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Back Positive

Functional capacity - back pathology - positive results

The patient is a 44 year old male. He was involved in a motor vehicle accident. His diagnosis was low back sprain / strain. MRI imagery revealed Degenerative Disc Disease L1-2, L2-3, L4-5. His current complaints were, chronic pain and intermittent muscle spasms, in the left lower back area. He noted that these symptoms were exasperated by ambulation.

Test Protocol

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

Functional Motion Analysis Results

Kinematic analysis [see Illustration I] revealed motion abnormalities of dynamic kinematic joint ranges, particularly right hip extension and left knee extension deficits. This pattern reflects a guarding type of gait.

Illustration I
Side View- Gait Kinematics

Graph I
Dynamic Range of Motion- Right Hip vs. Left Hip
[Note the Right hip extension pattern (red) vs. the Left hip extension pattern (blue)]

This ambulation pattern confirmed that the patient was avoiding loading to the left low back region. The patient was leaning away from the painful left side. The consistency of the dynamic range of motion graphs, from step to step, confirmed organicity and repeatability of the results [see Graph I]. EMG results revealed bilaterally, reveal the presence of distinct muscle spasm patterns, consisting of short, intermittent bursts, immediately following heel strike of the stance phase [see Graph II].

graph2

Graph II
Multi-Channel EMG- Lumbar Paraspinal Muscles

Note the prolonged muscle activity pattern of the RULP (right upper lumbar paraspinals) and the LULP (left upper lumbar paraspinals). The sharp burst of muscle activity corresponds Note the prolonged muscle activity pattern of the RULP (right upper lumbar paraspinals) and the LULP (left upper lumbar paraspinals). The sharp burst of muscle activity corresponds directly to heel strike of stance phase during ambulation. This is denoted by the initial vertical force curve on the green line of the graph.

Outcome

Upper low back paraspinal muscle spasm activity corresponds to the MRI finding of L1-2, L2-3, Degenerative Disc Disease. The patient's complaint of pain and muscle spasm was confirmed. The treating physician instituted a physical therapy program, based on specific functional motion deficits, reflected in the test results. The treatment was effective in restoring function and reducing pain to a manageable level.

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