When it Goes Right: A Quick Update to Chronic Lumbopelvic Pain – The Coccyx, Sacrum, Lumbar Spine, and Innominate.
A Reminder of The Patient and Case
The patient is an active 15-year-old female participating in volleyball, basketball, equestrian, and track and field. The patient was diagnosed with a subluxed coccyx after an ice skating accident approximately one and a half years prior to beginning treatment with me as her athletic trainer. In that time she had sought care with multiple physicians, an arthritis specialist, a chiropractor, reportedly becoming nauseas after adjustment, physical therapists, and a massage therapist. Her pain is centered around her sacroiliac joints with the left being more painful than the right. She also reports tenderness in her L5 vertebrae and coccyx area as well as upper back pain in the area of T6-T10. The patient also reports intermittent cramping and spasm in her right glute and left quadriceps. Including the use of prescription pain medication and muscle relaxers the patient claims that she has been in constant pain rated on a Numerical Pain Rating Scale (NPRS) at a 6-9/10. She also reports having almost constantly interrupted sleep since her injury. She has continued to play sports and engage in activity as usual over the course of her injury despite her pain. At the time of evaluation she had largely stopped seeking medical attention for her pain. As of 12/3/2017 The patient now goes full days without pain only suffering increases in pain with significant contact on the basketball court (she is a hustle player, picture a tiny Detroit Pistons era Dennis Rodman) that can be quickly addressed.
December and January Updates
Through the months of December and January the patient checked in on an as needed basis, generally after an adverse event such as a fall diving for a ball or a trip to the trampoline park with symptoms never more than 3/10 pain which are quickly resolved through Mulligan Concept MWMs into mulit segmental forward flexion with right anterior innominate rotation and left posterior innominate rotation. The patient would have the left posterior innominate rotation taped with cover role and leuko tape to help support the treatment in addition to a modified warm up prior to strength and conditioning programming that included left side banded hamstring curls and right single leg squats during warm up.
February and March Updates:
After basketball season the patient took a week off from training while she decided whether or not she would participate in track and field. Initially her thoughts were to continue with her strength and conditioning programing in preparation for the following volleyball season fearing that, despite her not reporting any low back, pelvis, or hip pain in the month of February, her participation in jumping events would cause a return of her back pain. In late February, the patient reported to me along with the rest of the girls track and field team, smiling in a rather snarky manner, for strength and conditioning. She had decided to continue to participate. On 3/7/2018 the patient participated in her first day of high jump practice without incident.