Simple Yet Comprehensive Clinical Management

Sometimes patient care is more simple than you think.

Far too often I see individuals receiving therapy for acute or subacute low back pain who simply aren't getting any better. They've received the best manual therapies, have been diligent with their "core" exercises, and are taking the necessary prescription medications to accelerate the inflammatory and tissue healing processes.

However, for some reason or other, they're progress is lacking. Occasionally this may be iatrogenic in nature and sometimes it may simply be a lack of necessary rest, but commonly, it is merely a function of not doing the little things necessary to minimize the aggravating factors the other 23 hours of the day that they are not in your clinic.

Think about it. Let's say you have a low back pain patient who is flexion intolerant. They may be an office worker, a "turtle" if you will, who sits at their desk all day. They may be a welder or mechanic hunched over at the job site. Or they may be an athlete who consistently exhibits poor technique with their training.

But maybe they are none of the above.

Maybe, just maybe, they are doing everything right. Right?

Wrong! Circle gets the square!

Perhaps you should ask them how they brush their teeth, pick up their child, lift a dumbbell off the bottom rack, get in their truck, etc. I guarantee you that their not consciously thinking of proper mechanics as they go about their daily activities. Sure we don't want to have to think about what we do when we're fully recovered, but when we're recovering, this is important.

Extremely important!

How many of you have recommended to your patients to "bend at the knees" when picking things up off the floor? If you raised your hand, slap it with the other hand. Bending the knees just perpetuates the problem.  Don't believe me? Just drop a pen and ask your next patient to pick up the pen with bent knees. Watch that low back flex like theres no tomorrow.

Here's a better solution:
.

• Tell them that they should act like a sumo wrestler and utilize their hips every time they lift, bend, sit, etc. Not only does this include when they sit on a toilet but also when they wipe with TP.
• Watch them get into their vehicle. Ask them to drive that right foot as close to the gas pedal as possible so that they may be able to utilize the sumo technique described above.
• Ask them to make sure that they always maintain a neutral spine. You'll probably need to demonstrate and explain what this is.
• When getting up off a chair, tell them they need to "spread the floor". This is a technique the powerlifters use when squatting heavy weight in order to maximize gluteal recruitment and subsequently, hip joint involvement.
• When necessary, ask them to utilize a low level abdominal brace to ensure volitional stability. This may not be necessary when they fully recover but while their still suffering, it is important.

Simple stuff folks. Kinda like using the john.
Look forward. Adopt a wide stance. Hold the load close. Ensure a tight grip. Breathe.So before you apply the latest and greatest of manual and rehabilitative techniques on your patient, make sure that you are first removing the aggravating factors!