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A Day in the Life of a PT Student

Low Back Pain

Published May 21, 2009 4:50 PM by Veronica Haywood
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Everything at my internship has been going great with the exception of some contract complications. But otherwise my CI is great. So far I have seen a pretty wide variety of patients. The number one issue that tops the list is low back pain. I find it amazing how so many people have LBP. I believe the statistic is that about 90 percent of the population will experience LBP at some point in their lives. When I first saw this I honestly didn't believe it, but since working in the outpatient setting I do now. For the most part, the LBP for our patients has been gradual and for the most part they can't remember one specific event that caused it.

I have found that these patients in particular have an extreme amount of lower extremity weakness. Most can barely perform a single leg stance for more than 3s or a single leg demi-squat-no matter the age, activity level, or physical build! It is amazing how something so simple as a single leg stance, which is needed every day to walk and perform many functional activities, can be so easily overlooked (especially when you have the big strong men who squat hundreds of pounds, but can't balance on one leg to save their life).

I think everyone should take time out of their day to practice the single leg stances and squats, and see if they notice a difference in their bodies. I know I have!

posted by Veronica Haywood
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4 comments
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If after strengthening and they still have pain, look for myofascial restriction which is often at the TL junction.  Releasing that fascia as well as the strengthening are a great combo for accelerated rehab.  That and Pilates based rehab.

Good luck with your career!
Eileen June 16, 2009 7:56 PM

Remember to not chase the low back in patients with LBP and forget to address the areas "linked" into this region.  Many patients that are not responding to "text book" treatment will improve when you address leg strength and balance issues that often are noted to be present in patients with LBP.  The "Core" doesn't only include the abdominals...

Michael

www.therapyeducationconsulting.com
Michael, PT June 1, 2009 4:48 PM

Veronica,

I remember when I first discovered the power of single leg stance.  It was in the kitchen of a home health patient...much later in my profession than you are now.  Congratulations for being ahead of the game.

Christie,

Great insight.  Your comment brought to mind Barbara Headley's articles which always challenge my perspective.  The body is an amazing creation.  But it is easy to get in a rut about how we view it.  Thanks for keeping our eyes open.
Jane Goude May 27, 2009 12:51 AM

As a PT certified in mechanical diagnosis and therapy and have also taken extensive pain classification courses, I present this question to you on which to ponder.

Do think people develop LBP due to the weakenss, or is the weakness there because of pain inhibition.  

I have my own opinion, but consider this when you work with your patients...as a hint to my opinion...if you can abolish the patient's pain, retest  the single limb stance and see what happens!!!

As PTs, we too often jump to the conclusion that weakness is the cause of pain, yet we all learned long ago that pain is inhibitory.  Why do we forget this when we enter the clinic?  

In the end, a "weakenss" does not always need to be treated...it needs to have the pain abolished to allow for full function.  So despite what we were taught in PT school, we DO have to treat pain.  

Good luck.

Christie ,, May 21, 2009 9:26 PM

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