HealthActions: Case Management Reports
 

Low Back Pain during Pregnancy

Patient presented to our clinic with chief complaint of low back and right posterior thigh/hip pain, 3 week duration, of          insidious onset.   

Medical history revealed patient  was 22 wks pregnant and had two prior C-sections.  She was not taking medication except for vitamins.  She reported 4-5/10 pain level that was worse with prolonged sitting and standing.  Also, denied any neurological symptoms or symptoms below the knee. 

Examination revealed right L5/S1 segmental motion loss into     extension with associated muscle imbalance from protective spasm.  Patient prognosis was determined to be excellent due to the mechanical nature of her symptoms as well as no apparent nerve root involvement. 

Treatment plan consisted of manual therapy intervention, our gentle release with movement technique that allows selective movement without protective muscle guarding.  She was performing self-mobilization exercise into extension and we selected a taping technique to apply that limited flexion activities during the day.

Patient response to treatment:  After 2 visits she reported being pain-free.  Motion was much improved with mild weakness remaining.  She was discharged on the 6th visit, reporting 100% improvement with no pain and full motion restored. 

Acute Low Back Pain

Patient is a 29 year old female injured in a motor vehicle accident with the  onset of lower back pain.  She went to the Emergency Room to have  x-rays, which were negative.  She was seen by her  family  physician and  referred to physical therapy. 

The patient’s pain was 8/10 across the lower back into posterior thighs and calves.  There were no neurological signs or symptoms.  There was pain with standing and walking, less with sitting.  The evaluation    revealed a loss of extension, as the primary movement restriction.  There was tenderness in the left psoas, L5-S1, and left SI joint.  Patient presented 3-/5 left hip extension/abduction with sensation intact.  The nerve stretch tests were negative. 

Patient was treated with anti-inflammatory modalities, functional manual therapy, and instructed to use ice at home initially.  The second visit continued with functional manual therapy. The patient regained trunk extension and a home exercise program was initiated. The patient was to continue with ice.  On visit three, the patient was greatly    improved; full range of motion without pain.  The patient was      educated further in proper body mechanics and core stabilization exercises.  On visit four, the patient was discharged to continue with a home exercise program and given the opportunity to participate in post rehab   wellness.


Chronic Low Back Pain

Patient is a W/F 52 years of age that presented with chief complaint of low back and right lower extremity pain rated as 5/10.  The lower extremity pain was above the knee and located in the posterior thigh region.    She reported that the pain started 2 years ago and was insidious in nature and worsening over time.   She had an MRI that confirmed an HNP at L4/5 level without nerve root involvement.

Prior treatment consisted of muscle relaxers, pain meds and she had received a total of 6  epidurals over the past 2 yrs.  Reported no significant relief after the last round of epidurals at which time she was referred to our clinic.

Patient examination findings suggest non-radicular discogenic involvement of the right lower lumbar region. The primary impairment involved lumbar extension     segmental motion loss.  Interventions were directed mainly at restoration of the movement impairment at the lower lumbar levels on the right.  The chosen method  of treatment was the functional manual therapy approach.   This is a direct manual approach        that is a combination of manual therapy and exercise.  Modalities were PRN and included heat / electrical stimulation.

Patient understanding of her home program to increase extension motion and avoid static flexion postures was critical to success. 

The patient completed a total of 9 visits. She demonstrated less protective spasm, increased motion and improved muscle function after the initial visit.  At discharge she was without pain, even with considerable physical activity.  She reported 95% overall improvement with no functional limitations.  A six month follow up was performed at which time she reported continued improvement with no pain or difficulty with daily activities.