Clinic

10-20-09

In clinic today, we began our day with a follow up assessment on the women in her mid thirties who complained of lower back pain. When we asked how the exercises we gave her last time were going, she told us that she could only get through one set with the prayer stretch. We then went on to re-assess her with lumbar mobilisations on T-12, L-1 & L-2 with Maitland's grades I & II on painful R side and grades III & IV on L side. These tests were done centrally and bilaterally. We noticed muscle spasms with in T-12, L-1 & L-2 R side. Her pain has gone down since last week when we last saw her. From there, we gave her some soft tissue massage and ending with giving her a revised Home Exercise Plan(HEP). On the HEP we took 2 out of the 3 sets in the prayer stretch seeing as how she could barely get through one last time but did add that if she felt capable of doing another set she should attempt. The next patient was also a follow up being a man in his early 70's complaining of lower back and R thigh pain. Since seeing him last week he has gone to get a MRI done but won't know his results till later next week. Doctors believe it could be spinalstenosis( spinal canal narrows & compresses the spinal cord along with the nerves) which would correlate with his pain into his thigh in regards with the nerve impingement. So we went on with a very light soft tissue massage over lumbar region. That is what we ended with and will wait till next week when we hopefully hear results from MRI. The following case dealt with a new patient, woman, in her later forties complaining of unstable R knee joint. Took her through some knee assessments and only found her to be quite laxity around the knee joint along with patellar misalignment to the medial aspect of knee. She has been a avid mountain hiker and cyclist but the only medical history she has had was from twelve years ago on a bike fall where she ended up braking her clavicle. Unfortunately, she has been living with this unstable knee for the last two years to the best of her knowledge and we can think it may be a degenerative disease. We did give her some strengthening exercises like the one legged squat but told her to only go down to 30 degrees. The last patient of the day was a N/P, woman, 18 year old footballer. Starting get pain around two months ago in L foot particularity the bottom of her heel as well as along the medial aspect of her foot. Pain is insidious so the patient is unaware of onset with lack of symptoms; just came about. The only medical history she has was she broke her L foot last year and was given orthodics for both feet but the orthodics turned out to be painful for her so she ended up not wearing them. Her tests that came up positive were resisted & passive inversion. We decided to refer her to the podiatrist as we though it was a mechanical problem on her gait analysis not a muscloskeletal problem.