Webinar Episode 9. Early-Nov 2023

Welcome to Webinar number nine with Joel Proskewitz streamed live on 5th November 2023.

The questions addressed and their respective time stamps were as follows:

0:00 - Joel introduction

2:00 - A specific case.
Surgical vacation packages.
A formal diagnosis is given from a standardised form and uploaded latest scans.
The patient flies back home in disabling pain. 
Pedicile screws ultimately needed removal and replacement.

Remember many clinicians only talk about their successes. All spine surgeons have had a disaster. Do your due-diligence. Seek and find trusted resource in the world of spine.

15:00 - Thoracic disc herniation on an MRI scan. What do I do now?

Most thoracic disc herniations are asymptomatic - no radicular pain or issues with nerve pain. 
Symptoms can include radiating pain around the torso rather than down your legs. 
Issues at these levels for surgeons are problematic due to access.
However, cord compression can need intervention.
Disc herniation at this level can also calcify very easily. 

25:30 - I’ve hurt my back, I’m terrible pain and I can’t walk - what do I do?

What are the symptoms?
Do you have ‘red flag’ symptoms - bowl issues, bladder issues or an inability to bear weight on your legs or use your hands?
Joel suggests you giving yourself 5 to 6 days.
Gentle movement and rest.
No movement that progresses or flairs the symptoms.
Now further assessment is viable to determine what route you’d wish to take.

30:10 - A severe spinal deformity has been diagnosed - a double spinal scoliosis.

Joels discusses scoliosis types in the adult. The questions also details a stenosis diagnosis.
Can personal physiotherapy or pilates movements help under a trained clinician?
When should physiotherapy be utilised?
All the above comes down to the diagnosis.

41:00  - The volume of training to improve motor deficits in the lower limbs.
Questions to answer include
- Is this getting worse? If so, how compressed is the nerve and by what?
- Do you understand what is compressing the nerve and can it be resolved.

All the above needs to determined on MRI (end of story).

From a training perspective:
- exposure very often through the day.
- high reps but many times a day assuming this does not increase pain.

However, pain can indicate a nerve provocation.