STARES 2

STARES 2

SITUATION
In outpatients I had been referred a patient who was approximately 26 weeks pregnant. She had been suffering from back pain for a few weeks. This referral did not give any more information. After talking to the patient I found it was a fairly constant pain that gets worse when she sits for long periods (especially at work when she often crosses her legs or sits slumped to one side). Although she had tried heat packs and other forms of pain relief it did not seem to get better. I pin-pointed the pain to the lower thoracic spine but found it could also go down into her lumbar spine.

On objective examination I found that her most painful movements were left rotation and right side flexion. On palpation there was a little tenderness through the spine, and I found quadratus lumborum on the left was quite tight in comparison to the right side.

TASK
I had to treat this patient’s back pain while taking into consideration the fact she is pregnant (which has physiological effects on the body but can also affect my treatment and the positions I can get the patient into).

ACTION
I thought that opening the spine on the left may be the problem. I started with some rotation snags where the patient rotated to the left. After a set of these there was no change in the patient’s pain levels or range of movement. I then tried snags into right side flexion. After one set of these the patient’s pain levels had decreased and she found it easier to move into right side flexion. I decided to do another three sets into side flexion and by the end the patient’s pain had decreased into side flexion (but had not changed into left rotation).

I decided to treat the left quadratus lumborum which was tight in comparison to the right. I decided to massage the muscle on the left, however I would normally do this in prone. This patient could not lie on her stomach as she was pregnant, so I chose to modify this position where the patient was in standing, supporting herself by leaning over the plinth. I could feel the muscle releasing as I massaged, and after finishing the patient could move into left rotation and right side flexion much more easily. I showed her some stretches to do at home and encouraged her to get her partner to continue with the massage at home.
Next I addressed her posture. She commonly crossed her legs and was sitting slumped to the side without even realizing it. I used proprioceptive taping to make her aware of her posture. The tape would not hold her in a specific posture but would remind her she was doing something wrong if she slumped.

To finish with I taught her some pelvic floor muscle exercises. These wuld benefit her in improving core stability (which may help with her bacj pain) but also prepare her pelvic floor muscles before childbirth.

RESULT
The patient’s back pain had improved during the session and she had a home exercise program to continue with on her own to help prevent the quadratus lumborum from tightening up again (and therefore preventing her back pain from returning). I am planning to see this patient again in one week to see if this treatment has longer lasting results and if she can manage this on her own at home.

EVALUATION
I feel I did a good job with this treatment. Although my first choice of rotation snags were not effective, I changed what I was doing instead of wasting time on a treatment that was not working. I felt I did a good job of modifying my massage by choosing an appropriate position for a pregnant lady. I think it was a good well-rounded treatment session as it included a lot of education, some hands on treatment and exercises for her to do at home.

One thing I did not do so well was getting the patient to move around too much. I did my assessment in standing, before getting her to sit on the plinth, then lie down. This part was good, however in my treatment I had her lie down, then sit, the lie, then sit again, then on the floor for an exercise. This is particularly uncomfortable for someone with back pain (especially when they are pregnant).

STRATEGIES
I should structure my treatment so I do everything I need to in one position before getting them to move into another. I need to think ahead of what I will likely be doing throughout the session.