This topic contains 3 replies, has 2 voices, and was last updated by 
Scott Glidden December 18, 2018 at 9:41 am.
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Scott Glidden
Today I had a new patient who is an MMA fighter. He takes pretty good care of himself, but 4 months ago he picks a guy up to throw him and tweak his back. His back was stiff and he rested for a week. He reports that he then went to his chiropractor and got adjusted. Since then he has had persistent back pain radiating to his R SI joint that is worse white sitting for extended periods of time.
30 year old male
4 months ago tweaked his lower back.
P+ sitting for long periods (6/10 pain at worst)
P- standing (0/10 pain at best)
4/10 in office right now (15 minute car ride to office)Strength, sensory, reflexes all WNL
Patient reports being very flexible
SLR
Left 100%/no sx, -Dorsiflexion
Right 100%/no sx -DorsiflexionSHF
Left 100%/ no sx
Right 100%/ no sxPalpation of SLR and SHF have minimal to no adhesion
QLF: 11222 Mild/moderate adhesion at R L4/5 joint capsule (“that feels like the spot”), mild/moderate adhesion of supraspinous ligament at L2-L3
KHE
Left 100+%, no sx
Right 100%, mild reproduction of sx. Mild adhesion of psoas @ L4/5SLPF: 100% with mild recreation of symptoms at bottom.
MRI: 2MM BROAD BASED BULGE WITH 10MM PROTRUSION ON RIGHT SIDE CAUSING MODERATE/SEVERE CANAL STENOSIS
#1 DISC
#2 Adhesion of R L4/5 joint capsule
#3 psoas adhesionFor most patients I would say you NEED to get this referred out, but for the patient who makes his living in the UFC, this makes it a tough call to tell a man he should quit his job. I told him that is major problem is his disc by a wide margin, but I might be able to provide SOME relief with treating adhesion. He has had a cortisone shot and got some PT exercises as well, but they didn’t do much.
Am I in the right to treat this guy, knowing that any improvement he can muster up is worth furthering his career? He also drives back to Chicago for the weekend every Thursday night until Monday morning when he comes back here to train–which is obviously not helping his massive disc injury.This is new territory for me, so I’m not sure what my message should be. Thanks!
Christopher Stepien
Good stuff Scott.
For a regular patient, 80% function in the low back would probably leave them symptom-free.
For a competitive athlete who needs 100% function and capacity, every little percentage can count.
So I’d say it just like that.
“Your function is very good, 80%, which for a regular person, would be fine. But you’re not a regular person, and every little bit of adhesion can cause you to perform at less than your best. People who run the mile will take 10 seconds off their mile, every time. So we should get this adhesion out as it’ll affect your performance.”
William Brady, DC
Great case. His problem is 90% disc plus the load of MMA doesn’t give it the chance to heal.
Progress through the order of operations. 1. His ranges are very good and a few visits here should clear out QLF. 2. Test his strength and correct any weaknesses. Even professional athletes will have imbalances. 3. LOAD MANAGE! Keep his spine in relaxed neutral as much a possible (sit slide lean, check his car seat, etc.) Remove loaded flexion from his training. Anything that produces a symptom during, after or the next day is to be stopped.
We can over focus on the manual therapy. This case will require load management, patient education and an environment that allows for healing. If he follows your advice and is lucky several months from now he will be doing a lot better.
The hard truth is you can’t exist in a destructive environment without being destroyed. At some point his MMA career will end. You may help extend it by several years.
Scott Glidden
Thanks for the help! I told him to eliminate any deadlifting or squatting for the time being and we will go over sit/slide/lean at his next appointment. I told him that if his trainers or any other docs have any questions I’d happily go over my findings and why he needs to have some restrictions.
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