We are frequently asked about what we do for specific diagnoses like rotator cuff pain, hip pain, scoliosis, lower back pain, etc.  The list goes on and on.  My initial response is always the same: “that depends on what we see on the initial examination.”  There are many causes of lower back pain.  Ask any clinician: PTs, orthopedic surgeons, nurses, PAs, neurosurgeons and they will all echo the same sentiment.  You can’t treat the disorder until you know the cause.  This rings especially true for the PT.

 

In the photograph below you are looking at an image of a young baseball player who was complaining of left lower back pain and right shoulder pain.  His diagnosis from the MD was simply: “Pain” in the respective body parts.  This, of course, is inadequate as a useful definition from a PT perspective, but it certainly points us in the right direction!  Once a patient arrives in the clinic we will begin an evaluative process that examines objective evidence as well as other obvious issues.  You may see friends or family members who have similar postural issues like this one pictured.

 

Presentation on initial examination:

Note the following: right shoulder lower than left, right scapula (shoulder blade) tilted and “winging-out” more than the left, right side of waist appears more concave than the left side, the hip crests seem “torqued” when comparing the right to the left.  These findings plus objective data noted on the clinical exam allow us to begin an intervention program designed to alter the cause of his postural deviations and his pain.  The end result is reduction of pain and in many cases changes in postural presentation. 

 Written by:    Mike Cantrell    |    Posted by:      Jen Zamora

As Physical Therapists, we are often asked to look at a great deal of different musculoskeletal problems.  Our observations on the initial examination are vitally important for the establishment of a sound treatment plan.

 

In the following videos I want you to look at the young lady and try to see the deviations in her gait pattern.

Click here to view the “Before” video.

 

Then look at the second video, which shows her gait pattern after multiple treatments.

 

 

She was not referred to therapy for alteration in her gait but for treatment of pain.  However, when we examined this young lady, we realized that the gait deviations were a significant part of her problem and were partly responsible for perpetuating her pain and were also a by-product of other larger issues.

 

In the first video of her gait, note that she appears to have a near collision of her knees as she swings one leg forward. Also, note the hyper-relaxed arm swing and that the arm swing is nearly side to side.  Note the dramatic internal rotation of the femurs as she loads weight onto her leg.  These are just obvious examples of instability created by a lack of recruitment of appropriate muscles.  It also indicates a pelvis that is rotated forward on both sides.

 

Take another look at the second video. This video was taken following multiple visits to Physical Therapy here at the Cantrell Center.  Note the major correction of the items outlined above.  This was accomplished with proper training of specific muscles.  Training certain muscles to lessen their activity and others to increase activity is a classic method for therapists to improve patient outcomes here at the Cantrell Center.

 

Written by:    Mike Cantrell    |    Posted by:      Jen Zamora