Many labral tears are caused from shoulder dislocations. Anterior dislocations are most common and are often caused from a forceful collision, fall on an outstretched arm, or a sudden wrenching movement. The patient may present with apprehension at end ranges of motion.
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Thoracic Outlet Syndrome can be tricky to treat because it can have both arterial and venous contributions as well as having multiple entrapment sites. Often times patients will complain of numbness or tingling in their hands as well as saying that their arms feel weak or even cold. Typically overhead movements of the upper extremities make the pain worse.
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Image via Complete Anatomy 2018 by 3D4 Medical
If you suspect that your patient has thoracic outlet syndrome this test is a good place to start. If this test is positive then you can continue further testing to figure out which entrapment site is the issue. (Click image to watch 1-2 minute video)
Once the entrapment site is found, manual therapy is a good choice to work on mobility in the area. The first rib is a common entrapment site. Take a look at how it can be mobilized! (Click image to watch 1-2 minute video)
Once you have worked on the entrapment site it is important to get the nerves and vessels moving again. This can be done through nerve sliders. After the patient has mastered sliders, is not irritable, and only has pain at or near end range make sure to progress them to tensioners! (Click image to watch 1-2 minute video)
1-year incidence of a first-ever episode of low back pain to range between 6.3% and 15.3%, while estimates of the 1-year incidence of any episode of low back pain range between 1.5% and 36%.
Low back pain is the leading cause of activity, limitation and work absence throughout much of the world and is associated with an enormous economic burden.
Individuals who have experienced activity-limiting low back pain often experience reoccurring episodes with estimates ranging between 24% and 33%.
See more prevalence information in the Clinical Pattern Recognition: Orthopaedics app here
Meet the 6 common low back pain patients from the Clinical Practice Guidelines!
Click on the pain pattern to learn about the patients and develop your clinical patterns!
Do you have a patient who has pain extending back or with rotation? That pattern is similar to that of lumbar facet syndrome. Look below for some things to consider!
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Image via Complete Anatomy 2018 by 3D4 Medical
A common movement fault seen with facet syndrome is extension rotation. Which means every time a person rotates their body to the R or the L they are also extending back which puts increased compression onto the facet joint. This will lead to irritation over time with repeated movements. (Click image to watch 1-2 minute video)
The above test on the left is apart of the “Clinical Pattern Recognition (CPR) for lumbar facet syndrome.” This is a grouping of 5 measures that are highly predictive for ruling in lumbar facet syndrome. These measures include a facet that is over 50 years old, someone who feels best walking, feels best sitting, onset is next to the spine, and they have a positive quadrant test. This CPR has been designed to help the Physical Therapist better ascertain the likelihood of Lumbar Facet Syndrome as a diagnosis. (Click image to watch 1-2 minute video)
Consider utilizing manipulations to reduce pain and disability in patients with mobility deficits who have acute low back pain. If all criteria from CPR are met consider using this technique. Check out the video above! (Click image to watch 1-2 minute video)
Therapeutic exercises chosen should always closely match treatment give in clinic; in this case the manipulation would address the mobility deficit. However, if manipulation is not appropriate for treatment another method would be to increase mobility of the lumbar spine. Quadruped rock backs work to help create space between the facet joints which can help to ease pain. This exercise can help increase lumbar flexion range of motion! Do not forget to correct the movement fault to help prevent any future irritation of the facet joint. (Click image to watch 1-2 minute video)
Do you have a patient who has low back pain across their whole back? Do they have pain bending forward and extending back or have had multiple occurrences of their back “going out” on them over the past couple of years? That pattern is similar to that of lumbar muscle strains. Look below for some things to consider!
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Image via Complete Anatomy 2018 by 3D4 Medical
A common mechanism of injury for lumbar strains are unaccustomed repeated movements of bending and lifting activities such as shoveling. This can be caused by is too much mobility from the lumbar spine and not enough mobility coming from the hip. (Click image to watch 1-2 minute video)
The above tests can be helpful to physical therapists to better ascertain the likelihood of lumbar muscle strain. A good way to “rule in” or “rule out” a muscle strain is if the muscle is 1) tender to palpation, 2) hurts when contracted, and 3) hurts when stretched. (Click images (Left/Right) to watch 1-2 minute video)
Above are two treatment techniques that can be used for both acute and subacute patients. The video on the left can be used for a patient that has a high level of pain. The video on the right can be used to help alleviate trigger points, muscle spasms, or decrease pain. (Click images (Left/Right) to watch 1-2 minute video)
Therapeutic exercises chosen should always closely match treatment give in clinic; in this case the above treatments would help to decrease pain and relax the paraspinal muscles. Consider using trunk coordination, and strengthening exercises to reduce low back pain and help with movement coordination impairments! (Click image to watch 1-2 minute video)
