Look at inc'd tension/dysfunction in the psoas/iliacus Bilaterally. I've
found that these contribute significantly to pain in that region. Soft
tissue techniques as taught by Gregg Johnson (Institute of Physical Art,
Colorado) are very successful.
> -----Original Message-----
> From: Miller, Tricia [SMTP:[log in to unmask]]
> Sent: Friday, January 29, 1999 3:50 PM
> To: [log in to unmask]
> Subject: sacral fracture
>
> 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
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