Case Study: Jack
Jack is a 44-year-old sales rep for a pharmaceutical company. He enjoys the long drives daily meeting with customers far and wide and loves to being face to face with his clients. Speaking of drives, his passion is golf which takes up most of Jack’s weekends and holidays. However, the past month or so has been really busy with trips out of town each weekend for his twin daughters karate tournaments. Once back to his usual routine Jack decided to book a three day weekend to spend as much time golfing on the course as possible. Unfortunately, he “pulled something” in his lower back and struggled to get out of bed by Monday morning. Since Jack was still in severe pain Tuesday, he sought help. An x-ray and examination ruled out any serious pathology, so his doctor suggested over the counter pain relief and physical therapy for conservative treatment. The physical therapy assessment showed a few postural abnormalities, including an increased lumbar lordosis, increased abdominal mass, anterior pelvic tilt, and slight knee flexion while stood up. Manual muscle testing and flexibility assessment were hampered due to the pain levels he was experiencing and the clear acuity of his injury. Gentle range of motion exercises were given to Jack to try and the therapist applied moist heat and electrical stimulation to help with the pain Jack was experiencing.
- Is it coincidental that Jack hurt his back after a month away from playing golf? Explain your reasoning.
- As his therapist palpating the structures in Jack’s lower back, what do you expect you may find? How will you adapt your palpation techniques in relation to the pain he is feeling?
- During your postural assessment, which muscles do you expect to find are tight or shortened? What muscles weaknesses do you expect?
- How do you suggest any tight structures could be stretched or lengthened, baring in mind how many joints those muscles cross. How could stretching be conservatively introduced in consideration of the pain Jack is experiencing? How can this be stepped up in relation to a reduction in pain?
- When do you recommend Jack to return to Golf and what measures can he take to prevent further flare ups in the future?
Adapted from Dr. Tawny Chamberlain, PT, DPT, Department Chair and Program Director, Physical Therapist Assistant Program, South University, RichmondCopyright © 2020 Books of Discovery
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