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Tests better, symptoms not

Exit forum ID Forum Discussion Tests better, symptoms not

This topic contains 2 replies, has 2 voices, and was last updated by   Andrew Wengert May 14, 2018 at 5:29 pm.

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    Andrew Wengert

      50 Year old male. Bilateral low back pain, SI region, with occasional burning into the anterior thigh. Patient had no pain at the initial exam, but rated it a 4/10 on average, and a 7/10 at worst.  Quality was achy and dull.  Provocative was bending, stooping, and sitting.  Palliative when it is bad, is laying flat on the floor.

      2nd order:

      Patient played hockey 2x a week until 1 month ago when he had a hard fall on his Left hip.  At that time he had to be helped up off of the ice.  Hasn’t played since, but has recently taken up golf.  He was lifting weights, primarily upper body, 5 days a week.

      QLF was 60% (00222)

      SLR was 57 degrees on the right and 55 degrees on the left.  Both produced a stretch sensation in the posterior thigh.

      SLPF was 3 inches from floor, with bilateral posterior thigh tension.

      SHF and KHE was 100% bilaterally

      Adhesion was palpable in the lumbar erectors and between the sciatic nerve and the external rotators.

      Diagnosis: Lower lumbar disc degeneration and adhesion.

      I treated this patient 3 times. Each time he said he was feeling a little better.  QLF had cleared up to 100 percent function after the third visit. Then the patient had a conference that was a 2 hour drive away, played golf thursday and Friday, Stood at his booth all day Saturday and half day Sunday then drove back home.

      Patient woke up Monday morning in 8/10 pain with burning into the quad.  Patient’s symptoms did not subside so I got the patient in for an MRI.  He has a ton going on.  I will screen shot the report.

      I have set him up to get in with a PCP with hopes of getting a steroid dose pack as the patient has been compliant with my recommendations for unloading the disc with out any symptomatic improvement .

      Does this patient need an additional consultation with these MRI findings?


      Drew Ruebbelke

        I’m not seeing the attached MRI report, but still a ton of room for improvement with this patient. Did his QLF regress when he came in after the increased load/symptoms? Although you improved QLF quickly, you still haven’t touched SLR or strength. And importantly, the load on his low back was a ton. I would fully expect a flare up with 2 rounds of golf, long drives in the car, and long standing postures that are not typical for him. If the report reveals severe degen with neuro compromise it warrants a referral now but if not, I would take him to maximum improvement with very specific load management instructions.

        Getting the image this early in care was super important for prognosis and severity purposes. Like I said, I don’t see it attached here so I don’t have all the info, but I would dial it in with him and keeping chipping away.


        Andrew Wengert

          Sorry I thought I had posted them

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