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MK Case Study

MK Case Study. Patient Profile. 22 year old man: bartender/student LBP onset 2 weeks ago (15 days) Spread to R gluteal pain 10 days ago. History. Onset AM after flag football game Gradual onset with return to work (bartender) Denies pain during game Previous Hx of ruptured Left RF

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MK Case Study

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  1. MK Case Study

  2. Patient Profile • 22 year old man: bartender/student • LBP onset 2 weeks ago (15 days) • Spread to R gluteal pain 10 days ago

  3. History • Onset AM after flag football game • Gradual onset with return to work (bartender) • Denies pain during game • Previous Hx of ruptured Left RF • No Rx • No Meds • No radiography

  4. immediate with standing Standing > 1/2 hr spreads to gluteal pain Running immediate increase in LBP stopped activity Prolonged sitting (>30) increases LBP Sitting relieves 5”, immediate return with return to stand Sit 15” to relieve Cannot run Must lay down 30” to relieve Able to sit if on L ischium only Aggravating …………Easing

  5. Observation • Stands WB primarily L LE • Slight L shift (contralateral) • Corrected SB R Upper Lumbar

  6. Objective • Flexion: deviates L, poor unrolling of lordosis limit finger tips to mid tibia No change in LB SM Correction of deviation some increase in pain improves range

  7. Objective • Extension: 0-5 degrees deviates to L Increases his comparable LBP correction increases c/o pain more

  8. Objective • SB R 0-5 degrees -increased his LB pain - flattened curve • SB L 0-15 degrees - painless

  9. Palpation • Hypomobility into extension L4 & L5 • *Stiff & painful with central PA @ L4> L5 • **Stiff & painful with R unilateral @ L4 • Slight decrease pain with R unilateral @L5

  10. Objective • Neurological: clear DTR, Myotome, Sensation • Special Test -

  11. Pain scale • Patient: @ rest “4/10” • Standing > 30”: 8/10 • Sitting > 3”: 3/10 • Running: 0/10 stopped activity • Lifting: 1/10

  12. Hip MobilityR L • Flexion 140 140 • Extension 15 20 • XR 60 60 • IR 40 45 • ABD 45 50 • ADD 20 20

  13. PSFS • Standing: 2 • Sitting: 4 • Running: 0 • Lifting: 2 • TOTAL =8 8/4 activities = 2

  14. ODI & FABQ • Oswestry Score: 20 = 40% • FABQW: 19 • FABQPA: 39

  15. CPR • No Sm distal to knee • < 16 days • FABQW = 19 • Hypomobility 4/5, 5/1 extension • Hip IR >35

  16. CPR • No Sm distal to knee • 15 days • FABQW < 19 • Hypomobility 4/5, 5/1 extension • Hip IR >35 both sides • Woahh ! 5/5 Positive Likelihood Ratio: infinite

  17. Trial Treatment • Supine LS V GPM in RSB Post • painless in standing • Extension: 10 degrees, decreased deviation, painfree

  18. Treatment 2 • Pain: 3/10 at rest in standing • Extension: 10 degrees, then pain dev L • SB R 10 degrees, P+ • Repeat V

  19. Treatment 3Pre-Rx • Painscale: 1/10 rest • Extension: 15 degrees no deviation, no pain • SBR 15-20 degrees P- • Rx -Active extension/active exercise

  20. Initial Re-test • Pain Scale: 6 1 • PSFS: 2 8 • Oswestry: 20 5 • FABQ: 19 6

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