I have an interesting and challenging case I could use some suggestions for.
An otherwise healthy 24 year old female came to the clinic 1 1/2 years after
a motor vehicle accident resulting in an L5-S1 transverse process fracture,
and sacral fracturing x 3. She has a history of spondylolisthesis of the
lumbar spine. 7 months ago she had her coccyx removed. She presents to the
clinic with complaints of constant pain in the sacral region and low back,
and little/no tolerance for sitting or static standing. Examination reveals
nearly full trunk ROM with pain on extension. Strength findings are
minimal, with minimal decrease in hip rotation and flexion muscle power.
Flexibility of the hamstrings is good, hip flexors good. Special testing
reveals pain with SLR, Fabers, long sit and prone knee bend. Neuro signs
are negative. Palpation reveals significant severe pain with mild-moderate
pressure over the central lumbar spine, paraspinals, and entire sacral
region.
This patient is facing spinal fusion surgery if conservative physical
therapy is not successful.
Please email any suggestions for effective techniques to decrease pain,
increase stability, etc. to allow this patient to meet her goals for
recovery.
Thank you,
Amy Corazzari, MPT and Tricia Miller, PT at MacNeal Hospital, Berwyn, IL
%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%
|