STARES 3 Intervention

S- A 59 year old male patient presented to the physio practice complaining of low back pain. In his assessment it was found that he had a control dysfunction into extension. After a few treatments by another physiotherapist who went on holidays I was given a handover to work on the patients control dysfunction, now that he is virtually pain free.

T- Task was to teach the patient spinal neutral, how to activate transverse abdominis (TA), pelvic floor (PF) and multifidus and commence a gym program that consisted of working on control of the lumbar spine.

A- In a treatment room I explained about how all the core stabilising muscles worked together to support the lower back and how it can help his problem. Firstly I taught him how to activate his TA and PF in sitting. I then went on to show him where and what his multifidus felt like which was done by palpation and raising and lowing his arm. Once he was able to activate TA and PF and knew where his multifidus was I asked him to get into 4 point kneeling. In this position I placed a stick that ran down his back to show neutral. I taught him to activate his multifidus by ‘swelling that area under my hand’. As he knew where multifidus was he was able to activate it.

R- the patient successfully understood able his core muscle system and was able to get into spinal neutral and activate TA, PF and multifidus for 4 breathes. His endurance for all these muscles was decreased and that would now become his home exercise program. I gave him a hand out with diagrams of what we went through today and so he could easily refer back to it.

E- I think that I taught this patient well and I feel as if I didn’t overload him too with too much information at one session. However I could have improved my explanation about what the PF and TA are and what they do. I think I talked myself into a circle at one point.

S- Strategies for improvement:
-Planning my explaining and writing it down so I can learn it in quick dot points.
-The more patients of this type I see.
-Keeping up to date with the evidence.
-Asking other clinicians the best way they explain and carry out this task.