Managing a Female Patient with Left Low Back Pain and Sacroiliac Joint Pain with Therapeutic Exercise: A Case Report

Physiotherapy Canada. Physiotherapie Canada - Tập 63 Số 2 - Trang 154-163 - 2011
Kyndall L. Boyle1
1Kyndall L. Boyle PT, PhD, OCS, PRC: Associate Professor, Northern Arizona University, Flagstaff, Arizona.

Tóm tắt

Purpose: The purpose of this case study is to describe the management of a female patient with chronic left low back pain and sacroiliac joint pain (LBP/SIJP) using unique unilateral exercises developed by the Postural Restoration Institute (PRI) to address pelvic asymmetry and left hip capsule restriction, which is consistent with a Right Handed and Left Anterior Interior Chain pattern of postural asymmetry.Client Description: The client was 65-year-old woman with a 10-month history of constant left LBP/SIJP and leg pain.Intervention: The patient was seen six times to correct pelvic position/posture and left hip posterior capsule restriction via (1) muscle activation (left hamstrings, adductor magnus, and anterior gluteus medius) and (2) left hip adduction to lengthen the left posterior capsule/ischiofemoral ligament. Stabilization exercises included bilateral hamstrings, gluteus maximus, adductors, and abdominals to maintain pelvic position/posture.Measures and Outcome: Left Ober's test (initially positive) was negative at discharge. Pain as measured on the Numeric Pain Rating Scale (initially 1/10 at best and 8/10 at worst) was 0/10–0/10 at discharge. Oswestry Disability Index score (initially 20%) was 0% at discharge. The patient no longer had numbness in her left leg, and sexual intercourse had become pain free.Implications: Interventions to restore and maintain the optimal position of pelvis and hip (femoral head in the acetabulum) may be beneficial for treating patients with chronic LBP/SIJP. The patient's pain was eliminated 13 days after she first performed three exercises to reposition the pelvis and restore left posterior hip capsule extensibility and internal rotation.

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Tài liệu tham khảo

Waddell G, 1987, Spine, 12, 632, 10.1097/00007632-198709000-00002

Maigne JY, 1996, Spine, 21, 1889, 10.1097/00007632-199608150-00012

O'Sullivan PB, 2002, Spine, 27, E1, 10.1097/00007632-200201010-00015

McKenzie R May S, 2003, The lumbar spine: mechanical diagnosis and therapy, 2

Maitland G, 1986, Vertebral manipulation, 5

Solomon J, 2004, Phys Med Rehabil Clin N Am, 16, 177

Aure O, 2003, Spine, 28, 525

Porterfield J, 1998, Mechanical low back pain: perspectives in functional anatomy, 2

Kisner C, 2002, Therapeutic exercise foundations and techniques, 4

Lee D, 2004, The pelvic girdle, 3

Roncarati A, 1988, J Manip Physiol Ther, 11, 158

Nadler S, 2003, Arch Phys Med Rehabil, 84, 329, 10.1053/apmr.2003.50102

Young J, 1997, Med Sci Sport Exerc, 29, S222

Rittenberg J, 2003, Phys Med Rehabil Clin N Am, 14, 111, 10.1016/S1047-9651(02)00082-7

Bodack M, 2001, Clin Orthop Relat Res, 384, 144, 10.1097/00003086-200103000-00017

Kisner C, 2002, Therapeutic exercise foundations and techniques, 4, 418

Sahrmann SA, 2002, Diagnosis and treatment of movement impairment syndromes

Damen L, 2002, Clin Biomech, 17, 495, 10.1016/S0268-0033(02)00045-1

Boyle K, 2009, Physiother Theory Pract, 25, 44, 10.1080/09593980802622677

Boyle, K (2006).Ethnography of the Postural Restoration subculture: a posture based approach to patient/client management [dissertation].Fort Lauderdale (FL):Nova Southeastern University

Kendall FP, 2005, Muscles: testing and function, with posture and pain, 5

Hruska, R (2005).Myokinematic restoration: an integrated approach to treatment of patterned lumbo-pelvic-femoral pathomechanics [course manual].Elon (NC):Postural Restoration Institute

Ebmeier, J, Hruska, R (2007).Postural Restoration Institute [Internet]. updated 2008; cited 2007 Dec 28Lincoln (NE): The InstituteAvailable from: http://www.posturalrestoration.com/

Masek, J (2007).Soccer hip impingement as it relates to postural restoration, part III: management considerations.Performance Soccer Conditioning.1-4

Hruska, R (2005).Advanced integration assessment and treatment of patterned pathomechanics [course manual].Lincoln (NE):Postural Restoration Institute

O'Sullivan S, 2001, Physical rehabilitation: assessment and treatment

Levangie P, 2005, Joint structure and function: a comprehensive analysis, 355

Magee D, 1997, Orthopedic physical assessment

Boyle K, APTA Annual Conference San Antonio, TX

Magee DJ, 1997, Orthopedic physical assessment, 4, 567

Norkin C, 1995, Measurement of joint motion: a guide to goniometry

Fairbank J, 1980, Physiotherapy, 66, 271

Ostelo RWJG, 2005, Best Pract Res Clin Rheumatol, 19, 593, 10.1016/j.berh.2005.03.003

Hruska, R (2003).Myokinematic restoration—an integrated approach to treatment of lower half musculoskeletal dysfunction [course manual].Lincoln (NE):Postural Restoration Institute

Moore, KL, Dalley, AF (2006).Clinically oriented anatomy. 5th edPhiladelphia:Lippincott Williams & Wilkins

Oatis CA, 2004, Kinesiology: the mechanics and pathomechanics of human movement, 661

Hruska R, 1997, Dental Clin N Am, 41, 211, 10.1016/S0011-8532(22)00081-7

Hungerford B, 2003, Spine, 28, 1593

Kendall FP, 1983, Muscles: testing and function, 3

Cook C, 2008, Orthopedic physical examination tests: an evidence-based approach, 259

Melchione W, 1993, J Orthop Sport Phys Ther, 18, 511, 10.2519/jospt.1993.18.3.511

Fardon DF, 2001, Spine, 26, E93, 10.1097/00007632-200103010-00006

Cibulka MT, 1998, Spine, 23, 1009, 10.1097/00007632-199805010-00009

Kasai R, 2006, J Phys Ther Sci, 18, 97, 10.1589/jpts.18.97

O'Sullivan P, 1997, Spine, 22, 2959, 10.1097/00007632-199712150-00020

Richardson CA, 1999, Therapeutic exercise for spinal segmental stabilization in low back pain: scientific basis and clinical approach

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Physiotherapy Canada. Physiotherapie Canada

Tập 63 Số 2

154-163

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