05/08/2022
جاتني بيشنت عمرها 42 سنة متزوجة وعندها طفلين وبتلد بعملية. كانت بتشتكي من Low back pain ومعاه Urinary incontinence
شغالة مساعد مدير... شغلها كان قعادو كتير فبتقعد ع الاقل 6 ساعات يوميا... وجع الظهر امتد لرجلها اليمين بقت م بتقدر تقعد مسافات طويلة...
لاحظت ليها لما تقعد بتميل على الجهة الشمال كمان عندها Forward head tilt + Rounded Shoulders
🪶 الROM بالنسبة للLumber spine كان مؤلم وم قدرت تتمو اكتر من 50%
🪶 في الHip كان في limitation لل Internal rotation and adduction الاتنين كانو مؤلمين بس بتتم الROM ما يعني انو عندها Tightness فيهم .
🪶 اخر حاجة الScar بتاعتها كانت عاملة Adhesions.
🪶 Problem list :
✅ Radiating back pain ✅ Decreased ROM of lumbar spine
✅ Muscle-guarding in low-back musculature ✅ Pelvic floor scar adhesion and pain ( she had a CS)
✅ Pelvic floor increased tone, inability to fully relax
✅ Pelvic floor weakness
✅ Frequency of urination and leaking of urine a minimum of seven times a week.
✅ Trigger point in right obturator internus and right piriformis
✅ Abdominal muscle weakness
✅ Piriformis and hip flexor tightness
✅ Postural deviation, patient unaware of proper posture and body mechanics
✅ Antalgic gait
✅ Decreased SIJ mobility on right; forward rotation of right ilium
✅ Inability to perform functions as wife, mother, and employee ✅ disrupted sleeping pattern
حددت ليها جلسات لمدة 3 شهور
3 مرات في الأسبوع اول اسبوعين بعدها مرتين في الأسبوع لأسبوعين وبعدها مرة واحدة أسبوعيا لمن نخلص ال3 شهور
🪶 Goals :
Within 6 weeks :
1. Decrease back pain to 2/10.
2. Return to work, life, and social activities, with pain no higher than 4/10.
3. Be able to do home ADLs with normal body mechanics and pain no greater than 4/10.
4. Report decreased pelvic floor pain to 3/10.
5. Exhibit decreased pelvic floor resting activity .
6. Exhibit decreased trigger point tenderness in piriformis and obturator musculature .
7. Demonstrate increased pelvic floor strength .
8. Exhibit increased strength of the lower abdominals, to 3/5, increasing lumbopelvic stability.
9. Correctly answer all questions about posture, bladder training, and bladder irritants.
10. Have normal muscle strength of piriformis, adductors, and hip flexors, as demonstrated by normal ROM for hip motion.
12. Decrease the number of urinary accidents from seven per week to three per week.
🌱 الgoals والTreatment intervention
🌱 The following goals were anticipated to be reached in 2 to 3 months, with visits no more than bimonthly during the last 2 months of care. The patient will:
1. Function independently in all work, life, and social activities, with back pain no greater than 2/10.
2. Demonstrate independence with all exercises.
3. Report decreased pelvic pain, to 0–1/10.
4. Report no pain on in*******se or tampon insertion.
5. Demonstrate absence of scar adhesion.
6. Demonstrate a resting tone of the pelvic floor.
7. Exhibit pelvic floor strength of 3+/5 or greater.
8. Reduce the number of urinary accidents to fewer than one per week.
9. Demonstrate independence with the home exercise program and decision making on progression of exercises.
Intervention :
✅ Ultrasound (US) is frequently used to promote wound healing and soften scar tissue.
✅ The intervention for the back pain was decided to include grade 2 joint mobilization to the right SIJ and the use of muscle energy techniques to derotate the right ilium. ✅ Trigger point massage of the piriformis trigger point was also performed, as was myofascial release of the pelvis and the abdominal region.
✅ Soft tissue: Scar massage, along with myofascial release of pelvic girdle, lumbar spine, and pelvic floor, as well as the scar adhesions, were performed.
✅ Strengthening: Pelvic floor strengthening exercises (starting with two sets of 5-second hold contractions, with a 5-second rest in between, followed by 10 quick [1-second] contractions) twice a day while supine; lower abdominal muscle strengthening exercises , and lumbar stabilization exercises.
✅ Biofeedback: To reduce the tone of pelvic floor and teach isolation of the pelvic floor contraction. ✅ postural training.
✅ Stretching of tight hip flexors, piriformis, and abductors.
By Dr Somia Alsheikh
