995). It is however important to note that the condition started about five years ago and it may be wise to refer the patient to a doctor to examine the extent of the injuries. But besides this, heat or ice can be directed to the affected areas so as to relieve the arthritis pain. Management of the disease will ensure that the player is able to continue enjoying his game. At the same time, the body needs plenty of vitamins to repair itself. It is thus important that the player be directed to eat plenty of fruits of vegetables so as to provide these necessary vitamin. A nutritionist may be drafted in to come up with a diet plan for the player, especially with regards to which types of fruits are vegetables are more beneficial and which ones should be avoided or eaten in moderation. Bibliography McCollam, R. & Cindy, B., 1993. Effects of Postero-anterior Mobilization on lumbar extension and flexion. Journal of Manual & Manipulative Therapy, Volume 1, p. 4. Muscolino, J. E., 2009. Joint Mobilization of the Lower Back. [Online] Available at: http://www.learnmuscles.com/joint%20mobilization%20of%20the%20low%20back%20-%20WI%2009.pdf [Accessed 28 March 2015]. Nordin, M. & Frankel, V., 2003. Basic Mechanics of the Musculokeletal System. Lippincott: Williams and Wilkins. Palastanga, N., Field, D. & Soames, R., 2006. Anatomy and Human Movement Structure and Function. London: Butterworth Heinneman. Petty, N. & Moore, A., 2001. Neuromusculokeletal Examinationa and Assessment: A Handbook for Therapists. London: Churchill and Livingstone. Porterfield, J., 1998. Mechanical Low Back Pain: Perspectives in Functional Anatomy. Washington: Saunders. Powers, C. et al., 2008. Effects of a single session of posterior-to-anterior spinal mobilization and press-up exercise on pain and response with lumbar spine extension in people with nonspecific low back pain. Journal of the American Physical Therapy Association, 88(1), pp. 485-93. Rose, G., 2014. A Golfers Guide to Lower Back Pain. [Online] Available at: http://www.mytpi.com/articles/health/the_golfers_guide_to_lower_back_pain_part_1 [Accessed 25 March 2015]. Spine-Health, 2014. Golf and Back Pain. [Online] Available at: http://www.spine-health.com/conditions/sports-and-spine-injuries/golf-and-back-pain [Accessed 25 March 2015]. Stephens, G., 1995. Lateral epicondylitis. Journal of Manual and ManioulativeTherapy, Volume 3, pp. 50-58. Vicenzino, B. & Wright, A., 1995. Effects of a novel manipulative physiotherapy technique on tennis elbow: a single case study. Manual Therapy, Volume 1, pp. 30-35. Zusman, M., 2011. Mechanism of mobilization.. Physical Therapy Reviews, Volume 16 (4), pp. 233-236. Read More