Recently, I was looking over a prescription for an evaluation I had scheduled that day which was a chronic low back pain patient that I was familiar with from prior evaluations with him for other areas. I already knew this would be a great evaluation to apply some of the recent skills practiced at the lumbar spine residency weekend I just attended 2 weeks prior. Thankfully, this patient was low severity and irritability, so I had the chance to apply many of the skills we went over. Though this was a productive evaluation for me as a resident to finetune skills, this was still a challenging evaluation due to the fact that I had a challenging time reproducing his symptoms, even with some of the more provoking techniques. I was able to identify a two potential asterisks to retest, however, these were inconsistent in presentation as well. One of them was neural tension through a positive slump test which allowed me to apply the slump stretching1 technique we also discussed during the weekend course. This significantly improved his slump test as well as his symptoms when asked on his follow up visit the following day. The other asterisk I identified was more of a symptom noted during transitional movements that warranted further investigation at the next visit due to time constraints during evaluation. However, at the follow up visit, I was able to influence the second asterisks more clearly with targeting trunk extensors. Overall, I think the evaluation went well, but there are still aspects I could have performed better. Though my objective exam efficiency is improving, and I did allot myself more treatment time with this evaluation, I can still improve on acknowledging and following the emerging findings as they appear throughout the exam. I can still improve on thinking even deeper on how to continue manipulating mechanics and positioning to rule in or out targeted areas. I am thankful for this patient experience because I think it is a rare occasion, especially during this time in residency. It is rare opportunity that I am already familiar with the patient, know his very easy-going personality, low severity and irritability, low fear, and know that he has a very positive mindset and expectation of our clinic from his prior experiences. Even though every patient encounter is a learning experience, I could really dive deep into this one and utilize many techniques with this patient that are typically too provocative for most LBP patient’s I see in the clinic. I am excited to see how his case progresses and how it will continue to challenge me to think deeper and push me to be a better clinician.

I have listed below the slump stretching article for anyone who would like to review it again!

References:
1.Nagrale, A. et al, “Effect of Slump Stretching versus Lumbar mobilization with exercise in subjects with non-radicular low back pain: a randomized clinical trial,” J Man Manip Ther. February 2012; 20(1):35-42. doi: 10.1179/2042618611Y.0000000015.