In physiotherapy schools and physiotherapy continuing education courses, many hours are devoted to learning how to reach patients. We recently interviewed a leading rehabilitation specialist and interviewed him on how to assess lumbar problems. Here are some questions and answers.

Interviewer: If we switch to more assessments here, can you describe how you evaluate patients with lumbar spondylosis?

Spinal rehabilitation expert: from

 Yes. This may not be the standard fare that people expect. If I really need to sort it out, I need about three hours and then start with the interview. I asked the patient about their pain pattern. What they see is the pain caused by activities, movements, postures and loads. What can they do without feeling pain? For example, when they turn over on the bed, will they suffer severe pain? For example, this would indicate unloaded spinal instability. So, we have a series of questions that explore their attempts to understand the nature of their pain. There are other things, such as what they are doing for them now? What kind of therapy they have tried in the past, but it has no effect, this kind of thing.

Then we look at their exercise habits, which is huge. We watched them enter the waiting room from the beginning. How are they sitting? Patients often sit in a way that causes back pain. This is almost contradictory. If someone flexes intolerance, they will bend their knees. If their extension is intolerant, they almost always sit and stretch. So this is a huge clue. Just watching them out of the chair. If you know that there are signs of gluteal deficiency and hamstring predominance, for example, this is a very common chronic pain patient.

Then we watched them walk. Then, if they say electricians, we might watch them bend over, go down to the floor, come back again, all these things. If they are athletes or athletes, we will ask them to do some painless and painful exercise. Therefore, these are characteristic patterns of exercise or habits that, if they do not change, often hinder the recovery of the patient.

Interviewer: Correct.

Spinal rehabilitation expert: from

 So now we understand why it is causing their suffering, and we already have some good ideas. We now prove this through provocative tests. We tried to provoke their pain. Does this make you worse? If they say "yes", then we are now fine-tuning it and honing it at a level, level of tolerance and capacity.

All of this is now used to guide the design of corrective and therapeutic exercises. Correct the patterns, lead to their habits of pain and tolerance, and then design progress; therapeutic movements starting with corrective exercises. Stabilize those factors that need stability. Mobilize those elements that are too rigid.

Then enter endurance training and you must find all the power. Adding more power to a painful back is often problematic because in the literature, power does not prevent future back troubles. As we have found, the reason is that you can choose a strong person, they can do three or four times the perfect power action, and they are protected. In the sixth time they began to fatigue, they broke a little bit of form. That is the time for them to retreat. Therefore, if you want to re-use power, the patient or athlete must have enough stamina to ensure a perfect shape.

Then, once implemented, we can turn to real performance variables such as power and speed. So this is a summary of the assessment and the progress of the movement.

Physical Therapy Continuing Education – How to assess lumbar dysfunction was originally published on Spring