My good friend Erson Religioso of The Manual Therapist fame recently contacted me to do a consult for some back/leg trouble he has been having.
It was a very interesting eval for many reasons. Online consults are a completely different animal, as you cannot do any hands-on testing.
Moreover, when you have a therapist who is initiated into pain neuroscience, you don’t have to go so much the Explain Pain route 🙂
So with this eval, we looked at things a lot through a PRI lens, and were able to get him strategies to modulate his pain experience. The eval runs a smidge over 1 hour, so here are some vids with a quick rundown.
– Getting paresthesia down the R LE that began 2 weeks ago after a car ride…has peripheralized since initial event.
– Symptoms are aggravated with static sitting or standing…onset ranging from seconds to minutes.
– Has tried loading/unloading MDT strategies, neurodynamics, Mulligan techniques, IASTM, compression wrapping, etc…all to no avail.
Objective (major findings)
– Limited B Apley’s scratch (1 per FMS scoring)
– Negative slump and ASLR
– Painful lumbar motions of extension, right rotation and sidebend. R sidebend was limited.
– Negative thomas test on left, positive on right
– Slight limitations in active seated hip IR B, R>L.
– Adduction lift scores 1/5 B.
If I were to classify Erson, it seems his symptoms would seems to be more dominant as peripheral nociceptive ischemic and central sensitivity (he stated he has always had findings with his back). I was less inclined to think he had peripheral neuropathic issues, at least yet, based on neurodynamic findings.
From a PRI perspective, Erson presents as an interesting case. The Thomas test was the most interesting finding, as he was negative on the left, but positive on the right. A positive Thomas test usually correlates with a positive Ober test. The negative test on the left implies some ligamentous laxity in the anterior hip capsule.
Based on the Thomas tests and hip IR limitations, I would classify him PRI-wise as a patho-PEC (marked extensor tone/pattern) with corresponding Bilateral BC (extension tone, bilateral anteriorly tilted scapulae. Basically, dude likes to hang out in extension and stand on his right leg.
Treatment & Result
1) cough reflex for quick repositioning – This improved Apley’s scratch mobility and Erson stating less symptoms/improved mobility with extension.
2) HEP included the following (in order)
– 90/90 hip lift
– L adductor pullback
– L glute med
– R glute max
So with this program, we are trying to get him some increased muscle tone on the left side to act as “ligamentous muscle” as PRI would call it
3) Postural feedback
– He was also instructed to stand and sit in corrective left stance. This serves two purposes
a) Helps reinforce a R AIC pattern, shifting his tendency to put most of his weight on the right side.
b) Help decrease the ischemic response from putting excessive weight on the right side with sitting and standing by making him put more weight on his left.
When this sensory input was given, he could change his symptoms with sitting and standing.
Thanks to Erson again for giving me the chance to work with him.