Question 20

We often get feedback from course participants that the course doesn’t provide enough information on treatments.  Hopefully, we did better this time!  For the female with low back pain in the videos, I categorized her as lumbar rotation / extension syndrome.  This was my attempt in changing her gait pattern.  Please watch this video to get an idea of my treatment for her.  The big idea is using MOVEMENT to treat the patients based on the movement system diagnosis.  Prioritize modifying the patterns in functional movements, rather than only giving them exercises.

Question 21

Your patient works in a factory and the conveyor belt is on his left side, requiring him to repeatedly rotate to his left.  After the initial evaluation, you categorized him as Lumbar Rotation Syndrome (secondary type).  What is the most important homework for this patient before his next PT treatment session?

• Practice optimizing thoracic rotation or step around with the feet while he is reaching to the conveyor belt, rather than rotating from his lumbar spine at work, as often as he can.

In addition to thoracic rotation, if the patient has hip rotation mobility (pelvis rotating over the femur), you can also encourage the patient to rotate the whole pelvis / knee / feet on the supporting surface. 

The point of this question was to prioritize the quality of how the functional task is being performed over any of the exercises, as supported by Van Dillen’s work in JAMA 2020.

Question 23

Your 70-year-old female patient experienced pain in the lumbar spine during the supine active unilateral hip and knee flexion test. The patient stands in a lordosis and has a short iliopsoas bilaterally. Which of the following exercises would be the best treatment choice to address this problem?

• Supine: passively hold 1 knee to chest while sliding other hip and knee into extension

When instructing this exercise, PT and patient need to monitor the pelvis and stop the hip / knee extension motion when the pelvis tilts anteriorly.  Do not fully extend the hip / knee.  The point of the exercise is to elongate the hip flexors while stiffening her abdominals within her current available ROM.

Since there is a high probability that she may extend her lumbar spine during return to hip / knee flexion, and/or gets pain, she needs to return by sliding her heel along the supporting surface emphasizing flexing the knee versus mostly contracting the hip flexors.