This week I have a brief summary of an examination that did not lead to reproduction of symptoms. As neuromusculoskeletal experts, physical therapists look to reproduce a patient’s primary complaints of pain, as one of the many things that we do. Physical therapists examine bodily movement, along with gathering a subjective history, to gain an understanding of how a particular motion may elicit symptoms. As a quick example, if someone was to have an Achilles tendon pathology, the patient would typically report pain with walking, ascending stairs, and coming up from a squat, which could then be reproduced in the clinic.
My patient reported low back pain with a gradual onset and no recollection of a cause. The patient did not present with any red flags or signs that indicated the pain to be outside of our scope of practice. During my examination, his/her symptoms of pain could not be brought on; however, the history did include that pain increased with prolonged sitting or standing. Movements involving the thoracic spine, lumbar spine, and hip could not reproduce his/her back pain, not even mobility testing. However, the patient did reveal significant lumbar paraspinal muscular tightness during palpation, within the area of his pain, which correlated with his/her sway back posture in standing. With a sway back posture, lumbar extensor muscles can be constantly turned on and shortened, think of it as irritating those muscles. My clinical instructor and I hypothesized this to be the cause of his pain, along with weak spinal stabilization musculature.
However, this was not all we found. This patient also presented with significantly tight hamstrings, weak hip musculature, forward head and rounded shoulders posture, and poor standing balance. These are impairments that could easily lead to decreased mobility and function. He/she did not expect these results from the examination, nor would anyone else expect to have these. The truth is that many of us could have impairments and not even know it until having been examined by a physical therapist. Though you are not having pain from these, some may affect you in the long run.
- Patrick Berner, SPT