Acute Post Shoot

The strangest things happen sometimes, and I do believe on this last day of 2005 I experienced my most odd and unlikely physical therapy practice experience to-date. Here is how it goes:

My youngest son Josh and I arose early this AM to take part in that time-honored South Texas ritual called deer hunting. We were fortunate and successfully harvested (OK….shot) a deer only a few minutes after getting situated in the blind and then made it back to camp earlier than expected. Since my uncle was still out in the pasture, Josh and I were enjoying some good father-son moments when my cell phone went off; it was my uncle Jack. He was in quite a bit of distress on the phone which initially had me quite concerned. As it turned out however, between grunts and groans, he said he had a sudden onset of severe low back pain and was now stuck on all fours right beside the deer he had finished field dressing (OK….gutting) just moments before and could not move. Evidently, when he bent over to work on the deer he felt a pop; when he finished and tried to stand, he collapsed with pain and was absolutely stuck in his present awkward position and was unable to move due to pain.

Josh and I jumped on Jack’s 4-wheeler (it was a great excuse to get to ride it and let Josh drive) and high-tailed it out to where he was hunting. What a sight: My uncle on hands and knees in the middle of the wild with his hunting paraphernalia was on his left and the now dressed-out deer lying to his right. I must admit I poked a bit of fun at him and made some ambulance sounds while circling around the scene.

It became immediately apparent he was in no joking mood, so I asked my 46 yr. old uncle if he had any leg pain (he had none below the knee), loss of sensory/motor or bowel bladder function (no to both). Now, I have seen and treated patients with similar histories (none quite this inane, though) many times before but usually not until several day s/p incident, often times weeks, and sometimes following a few days of bed-rest. In his case it was clear that the only examination information I was going to get that day was that he had pain <16 days, no pain below the knee and no other contraindications…..you could forget checking anything else; heck, I had to figure out how to just get him off his hands and knees. If I could get him positioned properly, current best-evidence in this case suggests he had a good chance a dramatic improvement (maybe as high as 85%) when treated with lumbo-pelvic manipulation just based on those 2 factors alone (Fritz JM, Childs JD, Flynn TW). 

Intervention: I stood behind Jack, reached under his arms, and quickly brought him to the half-kneeling position. Because he was moaning quite loudly, I figured I better do something quick….what to do? For lack of any other ideas and because I have found an added benefit clinically on many occasions, I dropped, kneeled behind him and performed a general distraction manipulation to his thoracic spine. I don’t know how effective it was, but it did quite him down a bit, enough to have him lay supine (in the dirt and leaves) where I was then able to perform a general lumbo-pelvic manipulation bilaterally. After a few long pauses I had him back on hands and knees and doing a hand-heel rocking exercise. I then did my behind-the-arms lift again to get him to his feet. After a few minutes and a few faltering steps, we began walking back, stopping intermittently when he would get a severe “spasm” and have to lean on me for support. These “spasms” went on for about 10 minutes but were progressively fewer and less intense…..we kept walking……finally, we got back to camp. 

Outcome: Hunters= 2, Deer= 1 near miss. My uncle had very minimal pain (0 – 2/10 from 10/10 previously) but felt if he moved wrong he would be down for the count again.  Josh and I went back and collected our gear. We then finished the morning taking care of the venison and cleaning-up. So there he stood the whole time, walking intermittently, chatting and seeming to enjoy giving orders. I gave him some general precautions to follow and will probably see him again in a couple of days. 

I know Jake Magel has a really interesting story about treating a total stranger stuck under the car at a gas station one time (I am foggy Jake, help me out here), that Julie Whitman has a really interesting collection interventions being performed in the most extreme locations, and that my practice partner Andrew Bennett is a Houdini with manual physical therapy feats, but how about you? Musculoskeletal problems “Happen”, and they sometimes happen at the oddest places and times. I think it would be a great way to close out 2005 by having folks share any outrageous physical therapy moments with our family of subscribers and casual readers alike.

From all of us at Evidence In Motion, we want to thank you for helping make this Blog what it is and wish you and yours a Happy and Prosperous New Year. We are excited about our profession and the opportunities to work with you in 2006 to make physical therapist practice synonymous with EPB and physical therapists the providers of choice for patients with movement-related disorders. Happy New Year!
 

Rob

Comments

[Troy Grubb]

Your story reminds of an impromptu "treatment session" at a restaurant where my extended family (the whole clan on my mother's side) regularly has a pre-Christmas "Get-Together". This year, as usual, the event was held at a "steakhouse" (term used loosely) where a room fit for only 20 people would house the 40 or so that would attend. Between the games of "Guess who's pregnant?" "Where's Daddy? (KY version of 'Where's Waldo'), and "Who Do You Belong To?", one of my MANY cousins approached me complaining of CT junction pain. After having had treated her before for the same problem (she works for UPS hurling packages twice her size) and discerning that we could get by with treating her on the spot, I proceeded to seat her in a chair and set her up to manipulate her C-T spine. Of course, the confines of the room meant that I was basically in the entry way and in full view of other patrons and restaurant staff. Needless to say, I caused a bit of a scare in the staff who immediately thought my cousin was choking and proceeded to rush to me to see if EMS needed to be called. I looked up and smiled, stating that she is fine and that I do this all of the time, which of course, drew stares like I had three heads. My cousin replied, "I'm fine, he's just cracking my neck and back". Of course, just as I finished the job, I hear someone yell "Git R' Done!" from the back of the room. This, though, should have come as no surprise to the restaurant staff, as I am sure that we always provide lots of fuel for their conversations every year that we come....I should start writing for Jeff Foxworthy....

[John Goodrich]

Rob, I've never done it in the woods, but I have had similar experiences in a variety of places. I wanted to share an experience recently on the opposite end of the spectrum. A friend from another town called me Christmas eve and shared that her husband had been on the floor in the bathroom the week before, unable to get up. Eventually, EMS had to be called and he was admitted to the hospital. PT was ordered at some point, but the therapist indicated they were not going to start treatment until they had the MRI report. By this time, it had been a week, it was a holiday weekend, and he had not been involved in any activity of any kind. I gave here some basic advice over the phone,and he was at least walking some that afternoon. I'm inclined to not be too hard on the therapists, because I know I've been there. But it reminds us how far we have to go in terms of education. As you recall from your courses, the primary reason the attendees expressed for not using manipulative techniques was fear. This seems to be less of an issue among our DPT students, or students with good manual therapy training, that intern with us, and that's a good thing, but there is still high fear avoidance issues among therapists. Thanks, and keep teaching.

[Rob Wainner]

Thanks guys.

I knew there would be a zinger out there Troy!

It is becoming clearer that an acute bout of spinal pain shouldn't generate the same kind of concern and inolved work-up as chest pain, but we have a long way to go.

Rob