Abstract
A 46-year-old woman with chronic low back pain and bilateral lower extremity radicular symptoms was seen for physical therapy treatment for 9 sessions over a 5-week period in an outpatient physical therapy clinic. Treatment was provided by a student physical therapist under the supervision of a licensed physical therapist. The patient was evaluated at the initial encounter with postural inspection, the Numeric Pain Rating Scale, range of motion (ROM) testing, sensory testing, segmental joint accessory motion testing, the Straight Leg Raise test, and the Modified Oswestry Disability Index. A plan of care was established to address severe low back pain peripheralizing into bilateral plantar feet, bilateral hip pain, impaired lumbar active ROM, limited sitting, standing, and walking tolerance; and restricted ability to work at a pharmacy. Primary goals for the patient were eliminating lower extremity radicular symptoms, decreasing overall pain, increasing active lumbar ROM, improving sitting, standing, and walking tolerance; and returning to prior level of function at work and with activities of daily living. The main interventions used were directional preference exercises into extension, soft tissue mobilization, stretching, traction, proprioceptive neuromuscular facilitation, nerve gliding, and modalities, in addition to a daily home exercise program. The patient responded well to the selected interventions, demonstrating a centralization of radicular symptoms, decrease in low back pain and overall pain, and improvement in sitting, standing, and walking tolerance. The patient was discharged to home to continue her home exercise program with a recommendation to return to outpatient physical therapy should her symptoms worsen.