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Case Study, Mid-Back Pain and TELEHEALTH

30/4/2020

Comments

 
It has been an interesting couple of months, with a lot of trying times. This has meant for us, a time to try more. So that is just what we have been working on. TELEHEALTH.

It isn't for everyone who needs physiotherapy and we will more than readily tell people when they need to have face to face contact with one of our physiotherapists.
  • We expected that people would be current on our lists and opt totally for online services - Check
  • We expected that perhaps we would see people come in face to face and then go online and vice versa- Check
The results have been beyond expectation with people really getting a lot out of their Telehealth consultations
BUT
  • We were pretty amazed when we started to have new people come to us online from regional Victoria and other remote locations in Australia !!!! -CHECK
CASE STUDY
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I have provided Telehealth Physiotherapy to a twenty year old man, isolating with his grand-parents on a farm in southern NSW. Coming in for treatment was not an option and he had several months of mid back pain radiating to the right rib cage.

It hurt to twist and bend, which is not so useful on a farm and it was uncomfortable to sleep. Anti-inflammatories offered little comfort. Happily, scans showed nothing abnormal and nothing to worry about. His mid back and ribs had jammed, but this created awful aching through the flank, the back and into the lower abdomen.

How can a physiotherapist help form a laptop in Melbourne?

The plan is like any assessment. We talk and get the clinical impressions of the problem. After being a physiotherapist for thirty years and having Specialist Musculoskeletal Physiotherapy training, I can recognise presentations quickly and have way to test my hypothesis. That is what we did together.

I got him to perform the movements I normally assess, look at the tasks and positions that caused the grief. In place of my hands, I then used a belt he had to isolate the movement to specific parts of the back and ribs to find where it was eased by blocking movement elsewhere.

The next step was to use the belt as self treatment, to mobilise the joints in the right direction and teach exercises just as I would in the clinic. We improved using chairs, blankets and pillows as props to gradually increase range.

After 5 visits, the pain had markedly improved and still improving with the exercise routine. Both he and I found this really encouraging, that Telehealth isn't just a novelty. And it reinforced just how much we physiotherapists can help peoplel by teaching how to do their specific exercise programme properly.

So, it is a trying time, but we will keep trying to help people every way we can. 

It has been a tough couple of months and we wish everyone, health during this time.
We have more info on Telehealth here:

Your movement partner
Jayce


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THE THORACIC SPINE ENIGMA

7/2/2020

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THE THORACIC SPINE ENIGMA

A well-functioning thoracic spine can accelerate your running and promote pain-free living.
The thoracic spine is the mid-back between the neck and the waist (lumbar-region). The ribcage attaches to it. This special part of our spine gets less attention in science journals than other spine areas. It an important source of local or referred pain for spine, hip and shoulder problems. This is due to its unique nerve supply and mechanics as a junction between the upper and lower body.
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“If you have unresolved issues of other areas of the body, your thoracic back is the link to examine."

As an important mechanical lever of the body, taking 47% of body weight (1), the curve of the thoracic spine impacts on shoulder girdle movements (2-3) and the lower limbs. For example, walking and running rely on thoracic rotation to store and generate momentum. In turn, the thoracic spine is very stable alongside its partner, the ribcage, affording protection to vital organs. Consequently, it is less mobile than the neck or low back.

“Back, hip, flank, neck and even arm pain may have their source from the mid-back."

Motion of the shoulders relies on rotation and side bending in the thoracic spine (2-3). If this part of the spine loses the little flexibility it has, more load is placed on the shoulder joint, girdle and rotator cuff. The compressive forces from a lack of spine flexibility can set up problems elsewhere in these other tissues.
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“The thoracic back has the unique quality of an energy-storing spring and a counterbalance.”
​

Walking and running uses to-and-fro arm swing and shoulder motion, whilst simultaneously the thoracic spine winds up and down via twisting motions. This enables balance and, like a spring, enables energy transmission to the arm swing to propel the body forwards. In fact, to increase speed when running, you need to increase your thoracic twisting motion (4). You can compensate for this via the hips or overarching the lumbar back, but for how long?
The nerve supply of one thoracic vertebral segment is also known to include several levels, meaning a mixed nerve supply. A problem in one area can refer to many seemingly unrelated regions of the arms, buttocks and legs. Occasionally, when counterfeit symptoms resembling organ pain are from thoracic joints, physiotherapists will judiciously examine for key features of musculoskeletal involvement, being pain on movement, tenderness and tightness of musculoskeletal structures (5). If these musculoskeletal features are absent, then the case requires further consultation from a medical practitioner.

References
1. White, A. A. 1969. Acta Orthopaedica Scandinavica Suppl: 127, 8-92.
2. Tsang, S. M. H., Szeto, G. P. Y. & Lee, R. Y. W. 2013. Manual Ther: 18, 431-437.
3. Crosbie, J., Kilbreath, S. L., Hollman, L. & York, S. 2008. Clin Biomech: 23, 184-192.
4. Tojima, M., Osada, A. & Torii, S. 2019. J. Phys. Ther. Sci.: 31, 661-665.
5. Harding, G. & Yelland, M. 2007. Aust Fam Physician: 36(6), 422-3, 425, 427-429.
 
Comments

    Luca Scomazzon-Rossi APAM

    Luca graduated from a Bachelor of Physiotherapy with honours and has a background in personal training.

    Jayce Gilbert FACP, APAM

    Clinic director & Specialist Musculoskeletal Physiotherapist* in treatment for back, neck, headache and TMD (Jaw/Face) problems.

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