HISTORY AND SUBJECTIVE COMPLAINTS The patient complains of right low back pain of two weeks' duration after lifting a 55-pound box from the ground up onto the bed of his pick-up truck. His symptoms have become steadily worse despite home application of a heating pad and taking anti-inflammatory and pain medication as issued by his family doctor. OBJECTIVE FINDINGS The patient is a well-nourished Caucasian male, 45 years of age. He is a construction worker. VITAL INDEX Height: 5 ft. 11 in. Weight: 200 lbs. OBJECTIVE ORTHOPEDIC AND NEUROLOGICAL FINDINGS There is a slight right-lateral antalgic position noted. Lumbosacral range of motion is guarded with flexion, extension, and left rotation. Static palpation reveals hyper tonicity of the right low back musculature. Motion palpation is restricted in the right sacro-iliacjoint(SI)and lumbar region. Kemp's test is positive for pain on the right. Straight leg raise (SLR) produces local pain at 60 degrees. Well leg raise (WLR) is negative. The neurological exam reveals normal responses to dermatomes, myotomes, and deep tendon reflexes. Valsava maneuver is negative. RADIOLOGY A-P and lateral lumbosacral radiographs reveal low femur head, sacral base, and iliac crest height on the left, with no indication of fracture, dislocation, or soft tissue distortions. CLINICAL IMPRESSION AND WORKING DIAGNOSIS Acute lumbosacral strain/sprain injury with related subluxation complexes and associated muscle spasm. TREATMENT Acute Phase — 2 to 5 days • Specific chiropractic adjustments • Ice and appropriate physiotherapy to reduce swelling, inflammation Repair Phase — 4 to 6 weeks • Specific chiropractic adjustments • Custom-made flexible stabilizing orthotics to support the pedal foundation in the best position of function • Specific rehabilitation exercises to strengthen injured and distorted musculature • Seated lumbar extension exercise to strengthen lumbar extensor muscles • Posterior pelvic translation exercise to correct the anterior pelvic distortion • Postural back rest to provide support. • Left torso lateral flexion exercise to correct right torso lateral flexion distortion (low right shoulder) • Posterior cervical translation exercise to correct the anterior cervical translation distortion • Cervical support pillow to provide neck support Remodeling Phase • Specific chiropractic adjustments (decreased frequency) • Specific home rehab program for long-term remodeling and strengthening of injured area(s) and postural faults based on follow-up postural analysis. DISCUSSION The trend in patient care management is to approach rehabilitation in an aggressive fashion. We seek to actively enhance a patient's health to its optimum state. Custom-made orthotic support can help to prevent re-injury in muscu-loskeletal areas previously susceptible to weakness and/or distortion. Low-tech rehabilitation based on injured area and postural distortions plays an active role in patient management and your patient outcome. At-home rehabilitative equipment can be inexpensive, easy to install, and simple to use. The reimbursable service is based on patient need. The positive effects are dramatic. Dr. John J. Danchik is the seventh inductee to the American Chiropractic Association Sports Hall of Fame. He is the current chairperson of the United States Olympic Committee s Chiropractic Selection Program. He lectures extensively in the United States and abroad on current trends in spoils chiropractic ami rehabilitation. Dr. Oanchik is an associate editor of the Journal of the Neuromusculoskcletal System. He has been in private practice in Massachusetts for 28 years. He can be reached by e-mail at [email protected].
