Today I followed another therapist at the clinic. We had one particular patient in for her second visit with unspecific pain in her back and legs. She gingerly got out of the chair in the waiting room and hobbled to the treatment room. Nonetheless, she was a funny patient, in good spirits.
After our subjective reassessment, the PT and I stepped out of the room to get the inclinometer. She said to me "I don't really know what's going on with her. Do you have any ideas?"
"Have you checked her pelvic alignment?" (My CI is big on that and checks it on everyone.)
This therapist admitted that she hadn't checked it yet and thought that would be a good idea. So back in the room we took her lumbar measurements and I checked the height of her PSIS, did a march test and checked the height of her ASIS in supine.
I found this patient was VERY flexible in her hamstrings and it appeared that her left illium was not moving as well on the sacrum and was slightly tilted anteriorly. So I decided to do a contract/relax treatment to adjust the ilium posteriorly. The treatment realigned her pelvis and she reported immediate relief.
I instructed her to stop doing hamstrings stretches into the extreme that she had been doing them and modified the abdominal exercises she had been doing as prescribed for her back pain several years ago, to focus on her transverse abdominus and stabilization of the pelvis.
When the patient got up from the treatment table, she was standing tall. She said, "Wow, I do feel better! You guys are miracle workers!" and she walked out of the treatment room fully upright.
It was a great feeling that my clinical reasoning all came together together to provide such quick relief for this patient and that I had thought of something the other PT had overlooked. That's what it's all about. :)
Posted by Michelle Gilpin,
