Question

Ms. Bewcyk is a 31 year old office worker with recurrent back pain since the age of 18. She initially was injured, as a result of a fall, while playing softball with friends. Diagnosis was “muscle strain” and was treated with pain killers and muscle relaxants. Her back improved quickly, but the pain never subsided. Ms. Bewcyk feels better when active, but has had a hard time keeping active due to the varying nature of her back pain. Just recently she had some test done. The results are as follows:

X- Ray – Normal
MRI – bulging disk between L4-5
Radiating pain from right buttock to right knee

1. What contraindication must you be aware of with Ms. Bewcyk?

2. What, if any, issues should you inquire of, or modify of her current employment?

3. Develop a core program for Ms. Bewcyk.

4. Develop a cardiovascular conditioning exercise program for Ms. Bewcyk to compliment the

   core strength program developed in question 3.

Answer 1

1)

• Disc bulging cause injury to the cushioning and connective tissue between vertebrae.
• This may cause backpain and physically disability .
• The pain is due to release of chemical mediators , [released due to inflammation].
• Nerve root compression may occur, this is because of increased internal pressure and membrane thinning from stretching.

2)

• Standing and lying balances internal pressure all over the disc.
• While sitting and bending causes variation in internal pressure.
• Variation in internal pressure can cause thinning of membrane, thiss maty result in ruputure of the membrane
• So the additional issue which the doctor must ask to patient is - about her posture during her work , due to the above reason.

3)

• Core program includes education, proper body mechanics and physical fittness.
• 1) education- it is mainly based on , the concept that - do not work beyond one's capability. And give adequate rest after a work, also emphasis on the maintenance of proper posture and body alignment.
• 2) proper body mechanics and physical fittness- there are excercises for back strengthening , such as press ups, upper back extnsion, transverse abdominis bracing and floor bridge. Pain persist means, that muscles at the back are weak. so, it has to be trained to strengthen
• Heavy lifting can be done with legs, not with back.
• Swimming
• Using Lumbosaccal support belts.-- for restriction of the movement at the spine.

4)

• Aerobic excercises cause elevation of heart rate and increase circulation.
• it also elevate backpain by reducing stiffness and increase in blood flow to spinal structures and also increase amount of nutrients - reaching the spine.
• Thus making the spine functional and mobile.
• Example of aerobic excercises are walking, electrical trainer excercise , stationary bicycling , swimming and water aerobics.
• This all have slight impact on spine .