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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