I agree that in typical LBP cases there is no value to seeing alignment, disc
space &/or degeneration.
In regards to Spondylothesis, if there is a suspicion of one present then an
x-ray would be appropriate. I advocate painfree extension exercises, shy of the
extremes of extension, in patients with Spondylothesis if the thesis is stable
and not active. If the patient is going to be doing functional activities into
extension then they should strengthen/stabilize into this ROM. Otherwise they
would be more likely to have further problems.
Douglas M. White, PT, OCS
Milton, MA USA
Michael Meddows wrote:
> Regarding Patrick Zerr's question:
>
> >Isn't there also some value to seeing the alignment, disc space and/or
> degenerative
> >changes?
>
> I would think "no". Degenerative changes are the norm in patients typically
> seen in a physio's office, disc space measurements from xrays are not
> reliable as they could be and 'abnormal' disc heights are not specific to
> anything in particular, and I don't know if alignment 'abnormalities' are of
> much help in planning a rehab programme. Of course there are exceptions such
> as in trauma, instability, and other cases, where seeing plain films will
> change treatment. (ideally the referral source is already aware, but you can
> never rely on that to be true)
>
> Most guidelines based on sound research state that x-ray studies should only
> be ordered if a red flag is present. Maybe there is also a point when an
> xray should be read if a spondylo is suspected.
>
> Can you justify using x-rays for LBP rehab based on anything opther than
> personal experience ( even if it is quite substantial ) ?
>
> >Do you get x-ray reports often? I do.
>
> Do they change your treatments? and how/why?
>
> >I typically avoid extension exercises when a spondylo is present.
>
> I think there was an article published regarding this issue recently, does
> anyone recall it?
>
> Michael Meddows
> [log in to unmask]
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