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Table 1 Outcome measures and treatment strategies during chiropractic care.

From: Use of conventional and alternative treatment strategies for a case of low back pain in a F/A-18 aviator

Tx#/Wk#

Functional Outcomes

Pain Control

Flight/USMC Fitness Training

1/1

• VAS = 1.5 current, 7.1 upon waking, 9.5 worst •Medication needed for pain control

• RMDQ = 5/24

• Significant pain with flight

• Unable to run/do sit-ups

• HVLAM [11] (T11-L2 & SI joint)

• AMRT [12,13] & PIR or PCS [14] of (g. medius, g. max, QL and PVTs)

• Home TrP Tx (g. medius)

• Moist heat pack

• See flight surgeon if pain increased

• G. medius stretch (2 @ 30 sec)

• Double knee-chest stretches (10 reps @ 10 sec each)

• Continue stretches recommended by PT and DO

• Walking, elliptical and bicycle to tolerance

5/5

• No sharp pain

• No medication needed to control pain

• Mild ache after flying high G several times per week

• Minimal pain with activities of daily living

Same as above

As above +

• Supine leg raises (Dead Bugs 50 reps)

• Static crunch to tolerance (90 sec)

• Prone isometric core endurance (plank) for 90 sec

11/15

• Verbal pain scale = 0

• Mild tightness associated with prolonged sitting

• Full activities

• Able to perform plank exercise > 2 minutes

• No pain with running

Periodic HVLAM, PCS and AMRT as necessary

As above +

• Oblique crunches (50/side)

• Isometric side bridge (60 sec)

• Static lunge psoas stretch

• Oblique crunches on gym ball

• Latissimus pull downs

• Seated rows

• Gradual return to running

16/30

• VAS = 0

• RMDQ = 0/24

• Able to perform plank exercise > 120 sec, side-bridges > 60 sec, 100 crunches in < 120 sec, 50 oblique crunches per side

• Able to fly multiple times/wk including long and high G flight with only mild tightness afterward

• Passed required physical fitness test with no pain

No treatment required

• Maintain core stability and coordination exercises as part of routine exercise

• 3 mi run 3x/wk, elliptical or stationary bike on other days

  1. Tx = treatment; Wk = week; VAS = visual analog scale; RMDQ = Roland Morris disability questionnaire; HVLAM = high velocity low amplitude manipulation; T = thoracic; L = lumbar; AMRT = active myofascial release technique; PIR = post-isometric relaxation; PCS = post-contraction stretch; QL = quadratus lumborum; PVT = paravertebral muscles; TrP Tx = trigger point therapy