Hi world!
After I posted previous mail I learned that the physiotherapy for
stenosis is directed at increasing mobility and reducing lordosis.
But I want to know the prognosis of stenosis by phisiotherapy.
How many treatments and term is needed for removing pain?
<mobilization of lumbar spine>
In my view A-P glide (not P-A)seems to be lessen lordosis.But I have
never heard of the indication of it for stenosis.
How do you think?
<mobilization of thoracic spine>
I would like to implement central P-A glide to thoracic spine,as there
is a remarkable kyphosis in thoracic.But as the patient could not maintain
prone position more than five minutes,the position which does not increase
lunbar lordosis will be needed, -- e.g.placing mat under the abdomen or
lying prone across the table with head and L/E unsupported by the table.
<exercise for a deep muscle group>
After the mobilization it seems to be important to maintain good
posture -- lessening lordosis.
For this purpose stabilization exercise for transversus abdominis and
lumber multifidus(though multifidus as extensor muscle may not
be indicated) seemed to be deemed essential.But considering that I can
meet the patient only twice a month and he seemed to be not so quick
of understanding,easy, easy home program should be suggested.
Hiro Wood
Japan
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$BAw?.<T (B : "Hiro Wood" <[log in to unmask]>
$B08@h (B : "For information & discussion on matters of relevance to manual
therapists." <[log in to unmask]>; "- for physiotherapists in
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$BAw?.F|;~ (B : 2002 $BG/ (B2 $B7n (B12 $BF| (B 20:56
$B7oL> (B : Intermittent claudication
> Hi World!
> Thank you for many helps when I posted last.
> Sorry for cross-posting.
> Today I want to ask about intermittent claudication.
> The detail of the case is as below.
>
> A 80 years old male has a symptom of intermittent claudication and
> presents with a few weeks history of right-sided low back pain(around
> PSIS) with radiation into the anterior? aspect of right thigh.
> One years ago he had a back pain after he walked for a long time and
> up and down many stairs.At that time he got well after the treatment
> of heat and electronial stimulation.
> He,at present,can walk only 10 meter without squatting for rest.
> He can ride a bicycle for a long time without pain.
> 1.X-ray(in my view)
> All lumbar spines have remarkable spurs.
> The interspace between the vertebral body of L5 and S1 seems to be
> narrower than others.
> 2.Inspection
> Moderate difficulty in turning on couch.
> 3.Palpation
> Tenderness over L5-S1 unilateral on R
> 4.Active movements
> Limitted extension.He complains of backpain after prone position for
> 3 minutes.
> 5.Dural signs
> nil
> 6.Neurological
> nil
> 7.Relieving(alleviating) posture
> He has already recognized most relieving(pain free)posture,which is
> lying on left side and rotating slightly left.When I rotate lumbar
> spine to the left further or to the right,he complains of pain.
> At the onset he couldn't lie on back without pain.
> 8.Interpretation
> Intermittent claudication reminds me of stenosis.The posture which
> opens left foramen of L5/S1 alleviates his pain.Unfortunately I have
> not lerned how to treat stenosis.It made me hasitate to do passive
> intervertebral movement test aggressively.
> In this case how do you develop(proceed)examination and interpretation?
> 9.Big question
> The difference between the concept of a orthopaedist and a PT about
> back pain has been a big problem for me.
> It seems that PT hasn't unique strategy for each diagnosis of orthopedist
> -- e.g.stenosis,spondylolisthesis ---. For example,Even if they are
> diagnosed
> stenosis by orytho.,PT tend to treat facet,ligament or muscle according
to
> his hypothesis which is difficult to be understood by ortho..
> This seems to be a big barrier to make orthopedists in Japan understand
> manual therapy.Here in Japan PT cannot do anything without their
> prescription,in which ortho used to order conventional physical therapy
> such as mechanical traction,hot pack,microwave and electronical
> stimulation.
> Is there a good answer for this question?
>
> Thanks in advance.
>
> Hiro Wood
> Japan
>
>
>
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