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fathersk
12-02-2007, 08:07 PM
Hi Cory (hope this is gonna get to you as first time on this site!)
This is Kate here and i work with Lloyd who has written regarding my LBP man ... i will try and answer your questions.

1) Re his pain when full after a large meal and less when evacuates. He tells me this varies in intensity and does not always happen. This is not something he associates with the initial injury when he was 16 or with hospital stay( ie i asked if he had had previous experience of constipation when in hospital) he thinks it started a few years ago but could not specify and now has become more noticable. He has not been investigated at all by G.P but i did ask him to see his doctor and discuss which he did. He said his doctor did not examine him but said he did not think it is a problem related to his spine. His doctor is referring him on but he could not tell me who to .... that reminds me i will call his G.P and ask!!
2) Re his pain pattern it is irratic. He can go many weeks without any acute episode but he says he always knows "it's there" and points to approx L4 level right low lumbar region. His right calf pain is intermittent and mostly associated with the acute episodes or if he over bends in standing with his knees straight. His acute pain comes on it seems with either flexion or side flexion or rotation movements separately and/or combined ie from sitting picking up files from floor -right S.F with degree of flexion or getting out of car ... it seems mostly when moving to right.This acute pain does not always occur with these movements only sometimes. He does not like taking weight through his right side in sit or stand as this increases his pain thus he shifts his weight to his left. Also note SLR immediate tensing and pain right holding onto plinth and jumping with pain. Plus palpation in prone start to get muscle spasm mid thoracic S.P and facet joint with pain++ at all lumbar levels right more than left. rotation in lying limited by pain and guarding and agg pain.

I saw him 2 weeks ago and his pain was "his normal discomfort" right lumbar no leg pain. I asked him to flex in stand he did with good range but immediately he said that he had gone too far too quickly and aggravated his leg pain. Started with 3 flexion in sit with knees and hips 90 degrees -no pain at time . He contacted me by phone 2 hours later saying he got out of car and c/o acute back pain with leg pain and tingling in foot. he described it as being thumped in his back ... he made it to the office and had to lay down for an hour. He did not take meds but within that time he could get up and move, he returned to sitting and work but pain worsening. He went home and within 24 hours pain settled and he did not miss any work. He talks about something "popping out and back in" when he gets pain and associates with acute pain.

3) Re night pain... he does not express pain at night. His sleep is diturbed by his baby only!!
I will tell more soon hopefully you will get this...
Kate:mg:

Diane
13-02-2007, 12:28 AM
Hi Kate, glad your guy is getting checked out medically as he does sound slightly red flaggy at the moment.

BB
13-02-2007, 07:08 AM
Hi Kate,
I agree with Diane. Good work on getting him to his doc.

His pain definately has a mechanical origin though. Possible that 2 separate issues are there one mechanical, another chemical?

fathersk
13-02-2007, 07:48 PM
Hi guys
thanks for feedback. Will chase medical checks re bowel symptoms.

Re pain any suggestions how to tap into this chap as he is guarding so much on physical assessment i am struggling with hands on stuff?? Also simple active exercises in session appear to aggravate him later ???

Thanks
scratching spikey haired Kate :confused:

lloyd
13-02-2007, 09:56 PM
Cory,
i am wondering where are you seeing the chemical aspect of his pain.?

and its easy enough to explain to this guy that its not his disc coming out and jabbing his nerve but what can we offer him instead to explain what it is thathe may be experiencing ?

lloyd

lloyd
14-02-2007, 03:41 PM
dear people -are we asking the wrong questions , or in the wrong place or ??

lloyd

BB
14-02-2007, 05:28 PM
Hi guys,
This place is fine. Just didn't get to it last night is all.

I mentioned a chemical component because he appears to have an aspect of his pain that is not mediated by movement. I was speaking of the pain that comes and goes with eating and BM.

Regarding useful treatment info. Try using the search engine for Diane "Seeing the light at the end of the tunnel syndrome" section. Lots of well described hands on ideas there. You can never go wrong with backing up and working on diaphragmatic breathing. Also, Bernard has some pictures of some helpful movements on here. Look around in the "Eyedeas" forum. I think that you'll find them there.

As for explaining his pain: Take a look at these handouts (http://www.somasimple.com/forums/showthread.php?t=2789) I made based upon Diane's descriptions and the "Explain Pain" book (which is excellent as well).

Hope that helps.

lloyd
14-02-2007, 07:08 PM
well there's definitly movement there- maybe not the kind we're used to assessing.
nice handouts Cory
I think regarding his description of something coming out and jabbing his nerve we could get alittle more detail regarding what it is that he describes this way.the description sounds pretty particular but it may be that the actual experience is a bit less dramatic -maybe its just a sharp pain.
Lloyd

Diane
14-02-2007, 07:45 PM
maybe its just a sharp pain. That is usually all it is. The rest is usually patient metaphor/perceptual fantasy.

Jon Newman
15-02-2007, 03:28 AM
Hi Lloyd,

I haven't chimed in because I don't know.

I'll be interested in reading what you figure out.

lloyd
17-02-2007, 10:56 AM
Nice process-
amazing how not much response ( to our requests for help)can be so helpful.
Its obvious perhaps but It seems that as my nervous system begins to integrate all this new understanding there's a settling related to confidence. Perhaps the sympathetic charge is down- less nervous.
this makes meeting, listening too and feeling the patient much more possible.
I had some new experience yesterday. I had a clear palpable sense(Without hands and with) of patients nervous system doing the same as I described for myself above.
What a blessing.
Finally I know i've found my work.:rose:
-palpable relief.
thankyou all -this site is a godsend( can I use that term here?)

regard s
lloyd

ps -patient on board and smiling

BB
17-02-2007, 05:15 PM
Hi Lloyd,

Glad to hear. Welcome aboard!

fathersk
05-03-2007, 11:31 PM
Hi
sorry for delay on update! contacted GP(who has been on leave) he is concerned re bowel symptoms and requested the patient attend for blood screen. This is interesting as when questioning the patient he did not tell me this and according to his doctor he has not turned up for the blood test... i will have a word with him on his next visit.
Regards his pain. Since carrying out breathing exercises and now starting to use movement patterns he feels happy with and gently increasing activity he has not experienced any acute pain( ie causing him to have to lie down for 1-2 hours). He still talks about his awkward movements causing intermittent sharp pain which eases within minutes of stopping the movement... i am working on this from a cognitive perspective aswell as a movement perspective. He feels he is improving... it is slow!! :confused: Any more suggestions ??

Cheers:teeth:
Kate

BB
06-03-2007, 07:01 AM
Hi Kate,
Could you be more specific with what you've got him doing so far and how it has progressed?

fathersk
07-03-2007, 12:36 AM
Hi Cory,
i have discussed what he means by his "awkward movements" which he explains is an exacerbation of his "back ground awareness" as he calls it which is on his right lower lumbar region. These movements cause various levels of intermittent pain and can bring on buttock and calf pain but are not consistent movements and can be combinations of flexion side flexion and rotation plus quick unexpected movent is often a trigger. There is no set pattern to his pain ie he can go 2 weeks with only his background awareness or he experiences between 1-3 exacerbations a week approx.

We have been v hands off using deep breathing with flexion in sitting, lying supine and cruk ly hugging alternate knee into flexion ie supporting with his hands behind his knee and gently extending and flexing his knee into a comfortable range for him but questioning when any discomfort is elicited how threatened does he feel by it. Last week we had him standing with knees relaxed carrying out relaxed rhythmical rotation of his trunk, placing alternate leg up on a chair with his hip and knee flexed to approx 90 degrees side flexing and combination of flexion aswell within his comfortable range. At the time his pain was not exacerbated but he is anxious about how he will react later and was not keen to do any more as he said " i am going away at the weekend and do not want to tempt fate".He is v anxious to flex with his knees straight at all and he becomes edgy in behaviour and often says " this will cause me a problem later" ie he is worried he will get an acute exacerbation that will drop him to the floor and cause leg pain .

we have observed his automatic movement and he moves well getting undressed and sits in various postures including crossing his legs either way. Does this help? Thanks Kate:eek:

fathersk
07-03-2007, 12:46 AM
Hi Cory!
It's late here in rainy Plymouth England!! And i forgot to say his progress to date is encouraging. He feels he is making progress as he has not had any acute exacerbations with leg pain for 4 weeks and he is bebinning to carry out breathing exercises with flexion knees bent at home and in work. He is still anxious re pain and movement particularly flexion with knees extended and calls his background pain " an awareness" that is always there according to him and does not change. Note he sleeps undisturbed by pain only his baby wakes him but still the bowel is unchanged.... see previous history but GP wants to look into this.

Hope this gives more info ... ask more!!!

Goodnight Kate:zip: !!

BB
07-03-2007, 10:22 PM
Hi Kate,

As he has issues with trunk flexion with his legs straight, maybe you could try having him sit and flex with breathing as you've been doing. But gradually add unilateral then bilateral knee extension in the symptom free range. Similar to the slump test position.

Then you could advance him to bending forward in a squatted position and gradually extend his knees working toward the standing with knees straight position.

Maybe try quadruped and have him raise up to plantigrade by extending his knees.

I'm just thinking of novel ways to bring him into the end position of flexed with knees straight. You could try any of the above with various skin input. More novel input to decrease threat level of the movement.

fathersk
07-03-2007, 11:43 PM
Hi Cory,

Will give it a go and let you know how i get on... he is off on business this week so seeing him next week,

Thanks for advice:angel:

Kate