Here is a brief overview of the case I will be presenting next weekend:
The patient is a 56 y.o. male who presents with a chief complaint of midline low back pain with secondary complaints of mid thoracic and lower cervical pain. He has had episodic low back pain for >20 years with his most recent episode one year ago. His pain is described as a constant, deep ache in the lower back with occasional pain and tingling into his R foot/ankle. He experiences low back stiffness in the AM for <30 min and stiffness after working on cars for >15 min.
Pain scale (VAS): 5-7/10
Modified ODI: 23/50
Keele STarT Back Screening tool: 7/9
Aggs: sitting prolonged in church, standing prolonged (~15 min), riding in a car, working on car engines
Eases: walking, self manipulation, softball trigger point massage, lying on a firm mattress, alcohol, NSAIDs
Initial hypotheses: Lumbar facet arthropathy (L5, S1), Lumbar radiculopathy (L5, S1), Lumbar disc pathology (L5, S1), Lumbar myofascial pain, SIJ dysfunction
Objective asterisks: lazy stander, hangs on Y ligaments; aberrant motion with lumbar AROM, painful arc upon returning from flexion, (+) R>L Ext, SB quadrant, (+) CPA/UPAs at L3-5, (+) prone SLR improved with manual compression, (+) passive lumbar extension test, hypertonicity and TTP at lumbar paraspinals, (-) Neuro exam, slump, SLR, (-) SIJ, hip clearing.
Initial treatment emphasis on education regarding prognosis, expectations from PT, biopsychosocial nature of LBP, manual therapy to address soft tissue prior to lower lumbar joint mobilization, and therapeutic exercise to improve lumbar flexion mobility.