Q: I am a physical therapist and I want to know the exact physiotherapy treatment along with manual therapy for sacralization. My patient is a captain in the Air Force so he can't stop all his normal activities related to physical stress. In short, he can't go for a long vacation so can you suggest me the exact format what to give for pain relief. Presently my patient is having pain on the lumbo-sacral area and I am giving ultrasound and short wave diathermy with light back isometric exercises.

A:The basic treatment plan would be to reduce pain, increase mobility, strengthen the back muscles, follow proper ergonomic principles for ADL. 1. You can try moist hydrocollatreral packs prior to diathermy or ultrasound. 2. For later use you can try TENS in case there are no contraindications for the same. 3. As per your evaluation I would suggest stretching of tight muscles if any. 4. Proper ergonomic principles, for all his ADL. 5. I would suggest, MckenZie approach 6. As far as manipulative procedures are concerned, I would not suggest a hard Technique. Soft Tissue massage should be fine. 7. Considering his occupation, a belt for long flights would be advisable only till his back muscles are weak. 8. Abdominal contractions are a must too. 9. You could guide him on his footwear and swimming once or twice a week, once he has had sufficient improvement as per your evaluation. 10. I suppose this should help him from recurrent attacks.