CBL - Low Back Pain

Question 1

biomechanical treatment plan for pt presenting w/ piriformis syndrome

Answer 1

1. initial management w/ OMT to reduce mechanical strain to piriformis
2. restore normal ROM and decrease pain
3. may start physical therapy to strengthen core muscles and stability
4. treat piriformis with OMT
5. teach pt piriformis stretches
6. ultimately surgery may be an option for unremitting pain

Question 2

respiratory-circulatory treatment plan for pt presenting w/ piriformis syndrome (w/ history of smoking)

Answer 2

1. may initiate bronchodilators such as albuterol and inhaled glucocorticoids
2. council patient on smoking cessation
3. help rib motility with OMT to improve tidal volume

Question 3

neurologic treatment plan for pt presenting w/ piriformis syndrome

Answer 3

1. pain management w/ initially consist of NSAIDs or acetaminophen but advancement to muscle relaxants or gabapentin if appropriate
2. can consider local steroid injections or botox injfections
3. consider referral to pain management clinic

Question 4

metabolic-energetic-immune treatment plan for pt presenting w/ piriformis syndrome

Answer 4

1. OMT to mobilize diaphragms and treat lymphatics and reduce stasis of fluid
2. benzodiazepines and antispasmodic agnets (cyclobenzaprine)

Question 5

behavioral treatment plan for pt presenting w/ piriformis syndrome (from case: pt carries wallet in back right pocket, hx of smoking and excessive drinking)

Answer 5

1. remove wallet, decrease repetitive pressure on piriformis m.
2. discuss potential for addiction w/ use of opioids and negative effects of smoking
3. offer psychological referal to help dealing w/ pain and substance use disorders

Question 6

what OMT treatments should you start off with in a pt presenting with piriformis syndrome

Answer 6

start with gentler treatments like soft tissue, MFR, FPR, CS

Question 7

when to use HVLA in a pt presenting with piriformis syndrome

Answer 7

no HVLA until red flag diagnoses are ruled out