Spinal Case Studies and Strategies

23-year-old cricket fast bowler with LBP- L5 Pars Stress Fracture

Subjective findings:

Support

• cricket bowler

• unilateral pain

• extension hurts

Refute

• no night pain

• bending hurts

Objective Findings:

Support:

• local tender

• neuro normal

• quadrant +

Refute:

• SLR limited

• XR normal

Assessment:

Refute:

• + response to PAIVM

23-year-old cricket fast bowler with LBP- L5 Disc bulge

Subjective Findings:

Support:

• bending hurts

Refute:

• extension hurts

• Co/Sn -ve

Objective:

Support:

• SLR limited

Refute:

• quadrant +ve

• repeat movements +ve

Assessment:

• +ve response to PAIVM

23-year-old cricket fast bowler with LBP- Stiff L4/5 facet

Subjective findings:

Support

• unilateral pain

• extension hurts

• no night pain

Refute:

• bending hurts

Objective findings:

Support:

• unilateral tender

• repeat movts -ve

• quadrant +ve

• XR normal

Refute:

• SLR limited

Assessment:

Support:

• +ve response to PAIVM

A patient with an L4/5 disc herniation (right posterolateral) with radicular pain in the right leg. There are no signs of conduction loss (strength/sensation/reflexes) in the lower limb.

MT 1: L4/5 Right Reverse LF PPIVM in L side lie 3x30secs // re-ax SLR and leg pain post

MT 2: L4/5 Right rotation PPIVM in L side lie (pre positioned with pillow under side)

Ex 1: Trial of McKenzie repeated movements into extension from prone, 3x6reps

Ex 2: 4pt or seated pelvic anterior/posterior pelvic tilts with focus on TA activation – 15 slow reps

A patient with suspected facetogenic pain originating from the left L5/S1 segment

MT 1: L5/S1 Unilateral PA glide GIII in prone, left side, 3x45secs

MT 2: L5/S1 LF PPIVM in R side lie, GIII 3x45secs, pre-positioned in L LF EOR

Ex 1: Mobility – Cobra into 4pt into childs pose, gentle transitions 3x5reps

Ex 2: Integration – Maintaining neutral lumbar spine with UL loading (theraband low row to overhead pull)

A patient with pain and localised spasm of the paraspinal musculature around L3 level since attending their first AFL training for this year yesterday. No injury or pain was noted during training, onset of symptoms this morning.

MT 1: L3 central PA GII or GIII 3x30secs in prone, consider pre-positioning in slight flexion or ext based on direction of symptom onset

MT 2: HVT rotation L3/4 (GV)

Ex 1: Bird-dog exercise in 4pt Ex 2: Hydrotherapy / swim session to reduce spasm and loading through lx spine

A patient with known spondylolisthesis of L4 due to bilateral pars defects. They have pain returning to neutral from flexion.

MT 1: Generally manual therapy not recommended for people with known structural hypermobility – however could conceivably do a low grade (GII for example) in any plane of movement that is not posterior-anterior (as would exacerbate instability)

MT 2: N/A

Ex 1: TA activation training in various functional positions – e.g seated, leaning against wall, standing

Ex 2: Supine, feet on exercise ball, controlled lowers to either side engaging TA, working obliques and rectus abdominus

A 59-year-old male mechanic presents with a 6-week history of gradually worsening left sided neck pain (NPRS 6/10), accompanied by intermittent radiating symptoms into the left scapula and upper arm as far as the mid humerus (NPRS 4–5/10). The onset coincided with increased workload involving additional shifts.

Symptoms are exacerbated by prolonged upward movements of the neck (>20 minutes) while working underneath vehicles and heavy overhead lifting at work.

D1: C4/5 facet joint sprain with radicular pain

D2:

M1: PPIVM (left) unilateral PA of C4- grade 3 

M2: PAIVM Direct glide to C4

T1: Long lever downslope (helps extension) mid cervical 

T2: Central PA SNAG into extension

E1- Deep neck flexors - chin tucks