DS: Low Back Pain (9-14-17): Day 1: Assessment and Home Program
Evaluation findings:
Standing flexion hands to ankles with pulling in the back of the legs and reproduction of mild Left lower lumbar pain
Standing extension with reach overhead with mild discomfort at end range
No significant pain with rotation
Supine Hip Mobility
Hamstring flexibility to about 70deg without back pain
Mild to moderate limitation in quad flexibility bilaterally
Increased hip external rotation with preference for toe position with moderate limitation in hip internal rotation
Quadruped
Preference for supported lumbar flexion taking hips back towards heels
Reproduction of mild lumbar discomfort with prone press up position
No discomfort noted with posterior pelvic tilt and able to control position in bear position
Standing
Squat
Significant toe out position with pelvic wink in deeper range
Single leg dynamic front to back reach with fair stability with quad dominant activation pattern
Assessment:
Patient presents with lower lumbar pain that seems to respond well to supported flexion in quadruped as well as emphasis on abdominal control to avoid excessive lumbar hyper extension
With Posterior chain activation he has a tendency to lose abdominal control and let his pelvis move anteriorly
Limitation in quad/hip flexor mobility along with hamstring/glute weakness feed into the tendency for the pelvis to tip anteriorly
Emphasis of program on controlling pelvic position with gradual increase in loading of posterior chain along with super setting some of his home exercise movements that emphasize abdominal activation with strength training movements that challenge the lower back
Use caution with posterior chain activation, beginning with movements in a slow controlled manner with emphasis on maintaining abdominal control
