Location of pain is often not the location to mobilize
Look at L4 in the following video and note when movement occurs at that segment.
For this patient any and all ADL’s that involve the slightest amount of trunk flexion, including but not limited to; dressing, brushing teeth, doing dishes, cooking, and reaching for items all elicit mobility and pain to the L4 region where he has a HNP. Even if we teach him to perform a full squat to retrieve an item off of the floor he will still elicit motion to L4, secondary to his severe limitation of trunk flexion without compensation (movement) to his lower back.
For this patient any and all ADL’s that involve the slightest amount of trunk flexion, including but not limited to; dressing, brushing teeth, doing dishes, cooking, and reaching for items all elicit mobility and pain to the L4 region where he has a HNP. Even if we teach him to perform a full squat to retrieve an item off of the floor he will still elicit motion to L4, secondary to his severe limitation of trunk flexion without compensation (movement) to his lower back.
98% of pain is caused by hypermobility or excessive motion
which causes, inflammation, more pain and greater instability as our
stabilizing core muscles shut down by 1% for every cubic centimeter of
inflammation. It is why surgeons fuse joints, we brace body parts, and doctors
cast broken bones.
Unless there is a blunt trauma hypermobility is caused by
hypomobility elsewhere. To adequately treat pain we need to stabilize the area hypermobility
and mobilize the area or areas of hypomobility.
Recently, I evaluated a shoulder patient who was considering
another RTC surgery secondary to pain and inability to play tennis. Like the above LB patient in the movie, when observing
almost every PROM of that upper extremity including, forearm supination, he
presented with early and excessive movement (hypermobility) and crepitus at the
Glenohumeral joint. He would compensate
for a lack of motion in the forearm and humerus with hypermobility at the GH
joint.
Treatment for this patient was to stabilize the shoulder
while mobilizing up the kinetic chain. The rationale for this is there will now
be attenuation of movement forces through the system and a delay or elimination of motion at the Glenohumeral joint. Post mobilization of the the forearm, there was no motion at the shoulder with full supination only at
the forearm where it should be. Post mobilization of the structures around the humerus early motion of the GH joint was delayed or eliminated.
Note I did not mobilize this patients shoulder but provided stability in the GH joint where he was hypermobile and mobility to the structures of forearm and humerus that were hypomobile.
Note I did not mobilize this patients shoulder but provided stability in the GH joint where he was hypermobile and mobility to the structures of forearm and humerus that were hypomobile.
