Abstract
A patient with chronic low back pain and left hip pain was seen for 10 treatment sessions over the course of two months at a physical therapy outpatient probono 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 using the Numeric Pain Rating Scale, manual muscle test, Oswestry Disability Index, Fear-Avoidance Belief Questionnaire, Patient Specific Functional Scale and prone instability test. Based upon this evaluation, the patient’s deficits were identified and a plan of care was developed. Primary impairments included increased pain, aberrant movement, lumbar motor control deficits, decreased left hip strength, decreased muscle flexibility, and fear avoidance beliefs. These impairments caused activity limitations including car transfers, walking, sitting, and sleeping; which all ultimately restricted the patient’s desire to participate in a strength training and an aerobic exercise program. The main goals in the plan of care were to decrease pain, improve motor control of the trunk and lower extremity, increase left hip strength, improve sitting and walking tolerance, improve functional disability, return to her regular gym program, and decrease the patient’s fear of movement. Main interventions used were lumbar stabilization exercises, motor control exercises, lumbar spine mobilizations, hip strengthening exercises, relaxation techniques for pain management, muscle flexibility exercises, task-specific training and patient education. Low back pain diminished during the course of treatment, from a moderate severity to minimal severity on the Numeric Pain Rating Scale. Manual muscle tests for the left hip demonstrated increased strength, especially hip abduction and external rotation. Fear of movement as measured by the Fear-Avoidance Belief Questionnaire, moved from a high category to a low category. There was an improvement in functional ability as measured by the Oswestry Disability Index from a moderate to a minimal disability rating. Four of five items in the Patient Specific Functional Scale moved from moderate difficulty to little or no difficulty. The patient was discharged home with a home exercise program and instruction on how to progress her exercises properly.