Last week I was treating a young gentlemen for his second physical therapy visit (the initial evaluation was performed by a different physical therapist.) The young man presented with low back pain with right lower extremity numbness and tingling and occasional left lower extremity symptoms down to his knee as well. Prior to starting treatment, the gentleman heard that I perform manipulation often & felt like his low back needed to be popped. In my head, I was thinking this would likely be an option, but I wanted to recheck his status from the initial evaluation first.
Per the initial evaluation note, the only unusual finding was hyperreflexia (3+) on the R. Due to this neurological finding, I chose to perform my complete neurological screening. My second visit findings were: Reflexes: Patellar: Right: 4+ (elicited while tapping quadriceps), Left: 3+ Achilles: Right: 2+, Left: 2+ Myotomes: Weakness on Right S1 (I also checked heel walking and toe walking which looked abnormal, but the patient had a unique compensation pattern.) Dermatomes: WNL Clonus: Right: 20 beats; Left: 4 beats Babinski: Inconclusive (no toe movement) Delving further into a subjective, he denied changes in bowel and bladder, denied recent constitutional signs and symptoms, or unusual weakness or fatigue. He reported no significant PMH, except his mother has multiple sclerosis. At the point, I knew I had enough findings NOT to treat this gentleman. Fortunately, I work at Concentra and our medical providers are within the same building. I had this patient seen that same day by the medical providers who have ordered an MRI. The purpose of this post is to always reassess your patient's status to ensure they are appropriate for your care. If I would have chose to manipulate this patient, I could have caused further injury. Always reassess! -Jim
5 Comments
Spencer Lee
2/6/2015 11:22:59 am
Hi Jim, I'm a 1st year PT student. Just wondering, what were the main red flags that caused you to refer the patient? Was it the familial history of MS coupled with the clonus and abnormal babinski? Thanks for the post!
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Jim Heafner
2/8/2015 11:34:32 am
Hey Spencer,
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10/18/2022 01:45:48 am
Here on your blog the medical health improvement suggestions are recommending for the public. I’m sure the numerous people are able to learn their skills and get rid of problems with their joints. Thanks for the provoking ideas always these are trusted keep posting more.
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1/13/2023 03:34:47 am
We are as a professional writing service specialized in academic writing and specifically discussion post writing see the situation when students - physical therapist find it difficult to prepare for the university theoretical works, they even can provide physical therapy services to patients under the supervision of a licensed physical therapist, but not theoretical one. But maybe you are wondering why we are writing here, just to say thank you for your blog where we drawing out ideas for our discussion posts that we write for students. Our work is also really responsible because we show in theory how hard is maintaining clinical records and communicating with patients and their families and do it in forms of discussion on order the students may talk over the researched topic and share different thoughts in the result with their tutors
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10/19/2023 02:34:50 am
In life, it's imperative to always reassess our paths and choices. Just like a magician continually refines their act, we must regularly evaluate our goals, values, and priorities. By doing so, we ensure that we stay aligned with our true desires and aspirations. Much like the secrets behind a magician's tricks, the key to our personal success often lies in our ability to adapt and evolve. So, take a moment to reflect on where you're headed, and remember that reassessment is the compass guiding us towards a more fulfilling and magical existence.
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