Presentation: Rodger is a 45year old male suffering from ongoing low back pain, mainly on the right-hand side. Pain worsens when Rodger bends to put on shoes and there is often a popping sensation. He has attended physiotherapy sessions for a few weeks with limited results.
Daily Habits: Rodger spends long hours sitting at work. He spends his free time mainly with his family but enjoys cycling and playing tennis.
Diagnosis: Rodgers Xrays showed a decrease in L5 disc height. He also has a left short leg and an associated rotation through his pelvis. On testing, he shows no sign of disc aggravation. However, has some strain on his right L5/S1 facet joint. He also tested positive to Thomas test for hypertonic (tight) hip flexors and has a postural anterior pelvic tilt when standing.
Functionally: Rodgers back pain is being aggravated by a tight psoas muscle. He has lost movement and function through his hip joint, pelvis and lumbar spine. His activities; sitting all day and road cycling; increase the tightness.
Treatment: We started Rodger on 1-hour treatments, giving us time to manually release the lumbar spine, pelvis and psoas muscle. Pin and move techniques we used to stretch out and release the psoas, as well as diaphragm breathing techniques. Gluteals, rectus femoris and quadratus lumborum are also being manually worked. L5 facet is getting chiropractic adjustment for motion restrictions, as is the pelvis.
Exercises: We have asked Rodger to refrain from road cycling but encouraged him to continue all other exercises. He has psoas and iliopsoas stretches to complete 3 times per day. We are also getting him to do isometric clams, plank and bridge. Plus supine toe dips with his pelvis elevated on the foam roller.
Post-treatment results: The clicking has gone and Rodger can easily bend forward. He feels freer through his hips and now gets up in the morning easily without taking 20min to get moving. The stiffness in his joint is easing and activities are becoming easier and less painful.
Ongoing: Rodger is only 4 treatments in and has graduated to 30min sessions. He is feeling 50% better but still has treatments to complete. He will then be given ongoing dynamic exercises to help support his posture and prevent the anterior pelvic tilt in the long term. We look forward to seeing his continued progress.
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