Abstract
A 70-year-old male with low back pain with radicular symptoms was seen for physical therapy treatment for 17 sessions over 11 weeks for outpatient physical therapy. Treatment was provided by a student physical therapist under the supervision of a licensed physical therapist. The patient was evaluated at the initial encounter using the Numeric Pain Rating Scale, the Slump test, the Straight Leg Raise, inclinometry, joint accessory motion testing, the Oswestry Disability Index, the Fear Avoidance Beliefs Questionnaire, observation, palpation, and patient report. The patient was found to have severe pain, limited lumbar range of motion, and severe disability with activities of daily living, such as standing, walking, and sleeping. A plan of care was established with the main goals of decreasing pain and improving lumbar flexion and extension to regain the ability to lie supine, stand erect, and improve his function with activities of daily living, such as standing and walking tolerance without the front-wheel walker, and being able to sleep through the night comfortably. He wanted to return to playing golf and cooking for his grandkids. Interventions used were directional preference exercises into flexion, traction,modalities, manual therapy, massage, range of motion exercises, stretches, motor control exercises, education, and a home exercise program. The patient’s pain level was significantly reduced and he was able to decrease his use of non-steroidal anti-inflammatory drugs to just at night, sleep through the night, and increase his tolerance for standing enough to cook for his grandchildren. The patient continued his episode of care with another physical therapist, due to the ending of the student’s clinical internship, to continue improving lumbar range of motion, addressing fear avoidance beliefs, motor control exercises, and strength and conditioning and a graded return to golf program.