A golfer with acute onset of low back, hip and anterior thigh pain with pins and needles, and numbness. She has constant pain worse with sitting AND standing, and has failed other conservative treatment. Has Sherlock met his match this time?
In this case study, Titled Musculoskeletal and Sports Physiotherapist Nick Kendrick (aka Sherlock Holmes aka the "Back Whisperer") assesses and treats a patient with pain and neurological symptoms. Discover how you can tie together your patients' history, symptoms and physical tests into a diagnosis and successful treatment
Part 1
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Patient history and body chart - Acute low back pain with pins and needles and numbness in the anterior thigh, following golf.
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Provisional diagnoses/DDx
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How to differentiate beween
- Upper or lower lumbar spine
- SIJ
- Hip
- Red flags
- Other sources of paraesthesia/anaesthesia
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Imaging findings and relationship to symptoms
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Mechanism of injury - golf, and relationship to pain
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How to identify if the SIJ is a source of nociception
Part 2
- Objective findings
- Neurological testing
- Neurodynamic testing and relationship to symptoms
- Nerve compression identification with neurodynamic testing
- Likely diagnosis
- Treatment, targeted manual therapy and home exercise program
Part 3
Followup treatments
- Key reassessment findings
- Manual therapy on followup sessions - What to do if your previously effective techniques do not work on subsequent sessions
- Home exercise progressions
- Incorporating patient goals into your rehabilitation program
- Patient advice
3rd treatment
- Additional home exercise progressions
- Graded return to golf
4th treatment
- Strengthening progressions
- Functional exercises
- Manual therapy progressions
- Full rehabilitation through to return to competition
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