“The Front of the Back”

https://twitter.com/Cinema_Air/status/535089100374556672

He walked with a very rigid trunk, no trunk reciprocation, and a compensatory forward R trunk lean with initiation of R LE swing. He seemed to have difficulty loading his R LE. His general complaint was pain and major stiffness throughout his R hip, low back, and neck.

We worked on mobility and motor control to improve R LE loading for better & pain-free gait, but nothing major changed. I decided to have him on the table and check passive pelvic mobility; that’s when it got interesting. R pelvic anterior elevation seemed “boggy” and posterior/anterior depression was incredibly limited. And, it seemed like something anterior/superior to his R pelvis was preventing him from moving.

“Mind taking off your shirt? I feel like something along the front is preventing you from moving better and I’d like to take a look.”

“Sure.”

“WHAT HAPPENED HERE?”

“Oh yeah, I had major abdominal surgery in my late teens after a stabbing incident.”

During the Initial Evaluation (last visit) I observed him from anterior, posterior, and lateral angles. I asked him to take off his shirt; so he got down to the tank-top he was wearing underneath. When viewing from posterior, I rolled up his tank-top to get a better view of his low back. I asked him to turn around so I could view him from the front. He rolled down his tank and turned around. Then we did lateral views.

In case you didn’t catch it, my error was in NOT asking him to take off his tank-top as well so I could have a clear view of his trunk. While most men don’t wear more than 2 layers on top, this guy sported 3-4 layers of clothes. I should have cued him to go completely topless instead of making due with the remaining 1 layer of clothing on his trunk.

This error revealed itself in grand form on his next visit (as you read at the beginning of this post).

Lesson Learned: Always get prior medical history related to the abdominal and ribcage areas, and never forget to assess “the front of the back”.

Erica was right; I’ll never forget it.

@Cinema_Air

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