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Low Back Pain Case S one! But a good outco

Written by Dan Lewinden. (No longer at the P Physiotherapist)

This is the case study of a 38- year old t and hea acute onset of severe lower back pain, an extreme approximately 60% of us at one stage or another i account of my management, which demonstrates assessment and a close working relationship with best outcome possible in the shortest space of tim Subjective Questioning Problem: Constant, unremitting lower back pain, buttock to heel. He also reported the presence of Aggravating factors: Any static position aggrava for over 10-15 minutes. Easing factors: There was nothing that he could 24hrs: He reported difculty sleeping, but no signi symptoms. Special Questions to Exclude Serious Patholo bowel function, no sudden unexplained weight los

and needles/ numbness in groin region, no signic History of Problem: A sudden unexplained episo that started 8 weeks ago. He reported a history of pain and occasional low-grade leg pain, but nothin Social History: Business man, who was normally socially and running regularly. Past Medical History: No medical problems of n General health: Good. No cardiovascular nor res lower back pain, arthritis, diabetes, epilepsy Drug history: Due to the severity of his symptom killers and muscle relaxants. Objective Examination Observation: Unable to 1-2 minutes Active movements: (Patient performed especially exion, which reproduced both back an Passive movements: (Physiotherapist performed accurate assessment of segmental spine moveme Palpation: Local tenderness at the distal two joint widespread muscular spasm. Palpation of L4/5 eli Neurological Tests: Reex testing, sensory and m symmetrical side to side. There was evidence of s stretched Analysis of Pathology His symptoms led me to b prolapse at L4/5, causing compression to the scia was likely that his condition would become more s Initial Management Immediate referral to an Orth Orthopaedic Consultant Assessment This gen Orthopaedic Consultant, who specialises in Spinal was conrmed. The scan also identied that a sma leaked out, known as a sequestration. On discuss procedure was performed to remove part of the di nerve. Post-Operative Physiotherapy Following a brief was re-referred to the clinic for post-operative care following agreed goals:

1. Restoring full range of movement of spinal joints manipulation and active stretching.

2. Developing the strength and co-ordination of th protect the spine from injury. Evidence has proven strengthening of these muscles and a reduction in that these muscles will deteriorate quickly with pai educated with a gradual specic strengthening pro

3. Restoring normal nerve movement along the len mobilisations and local soft tissue techniques.

Outcome Following six weeks of Physiotherapy, this gentlem and is left with only an occasional mild buttock pa eradicate with ongoing treatment. It is now our plan to introduce sports specic reha playing in the near future.

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