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Functional capacity - back pathology - negative results

The patient is a 52 year old male. He was involved in an industrial accident. He claimed he was thrown from his forklift, when his vehicle was struck in the side, by another forklift. The patient was taken to the emergency room with "acute" back pain. X-ray's and physical examination were unremarkable. He was sent home with an order for three days rest. At re-examination, the patient claimed continued acute pain. He developed a severe limping gait pattern. Physical therapy was ordered. The patient was kept out of work. Six months from onset, the problem was not resolved. In the interim, EMG and MRI were performed. All tests were negative. The insurance case manager suspected malingering. A gait and motion analysis were ordered to determine if his clinical signs were consistent and compatible with his alleged back injury.

Test Protocol

A test was designed to analyze the kinematics, kinetics and functional electromyography of the patient's functional ambulation, and balance. Video computerized motion analysis, walking track force platform system and multi-channel dynamic electromyography procedures were implemented to gather the necessary data.

Functional Motion Analysis Results

Kinematic analysis revealed motion anomalies of dynamic kinematic joint ranges. However, all joint ranges displayed extreme inconsistency from step to step and trial to trial. [see Graph I]


Graph I
Dynamic Range of Motion - Right vs. Left Knee

EMG results revealed the patient was exhibiting normal muscle firing pattern, in proper sequence, and symmetry. Frequency fatigue analysis revealed normal fatigue, frequency shifting patterns and amplitude [see graph II].


Graph II
Multi-Channel Dynamic EMG- Lumbar Paraspinals

Kinetic force platform results revealed further inconsistency in the patient's limping pattern. Multiple trials, failed to duplicate his limping pattern for either the right or left foot [see Graph III and IV].


Graph III
Force Platform-Right Foot


Graph IV
Force Platform-Left Foot


Motion analysis conclusion stated the patient was unable to duplicate his limping gait pattern from step to step and trial to trial. This was confirmed with kinematic and kinetic test results. EMG failed to confirm the patient's claim of muscular distress. The test results were incompatible with the patient's claim of acute low back distress. Symptom Magnification was clear. In the absence of positive, objective clinical evidence to support the patient's subjective claim, he was terminated from active medical treatment and returned to work. A legal claim petition was filed on the patient's behalf, by his lawyer. The claim was dropped at the conclusion of discovery and deposition, for lack of evidence.

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