Combined movements

Hi all
Thanks to Caris for her comments on my last post. That particular patient has since improved somewhat, and during my last session with her I concentated on reminding her how much she had improved in a week.

I know we are supposed to blog about clinical situations that we are having some trouble with, but my last week in Tom Price was really positive. With this in mind I wanted to tell you about a learning experience. Last Monday I had 6 new patients (all outpatient musculoskeletal). Two of them were acute back pain resulting from injuries sustained less than a week previous. One of these patients presented with alot of pain after spending the previous day rushing around the house doing the vacuuming. I did the subjective and objective and decided to talk to my supervisor about it before I started treatment. Although I had a reasonable idea of what was going on, I wanted to have a look at some treatment options that wouldn't aggravate or increase her pain. We discussed the patient and I noted that she had an opening/stretching (as opposed to closing) pattern of pain on movement. My supervisor decided that we should take a combined movements approach, which I didn't know much about. We looked at her two worst affected movements - flexion followed by right side flexion (both causing pain on the left side). From my understanding, combined movements approach involves picking the two worst restricted movements and working away from the pain. So, the ideal teatment plane was flexion and right side flexion. Because the patient was very sore, the first session used flexion with left side flexion (which was a movement that eased her pain). The treatment was done with the patient in right side lie and in as much flexion as possible. The I did some grade 3 side flexion mobs (same as used for side flexion PIVMS). The result was an increase in flexion and right side flexion with a reduction in pain. The most important part was that the treatment wasn't painful at all. Other treatment options (such as unilateral mobs ..) would have been too painful. I saw the patient again two days later and did the same treatment, but the side flexion was into right side flexion this time. The patient is still sore, but her pain has been reduced significantly and her AROM is almost back to normal. What I liked about this (apart from having some good treatment effect) is that I feel I am adding to the options I have to choose from when I decide on the treatment I am going to carry out.

Anyway that's all from Tom Price
M