Sij Dysfunction Reflection

Assessments are lumbosacral intervertebral disc disorder with radiculopathy, lumbar spondylosis without myelopathy or radiculopathy and myalgia.

Per medical report dated 01/23/15, the patient reported of middle and lower back pain and bilateral leg pain with tingling. He was diagnosed with thoracic compression fracture and lumbar spondylolisthesis.

Once Dr. Swartz acknowledged the ROM method was improper in this case, I turned Dr. Swartz attention to the DRE method. After reviewing the table for the DRE Lumbar Category on page 384 of the AMA Guides, Dr. Swartz placed the applicant into a DRE Lumbar Category II and assigned an impairment of 5% WPI. Dr. Swartz supported her opinion based on the fact there is a subjective complaint of pain radiating into the applicant right leg as documented in his evaluation report of June 16, 2016. However, Dr. Swartz acknowledged there is no objective evidence to verify the radicular complaints, thus the placement into DRE Lumbar Category II is appropriate since there is no verifiable radicular complaint.

There is pain with lumbar flexion and extension. There is no aberrant behavior. The patient feels that he can perform increased activities of daily living with his current medications.

10/30/15 Medical Evaluation reported neck, low back, and left sacroiliac pain. Physical examination of the lumbar spine revealed decreased ROM on

Diagnoses include failed back surgery, lumbar; degenerative disc disease, lumbar spine; back pain; lumbar radiculopathy; spondylosis without myelopathy or radiculopathy, lumbar region; impingement syndrome of bilateral shoulders; myalgia; xerostomia; erectile dysfunction; testicular hypofunction; chronic anxiety; chronic depression; and chronic insomnia.

On examination, he has moderate pain to palpation to the lumbar spine and paravertebral muscles over the bilateral facet joints at L4-L5-S1. He has a positive straight leg raise test to the right.

Per the medical report dated 08/12/16 by Dr. Gunderson, the patient had neck pain, as well as headaches, dizziness and blurred vision. The neck pain radiated into both shoulders, but more so on the right, and occasionally she had tingling in her upper extremities. She described the neck pain as severe and intermittent, and not related to any specific activity, and relieved with massage. The pain in her lower back was in the beltline and radiated into both lower extremities, more so on the left. She described the pain as moderately severe and constant, and not related to any activity, and only relieved with nerve medicines. On examination, the patient had tenderness in the lower cervical region about C5 to C7. Range of motion of her neck was 75% of normal. Motor, sensory, and reflex examinations in the upper extremities were normal. On examination of the lumbar spine, the patient could dress and undress without difficulty. She had a bent forward posture and gait. She had reduced lumbar motion and with maximum forward flexion, her fingertips were 12 inches from the floor. Lateral flexion was 50% of normal, and she had no active extension in the lumbar spine. Motor, sensory, and reflex examinations in the lower extremities were normal. There was paravertebral tenderness about L4-5 bilaterally, as well as in both sacroiliac and sciatic notch regions. Straight leg caused hip and thigh pain at 50 degrees bilaterally. Of note, X-rays of the cervical spine demonstrated disc degeneration at C5-6. X-rays of the lumbar spine were normal. Patient sustained

Defined as dysfunction of the sacroiliac joint also referred to as the SI Joint commonly associated with sharp or shooting pain. Dysfunction may appear in various types and causes including, hypermobility, hypomobility, anterior or posterior rotation, or up slip of the pelvis.

O: mild grimace on her face; sitting strait up on the exam able without the support; tender over the left side of the lumbar spine, Full lower lumbar ROM with some pain; able to perform heel and toe walks; negative straight leg raise; no impairment of NVS; DTR 2+to bilateral lower extremities

Chiu-Fang Yan, M., CNM, RN (Clinical Instructor)a, Ya-Chi Hung, MS; (Instructor, P. s. b., c, Meei-Ling Gau, PhD, CNM, RN, IBCLC (Professor)d,n,1,; Kuan-Chia Lin, P. P., Statistician), Effects of a stability ball exercise programme on low back pain and daily life interference during pregnancy. Midwifery 2014, 30,

The patient experienced the same amount of pain and felt the same as the initial assessment day. The therapist started the treatment by placing the hydrocollator on the patient’s lower back for 10 minutes. And for the next 40 minutes, Manual Massage Therapy such as Swedish massage, Joint Mobilizations, MET (muscle energy technique), and Fascial Release techniques were performed in the lower back, Gluteal region, and legs. As for the homecare, the patient was instructed to perform Hamstrings and Gluteal muscle stretches, and strengthening exercises to strengthen the Abdominal muscles (Table 2). In addition, the therapist recommended the patient to use the heat packs and to support her lower back during her daily activities.

This week I completed an SI joint and a calcaneus exam, which I thought I would never see. I hope to comp both exams along with several others. The SI exam was a total recall from the days in the lab. I could not remember the angulation for the AP projection until I had the patient on the table and as I looked at the patient I just visualized the sacrum. The image had good penetration, contrast and was centered laterally but was a little low on the IR. Whitney said I did a good job and Troy told me since I got the SI joints open to go ahead and send them for pre-approval, which I intend to do that this week. I do believe that the information that we practiced in the lab is in our brains somewhere I just hope the ability to recall the

I will still continue the same process in manging this case with adding several more components during the screening process. Since the trunk instability could affect the lower limb, I woulde investigate about the lumbo-pelvic stability to see if thre is any instablity or weaknes in those area. Additionally, I would add in this process a screnning for the central sensitisation. Sence the injury hapend long time ago, the soft tissu that injuried should be healed. However the brain may still think the injury still there, thus produce pain bilaterally. I would screen for the stress when the injury occured and if there are any stress in the family as well as if there are any history of other injury, which indicat central sensitisation. Moreover,

From the biomechanical testing my client exhibits normal ability to adapt and lock his foot, as well as respond to vertical loading. He also has no issues with his knee position. However, he will want to address his postural issues. The lordotic posture could be caused by tight hip flexors, and erector spinae group. It also could be coupled with weak or lengthened abdominals and hamstrings. This is coined as Lower Cross Syndrome (Janda, 1996). Because of the lordotic posture I will want to test for muscles strength and flexibility know which muscles is most at fault and address it. Another point to note is the forward upper cross syndrome. This could be due to years of studying and looking at a computer or phone. He could have week neck deep neck flexors and lower traps while his upper traps and sternocleidomastoid could be tight.