This is the last post and answer to how I treated a difficult case that popped up on me.  Before reading further, go back and read part 1 here, and part 2 here.

So, I was becoming quite frustrated to improve these symptoms, provide a centralization phenomenon, and just in general do more than ‘dampen’ the symptoms.  Instead of going further writing in third person, I will change to first person narrative: because this case is about me.

As described in part 1, the symptoms go so bad one day about mid-day at work that I could not even walk to talk with other coworkers and more importantly, just could not perform my job.  I was so focused on this constant complaint that I was not listening to my patients, I would just sit down beside them and really went out my way to do less than I needed to.  This had to stop for many reasons (pain mostly!) but I like to give it all to my patients and I was taking my own personal issues ahead of them.  Plus, I was about to go on a continuing education trip (needing to fly, walk in airport, stand at course, etc.) the next day and then travel to Chicago for a personal trip the following weekend.  This had to be fixed.  I was about to give up and go get a prednisone series! (no!) and go the medical route.  Instead, the pictures below show what I did.

I brought myself up in as much lumbar flexion as possible.
I then rocked my hips to the right.
I then rocked back to the left (actually felt more restricted this way…approximately 15-20%).

So I performed this exercise for about 3-4 minutes straight and blam!, got up and symptoms were abolished.  Not a dampen, not a “I think this is better”, but my brain actually giving me positive signals.  I had a full explosion of relief and overall just felt unthreatened.  If you have ever had “nerve pain”, then you know what I mean.  This is no joke and now I understand how my patients feel when their referred symptoms are improved, or abolished in the matter of minutes.

So, the next question is, “what was wrong!?”.  To be honest, I try not to care too much about this as it leads into psychosocial aspects (such as, wow, was this a discogenic issue?  will I have it the rest of my life?).  This aspect of pain is real and very difficult to get ‘off’ your mind.  Sometimes ignorance is bliss as I wish I would not have thought about it as much.

I may have had an extreme lateral and possible anterior derangement on the left side that responded best to full flexion in sagittal plane, and then transverse plane by rocking.  Or, symptoms could have arisen from the thoracolumbar junction, and then exercise helped ‘flatten’ this area to decrease the amount of extension.  I may never know fully but would like your feedback.  What do you think?

 

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12 comments

  1. Well, I chose it mainly in that Extension-based treatment were not working (and had not worked in both a prone press-up with multiple trials of having the pelvis shifted (with and without overpressure), manipulation and just simply being active (standing more at work while working with pt, making a desk that I could stand at to do work…as I have been sitting more driving). It seemed as more extension was not the answer!
    So, I just got down and tried this as actually being more lazy (not exercise as much) with a poorer posture helped! I have full ROM and no pain with it, so I just took it way up and got as much flexion as I could. Then I just started rocking. Nothing hurt…as no other exercises hurt in particular except and I had more numbness after I ran or swam.

    I know I should be able to get rapidly reversible results for a mechanical problem. I was getting frustrated…wanting some medication as there may be a chemical component to what is going on.

    Heck, it worked!

  2. I (and the owner of the clinic who still treats more than any other owner I know!) thought that sometimes the TLJ region can refer in a stocking-glove pattern. I had this area manipulated two different ways and some improvement, but may have just damped the symptoms but not abolished.

    I also knew poorer posture seemed to be better believe it or not so I wanted to promote as much flexion as the TLJ vs extension. Such as if I walked with a more flexed posture such as looking down as slouching, the symptoms at their peak was not as bad….

      1. This is described as the two-leg rotation or “gate” technique. Supine, flex hips up, rotate toward side of pain. Once pain is felt, try flexing or extending slightly to dec pain, tthen rotate farther, once again flex or extend to try to dec pain and try rotating farther. This sounds a little different than what you were doing, but the idea is similar. If you have a spine model that gets twisted up, you can imagine how you need to move things around back and forth to get things aligned again. I don’t know if that is what is actually happening, but as long as the pain goes away, it’s all good.

      2. Jason,
        Thanks for checking this out! I did borrow a colleague’s Mulligan book and found what you are describing. This is definitely similar to what I did. I just made mine up based on what worked best for me, but good to have parallel thought processes with one of the best in the field. If it acts up again, I’ll try this technique (I may just need to be in more flexion). No pain at all with mine in the back with any exercises so definitely a little different.

        Best,
        Hv

  3. I am a student researching stretches and physical therapy and I have a few questions. I have had back problems in the past due to tight hamstrings. If I did not go through physical therapy, do you believe that I would be able to do things like, play volleyball, run, and simply bend over without pain? Would the pain have gotten worse if I did not do the stretches I was given?

    Thank You!
    -Bella

    1. Bella,
      It is tough to say if you did not go to PT that you would have not gotten better but it seems e stretches do help. If you can keep your pain away by stretching, then I would continue with them.

      Hope this helps,
      Harrison

      1. Harrison,
        Would you say the main benefit of PT would be that it just simply reduces pain? Are there anymore benefits?

        thanks again!
        -Bella

      2. Bella,
        Much more benefits but pain relief is surely one of the top benefits. Your home program should assist in preventing the onset of pain again, get you back to your prior level of function or even more of an active lifestyle. It should also expose that you can be an integral part of your own health and allow you to start treating yourself. You can’t do that with medication.

        Harrison

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