Are You Categorizing Your Low Back Pain Patients?

Hi, and welcome to Dr. Scott Gray’s redefining physical therapy podcast for orthopedic, sport, and manual physical therapists. Delivering practical and real life content and strategies for busy clinicians. Here’s your host and expert physical therapist, Dr. Scott Gray.

Dr. Scott Gray :                    What’s up everyone? This is Dr. Scott Gray, and welcome to this next episode of the Redefining Physical Therapy podcast. So today I want to talk to everyone out there about something that’s been on my mind as a clinician in regards to treating the lower back. So that’s one thing I want to talk about is categorizing your lower back pain patients, and so what I mean by this is certain types of patients will come into the clinic presenting with different types of symptoms. You need to categorize them in your brain based off their subjective history, their physical examination, et cetera.

So this just helps with your treatment outcomes because your interventions are going to matter dramatically. So for instance, right now I’m treating this patient. He is about 40 years old and he’s an ectomorph. So typically ectomorph patients are typically hypermobile, and this guy, let’s give you a little background about him. He has had two fusions at the age 40, he’s had in his mid-cervical spine, and his lumbar spine. Now, this type of patient actually needs strengthening and neuromuscular reeducation so that he doesn’t go into his outer ranges of his joints, and potentially herniates his disc.

So in this regard you’d want to test his … I would say his active movement, but his accessory motion is going to be vital for you to assess and feel the joint play and the integrity of his joints. You can do this by assessing spines every day, day in day out you’ll be able to feel a difference between someone who’s stiff and needs mobility versus someone who needs more stability and control. So this gentlemen, he really needs some really strong multifidus muscles and neuromuscular coaching to keep his lordosis when he’s in these different positions at work or whatever so he doesn’t potentially herniate a disc.

Now conversely, a mesomorph individual, that’s typically your athletes, they are a little bit more bulkier. They’re usually tight and stiff. Right? So those type of guys you want to loosen up the joints and stretch out the muscles, in that regard you’re going to work on some of their biomechanical things as far the hip and the thoracic spine. So those are the type of patients you want to discern. In this case with the athlete usually you’ll find a lot of the facet pain because they are … a lot of sympathetic drive, so they’re always kind of in a extended position. So you want to kind of teach them to unload their facet joints and reduce the tone in their low back muscles.

Again as I just said, work on some of the biomechanical stuff of the hip, the foot, whatever it might be. If they have pain when they’re running or something along those lines. But those are just two simple things that you need to consider when you’re working with back pain patients is doing a very thorough history, and kind of categorizing them based off of their subjectives complaints, and then based off their physical examination what you feel with their joint play and accessory.