SPINE AND PELVIS TREATMENTS

LED LIGHT THERAPY

Cervical Disc Herniation and Stenosis

Subjective:

Herniated cervical discs create pain in the lateral neck
and shoulder in mild cases. In moderate to serious cases, there can be severe pain that radiates into the ipsilateral middle back, arm and hand. The patient may present a history of trauma, but insidious onset is common.

Assessment:

Improvement will result in the centralization of pain followed by decreasing neck pain, increasing the range of motion, and, when present, normalizing neurological signs. LED Light Treatment Plan: Treat the site of herniation with 25–600 joules and then slowly paint over the nerve roots in the lateral neck with 10 to 100 joules. Finally, trace a few tender points in the arm with 5 to 25 joules per tender point. Treat two to three times per week for two to six weeks, decreasing frequency as symptoms improve.

Adjunctive Treatment Plan:

Most patients find relief from avoiding cervical spine extension and ipsilateral side bending. Many patients report relief from gentle home traction and regular resting in the supine position, to minimize loading of the disc. Prescribe arm and chest stretches to relieve brachial tension, with an emphasis on middle back strengthening as symptoms abate. Initial use of ice and then later use of ice/heat on the cervical spine can be helpful to decrease inflammation and control symptoms. A home program that includes upper extremity stretching can be helpful. If symptoms are
not improving after two to three weeks, or if there is increasing pain or motor weakness, consider a referral to an orthopedic specialist.

SPINE AND PELVIS TREATMENTS

LED LIGHT THERAPY

Cervical, Thoracic, Lumbar Sprain/Strain

Subjective:

Sprains and strains typically cause localized back or neck pain. In moderate cases, there will be muscle spasm and even radiating pain into an extremity or around the ribs and into the chest or abdomen, especially with moderate injuries to facets or ribs. The patient may feel relief with flexion or extension.

Assessment:

With appropriate therapy, the patient will note improved joint play with decreasing spasm and pain within the first few treatments.

LED Light Treatment Plan:

Treat two to three times the first week, decreasing frequency as symptoms subside. Treat with 10 to 100 joules directly over the problem facet. Treat with 5 to 25 joules per tender point if there is radiating pain down the arm, leg, or along intercostal nerves, if there is a radiating neuritis. Maximum initial dose should not exceed 100 to 150 joules, increasing to a maximum of 600 joules per session.

Adjunctive Treatment Plan:

In the acute stage, the patient should avoid any position or movement that increases pain. Initially using ice for 2 to 3 days and then ice/heat can assist in symptom control. Mobilization often provides dramatic relief of symptoms. The patient should only perform exercises that provide relief from pain in the early stages and progress to gentle stretching and strengthening as symptoms decrease. With rib sprains, no flexion or side-bending stretching should be performed for one to two days after joint mobilization. If one week of treatment has not produced a significant improvement, consider referral to an orthopedic specialist for more potent anti-inflammatories and an
additional diagnostic workup.

SPINE AND PELVIS TREATMENTS

LED LIGHT THERAPY

Coccydynia

Subjective:

Patients usually complain of lower coccyx pain that is aggravated by sitting. Although onset can be insidious, the most common cause is direct trauma or repeated strain caused by activities such as cycling or rowing. Childbirth, due to the increased flexibility of the joint and the resulting strain and pressure, can also cause this syndrome. The result is an injury of the sacrococcygeal junction.

Assessment:

Improvement will be noted after 1–2 weeks as a decrease in localized, sacrococcygeal complaints. If improvement is interrupted by a flare-up, make certain that the patient uses upright and slightly forward-leaning posture when sitting.

Adjunctive Treatment Plan:

To reduce direct strain on the coccyx, patients need to be encouraged to avoid sitting down for long periods of time. Sitting on the edge of the chair, with the weight on the ischial tuberosities, can often reduce pain over time. Some practitioners believe that intra-anal mobilization techniques may be of benefit. Anti-inflammatories, ice, and sitting on a “doughnut” cushion or pillow can help control symptoms. In acute cases, a stool softener can reduce discomfort during defecation.

LED Light Treatment Plan:

Begin treatment with 25 to 100 joules with half of the treatment painting directly over the sacrococcygeal junction and the other half slowly painting the adjacent areas of the sacrum and gluteal muscles.

SPINE AND PELVIS TREATMENTS

LED LIGHT THERAPY

Costochondritis or Chest Pain

Subjective:

This condition often presents with sternal or rib pain localized to the costal cartilage. This syndrome is common after motor vehicle accidents and sports injuries but can be of insidious onset.

Assessment:

Treatment usually results in rapid resolution of the majority of symptoms. LED Light Treatment Plan: Treat each tender sternocostal joint with 10 to 50 joules and then paint over the wider symptomatic area with 25 to 100 joules. Treatment in the acute stage often requires no more than two to five treatments, each with a maximum of 50 to 600 joules.

Adjunctive Treatment Plan:

Ice/heat at home can help reduce inflammation. Stretching should be avoided for one to two days after treatment. Gentle mobilization of the sternocostal and costovertebral joints can help alleviate dysfunction, when present.

SPINE AND PELVIS TREATMENTS

LED LIGHT THERAPY

Herniated Lumbar Disc

Subjective:

A herniated lumbar disc will create low back and/or leg pain that is increased with at least one or two of the following activities: coughing, sneezing, sitting, long-term standing, rolling over in bed, moving from lying or sitting to standing, and repeated bending, twisting, and lifting.

Assessment:

Proper therapy usually results in improving range of motion, decreased pain, and less positive orthopedic tests.

LED Light Treatment Plan:

On the first treatment, start with 25–600 joules depending upon the severity of the injury. Always start with a lower dose and titrate upward slowly. Treat two to three times the first week, decreasing frequency as symptoms improve. Use lower doses if a patient has severe pain, to reduce the likelihood of a flareup. Spend one-third of the treatment time directly over the injured disc, one-third painting the lumbar nerve roots above and across the crest of the ilium, and one-third of the dose treating points in the buttocks and leg. Treatment may be required over the lumbar or leg muscles if there is a spasm, including hamstrings, quadratus lumborum, gluteus medius, and tensor fascia lata.

Adjunctive Treatment Plan:

In the acute stage, the patient should decrease sitting, bending, twisting, and lifting. Initially using ice and then ice/heat can assist in symptom control. A back brace often provides an increased sense of stability during the most accute stage. The patient should only perform exercises that provide relief from pain in the early stages and progress to stabilization exercises and leg stretching as symptoms decrease. Later, progression to stabilization and strengthening of core muscles is recommended. Traction can be provided when appropriate, and education about posture and body mechanics is vital. If there is no improvement after one to two weeks or symptoms worsen, a referral to an orthopedic specialist may be indicated for an MRI or other types of intervention. If there is bladder or bowel disruption or a noticeable increase in neurological symptoms, especially motor weakness, refer the patient to a physician
immediately.

SPINE AND PELVIS TREATMENTS

LED LIGHT THERAPY

Lumbar Stenosis

Subjective:

Lumbar stenosis commonly presents with low back pain that radiates into the hip and lower extremity, aggravated by lumbar spine extension. Often lying prone aggravates the pain, while slumped sitting and pelvic tilt positions can give some relief.

Assessment:

If treatment is successful, the patient will experience less radiating pain and improved functional activities. LED Light Treatment Plan: Treat the site of stenosis with 25 to 200 joules and then paint over the nerve roots with 10 to 100 joules above the crest of the ilium. Finally, trace the radiating pain down the sciatic nerve with 5 to 25 joules per tender point with the treatment of the foot and toenails in severe cases, for a maximum of 50 to 600 joules per session. Adjunctive Treatment Plan: Initial use of ice and then later use of ice/heat on the lumbar spine can be helpful to decrease inflammation and control symptoms. A home program that includes an application of heat to the leg muscles and lower extremity stretching can also be helpful. Most patients find relief from gentle flexion exercises, leg stretches, with an emphasis on abdominal and core strengthening. If symptoms are not improving after two to three weeks, or if there is increasing pain or motor weakness, consider an immediate referral to an orthopedic specialist.

SPINE AND PELVIS TREATMENTS

LED LIGHT THERAPY

Pubic Symphysis Sprain

Subjective:

This syndrome will create pain at the pubic symphysis, aggravated by activity, even walking. In more severe cases, patients can hear a “clicking” emanating from the joint with vigorous physical activity, trauma, pregnancy, or obesity.

Assessment:

With improvement, there is a rapid decrease in subjective complaints.

LED Light Treatment Plan:

Place the probe directly over the most painful part of the pubic bones for 10 to 100 joules. Then paint over the area with 25 to 50 joules. Treatment can be provided two to three times per week for one to three weeks, decreasing frequency of treatment as symptoms abate. Because the symphysis is close to the genitals, consider having the patient hold the probe over the pubis.

Adjunctive Treatment Plan:

Initial use of ice and then later use of ice/heat can be helpful to decrease inflammation and control symptoms. Patients should avoid any extreme range of motion of the lower extremities. Isometric thigh adduction and abduction can strengthen and stabilize the region once the acute symptoms have been relieved. In some cases, mobilization or stabilization of the sacroiliac joint can help alleviate pubic symptoms.

SPINE AND PELVIS TREATMENTS

LED LIGHT THERAPY

Sacroiliac Sprain

Subjective:

A sacroiliac sprain or strain will create low back pain that centers primarily over the PSIS (posterior superior iliac spine) with, in more serious cases, pain radiation down the lateral thigh, but above the knee. Pain can sometimes be relieved by sitting and aggravated by walking or repeated bending and twisting.

Assessment:

Decreased localized pain with increased range of motion.

LED Light Treatment Plan:

Place the probe over the superior and the inferior part of the joint to deliver 25 to 100 joules per region. Painting over the joint and treatment of tender points in the gluteal region and the lateral thigh may help reduce symptoms. Treat two to three times, over a period of one to two weeks, or until symptoms have significantly decreased. Utilize a maximum of 50–600 joules per session.

Adjunctive Treatment Plan:

Mobilization can often provide rapid, short-term relief. Initial use of ice and then later use of ice/ heat can be helpful to decrease inflammation and control symptoms. The patient should only perform gentle exercises that provide relief from pain in the early stages. Often, active and passive hip flexion and extension exercises can “self-mobilize” the joint and provide relief. In the subacute stage, progress to stabilization exercises and strengthening of core muscles. If one week of treatment has not produced a significant improvement, consider referral to an orthopedic specialist.

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