1. CHIROPRACTIC PHYSIOLOGICAL THERAPEUTICS COURSE #7121

2. Patient presents with a chief complaint of pain in his low back of 2 days duration as a result of lifting a bag of fertilizer into his truck. Standing, sitting and quick sudden movements is provocative. Lying down on his side is more comfortable. Pain analogue scale is 75 on a scale of 0 to 100. The pain is of a aching and burning type and it seems like it never goes away.

3. PAIN SCALE

4. There is a slight radiation of his pain into his right buttock. The patient denies any previous trauma. The patient is 34 years old. PMH is unremarkable and no surgical history is admitted. No allergies (common or Meds). Patient is a non smoker and is a social drinker.

5. VITAL SIGNS BP: 140/80 RA, 150/90 LA HS: Strong, regular with no arrhythmia's Lungs: Clear, no rales PR: 72 Temp: 96.4 EENT: e/n Auscultation of subclavians and carotids were clear with no bruits CVFM : normal at 1 minute bilaterally

6. ORTHOPEDIC EXAM Bechterew’s : + R Kemps: + L & R Reflexes: LE - 2+4 bilaterally RSLR: + at 35 degrees with radicular pattern Braggards +(R) Laseque’s: + (R) WLR: + at 45 degrees Lindner’s sign: +

7. ORTHOPEDIC EXAM Milgrams: unable to perform Dermatomes were asymmetrical with (R) diminished at L5 and S1 Yeoman’s: + (R) Ely’s: 0 Hibbs: 0 Gaenslen’s: 0 Turyn’s: + (R) Sicards: + (R)

8. ORTHOPEDIC EXAM Nachlas: + (R) Goldwaith’s: + (R) at 35 degrees

9. POSTURAL EXAM Occiput High on (R) (L) Shoulder elevated (L) Scapula elevated Pelvis high on (R) Pronation bilateral feet

10. MOTION SCAN INTERSEGMENTAL There is considerable decreased motion of the lumbar spine in flexion, extension, lateral bending to the (R) and (R) rotation.

11. STATIC PALPATION Palpation of the full spine reveals hypertonic musculature of the quadratus lumborum bilaterally. Paravertebral muscular spasm noted in the thoracic region. Tenderness noted on spinal compression at L5/S1 level as well as T6-T8. Multiple trigger points found in the trapezius bilaterally.

12. DIFFERENTIAL DIAGNOSIS Lumbar disc herniation Lumbar facet syndrome Lumbar sprain/strain Postural alterations ISJD in the lumbar and thoracic spine

13. LUMBAR SPINE X-RAYS

15. MRI LUMBAR SPINE

16. DIAGNOSIS A.Lumbar facet syndrome B.L5/S1 disc herniation C.Lumbar sprain/strain D.ISJD of L5/S1 and T6-T8 Answer is? B,D

17. DIAGNOSIS L5/S1 disc herniation with radiculapathy ISJD of T6-T8 and L5/S1 with associated myofascitis and myalgia

18. CASE MANAGEMENT 1.Modalities 2.Adjusting 3.Orthopedic support 4.Orthomolecular support 5.Home instructions 6.Appointment schedule

19. MODALITIES Ultrasound XA.Continuous XB.Pulsed Interferential XA.Frequency High Volt Hot Moist Heat Cryotherapy Russian Stimulation

20. MODALITIES Diathermy Microcurrent Combination Therapy XA.(US and High Volt) XB.US & Medium frequency Passive static stretching Orthopedic support XA.Low back XB.Orthotics

21. ADJUSTING A.Flexion/Distraction B.Extension technique C.SOT D.Activator E.Diversified F.Thompson

22. HOME INSTRUCTIONS Heat Ice Sleeping Sitting Exercise Orthomolecular support Emergency

23. TREATMENT PLAN How often? Re-evaluation?