41 yr old male w/ 2yr hx of LBP, right SIJ and post hip

Hayashida & Associates Physical Therapy

41 yr old male w/ 2yr hx of LBP, right SIJ and post hip.

No apparent mechanism of injury. Pt does work in office setting involving significant time spent in computer related tasks. Pt is active w/ mtn biking and traditional bodybuilding as main activities and reports no pain with exercise. He typically has no pain at rest. Sx's worst x30 min after rising with increased stiffness/ache R SIJ/low lumbar, relieved w/ "moving around and warming up". Pt has participated in prior PT intervention which involved SIJ/lumbar mob, stm, stab and flexibility home exercises w/ overall good success, however primary sx's of stiffness/ache persist.

Objective: healthy appearing 41yr old male who ambulates w/out obvious gait abnormalities into the clinical setting. Posture in standing is symmetrical, illiac crests level w/ slight ER at the hips B R>L. functional squat is neg, lumbar range of motion is as follows: flex lacking 25%, ext lacking 40% (slight stiffness R L5/S1), SB R/L WNL's. Supine exam shows no pelvic obliquity, pos R faber, neg SIJ compression/distraction, Pos R SIJ shear, HS length B WNL's, quad length B mod limited, Thomas test pos B for severe rectus and mod psoas restriction. Prone palpation exam shows severe stiffness R L5/S1 with mod stiffness R SIJ and L4/5. Pt describes R L5/S1 as "the stiff spot". L lumbar palp reveals min stiffness L4-S1. Prone hip IR to 20 deg R, 40 L.

Treatment: Unilateral PA GR III to R L5/S1 and SIJ w/ c/o stiffness > achiness w/ minimal improvements in jt mobility and no improvement in lumbar ROM. Pt placed in ATM2 w/ slight pelvic rotation L to facilitate closing R L5/S1. Pt performed 3x10 lumbar extensions w/ resistance painfree. Pt instructed in HEP for lumbar stab.

Results: Post ATM2, pt's lumbar extension improved to full, flexion to 90%, mob R L5/S1 min limited and pt reported feeling "significantly less stiff" throughout lumbar spine.

Opinion: The ATM2 stabilized the pelvis to facilitate movement through the dysfunctional segment in a functional manner which provided immediate results in improved ROM and jt mobility for this pt. It seems to be effective for pt's whose primary dysfunction is related to stiffness as well as pain.