Recently I saw a patient in musculoskeletal outpatients who presented with hip pain and hypomobility and lower back pain. The patient was obese and had had many back problems in the past including a laminectomy. After assessment I concluded that the patient's hip pain was in fact being referred from his motor control impairment of his lumbar spine.
Therefore I decided to manage the patient's condition by teaching him PF and TA activation exercises. However I was unable to palpate a contraction as he had such a large stomach so was unsure whether or not he was doing it correctly.
It made me think whether it was the best treatment that I could provide for this treatment and whether it would actually have an effect on his LBP and hip pain. I also wonder why we try to isolate TA when it never really works in isolation in healthy individuals. Wouldn't we benefit more from strengthening the entire core musculature?
Has anyone had similar patients to this and seen an effect of managing them in this manner?
I am still unsure of how to approach these patients but will continue to manage them in this way until I am shown evidence of a different technique being more effective.
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2 comments:
Hi Adam,
Some interesting ideas regarding if he should be doing isolated TA exercises. If you can not palpate it do you have access to RTUS to view it? Is there an argument for doing more 'functional' work / active / relevant work as rehabilitation and looking at motor control from a broader perspective? What is driving the pain? Are there benefits to increasing his general fitness levels? It becomes difficult sometimes to work out what would be best.
What do you think
I think the patient would generally benefit from a full body exercise program in order to improve their fitness and muscle strength. TA activation will still be beneficial however and don't be afriad to palpate more deeply or else get the patient to palpate themselves first to make them feel more comfortable. Also remember can approach TA contraction via education concerning pelvic floor muscle activation.
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