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Hey Amanda! Are you referring to this questions?
“A 30-year-old male IT consultant was referred to you by his personal trainer. He complains of low back pain for the past 2 weeks that has caused him to miss several days of work. He reports that the pain is primarily in the right lower lumbar region, although he occasionally experiences pain and numbness into the right gluteal region when sitting at work or performing a seated leg press at the gym. His symptoms are worse in the morning and typically improve once he gets started with his morning routine. He also complains of intermittent pain in the upper lumbar region. He rates his pain at 2/10 on a visual analog scale (VAS) during the majority of the day. At worst, the pain is rated as 7/10 on a VAS when he is sitting at his desk for prolonged periods. On physical examination, he has a normal gait. Lumbar flexion is painful. Repeated flexion reveals aberrant motion when returning to an upright position. Right rotation and right side-bending are painful and limited. Extension is limited at end-range but not painful. Hip mobility is within normal limits. Hip abduction strength is 4/5 on the right; otherwise, manual muscle testing is within normal limits. His Modified Oswestry Low Back Pain Disability Questionnaire score indicates a 50% disability. His Fear-Avoidance Beliefs Questionnaire work and physical activity scores were both 15. Segmental mobility assessment reveals hypomobility at the L4-L5 and L5-S1 segments”
Based on the available information, what would be the best intervention to start?
If so, the correct answer would be thrust manipulation.
Thanks
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No, sorry. I read the other post about being more descriptive in the future. The question was relating to a guy who tweaked his back working on his shed and went to the ED with intense pain. The question states that his hip ROM is WNL, there wasnt any s/s distal to knee, he was hypomobile, and he had gone to the ED right away so it was <16 days. This all points to manipulation to me, though the correct answer with directional preference even though nothing in the question shows a directional preference.
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Gotcha! Thanks for clarifying.
Yes this questions is tricky. Purely looking at it from a CPR standpoint indicates manipulation, but the most recent low back treatment based classification introduced a new paradigm for intervention selection. Given the severity of symptoms, this case falls into the symptom modulation classification which indicates the use patient led directional exercises prior to manipulation.
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Got it. Do you have a reference or can offer help with knowing how to answer those questions on the test? Because even with symptom modulation classification, manipulation would be appropriate. Seems like both answers would be equally correct. How would I know which way the test writer is thinking?
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https://academic.oup.com/ptj/article/96/7/1057/2864925
this article is probably you’re best reference to grasp how to navigate the low treatment classification. You’re absolutely correct that manipulation would be appropriate, but only if you we certain centralization had plateaued with directional exercises, we didn’t state that specifically but set the table knowing that people would easily make that assumption.
On the actual OCS exam, never assume, go strictly with the facts given. They can only test you on what is explicitly asked. And rest assured that if a question is written poorly, it will be consistent answered incorrectly and they will throw the question out.
I hope thats helpful?
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Yes, that was helpful along with the article. That’s still something i need to work on, choosing the correct treatment when multiple are appropriate. So just to clarify: even if the question doesnt specifically illustrate a directional preference, that would still be the appropriate answer to try first prior to manip? I ask because there have been other practice questions I’ve taken and DP is wrong because “no DP was illustrated by the patient.”
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If the patient is in severe pain with all activities, and based on what is provided it’s unclear as to how they have responded to DP exercise, then YES assume that DP is the most appropriate starting point.
The severe pain with all activities, is the key overriding factor, otherwise in any other circumstance you would follow the decision making algorithm per usual.
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Thank you. On a similar note, if a lumbar radic patient aligns with the criteria for traction, should nerve mobs still come first?
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you’re welcome… No there is a lot of strong evidence supporting nerve mobs as a primary treatment for radiating pain. You’re decision making algorithm should always start with which of the highest rated intervention are indicated here, if the patient is in severe unrelenting pain, you’ll want to pick the most conservative intervention option first even if the more aggressive intervention appears to be slightly more supported with the findings provided.
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