Mel -
It's probably a spondylosis or spondylolysis until proven otherwise
and a bone scan would prove the point. If one goes to the writings of Dr.
Lyle Michele, from Boston Children's and Harvard, this is a classic
presentation. The mistake often made by clinicians is to evaluate the
youthful spine as an adult spine and reach the wrong conclusion. Good
luck...
Sandy
William S. Quillen,PhD,PT,SCS
Associate Professor & Director
Physical Therapy Program
Indiana University School of Medicine
Coleman Hall 120
1140 West Michigan Street
Indianapolis, IN 46202-5119
317-278-1851
[log in to unmask]
-----Original Message-----
From: [log in to unmask] [mailto:[log in to unmask]]
Sent: Monday, January 08, 2001 2:48 PM
To: [log in to unmask]
Subject: Athlete with Back Pain
A coaching colleague of mine has posed the following questions and is eager
to obtain some more professional comments.
Dr Mel C Siff
[log in to unmask]
-------------------------------------
<One of my teenaged athletes who has been having chronic lower back pain was
recently evaluated by a physical therapist. He did the knee jerk and ankle
jerk reflex tests, and told her that, based on these tests, the nerves
surrounding L5 disc were not affected.
In one of Cailliet's books, he says, "The knee jerk and ankle jerk reflexes
are routinely tested to determine the integrity of nerve roots L3-L4 and S1.
There is no reflex to test L5, as the muscles innervated by this root have
no
specific tendon."
This lass was having balance problems (always tripping over her feet) and
her
left middle three would often go numb. (In the past the doctor called it
"restless leg syndrome" and not to worry about it.) Cailliet says "The
ability to pick one's toes up and clear the floor while walking so one does
not scuff one's foot in walking is a function of L5."
My question is, has there been a change in the extend of the effectiveness
of
the reflex tests since Cailliet's books have been published? Or should my
athlete seek out another therapist?
Also, she had problem rising from a squat (and this is figure skater), but
in
an X-ray taken a year ago there was no problem with L3-L4. Calliet states,
"The L3-L4 nerves go to the thigh muscles. These thigh muscles extend
(straighten) the knee and permit a person to do a bend at the knees, do a
deep knee bend, rise from a sitting position, climb or descend stairs, and
do
squats. These muscles permit the patient to walk, run, jump, and so forth
by
virtue of the fact that they control the muscles that perform these
activities." Also, "By virtue of their specific distribution, if these
nerves (L2, L3, and L4) are irritated, they will cause weakness of the thigh
muscles. This weakness will make it difficult to do a deep knee bend, go up
and down stairs, or get in and out of a chair.
So, my second question is, is it possible that the X-ray is not a good way
to
determine irritation in the discs? Or could the doctor simply had misread
the
X-ray?
Any insight would be appreciated. >
----------------------------------------
Dr Mel C Siff
Denver, USA
[log in to unmask]
