Abstract
A patient with chronic low back pain was seen for physical therapy treatment for 6 sessions over an 8-week span at 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 body structure and function measures that consisted of the numeric pain rating scale for pain intensity, range of motion of the lumbar spine as measured by side bend range of motion test, strength testing of the trunk muscles as measured by manual muscle test, endurance testing of the trunk muscles as measured by the prone plank test, lumbar stability as measured by the prone instability test, muscle flexibility tests as measured by the straight leg raise test, lumbar hypomobility as measured by lumbar spine joint accessory motions, and tissue tenderness assessed by palpation. Activity limitations measured by patient report consisted of: standing duration, sleep quality, and ability to go to the gym. The activity limitation of lifting mechanics was measured by patient report and observation. The Oswestry Low Back Pain Disability Questionnaire was used to evaluate the patient’s ability to engage in his usual activities of daily living. The patient’s ability to play basketball at the gym and work at his personally owned landscaping business were used to evaluate his participation restrictions. After identifying his impairments, activity limitations and participation deficits, a plan of care was established. The main goals for the patient were to decrease pain, improve strength and range of motion, improve lifting mechanics, and increase his time spent at work. The main interventions used to achieve these goals were a consistent gym regimen, a stretching program, lumbar stabilization exercises, training in correct lifting mechanics, deep tissue massage, and manual techniques to the fourth and fifth lumbar vertebrae. The patient achieved his goals demonstrating improved range of motion, core strength, lumbar stabilization, standing tolerance, and lifting mechanics. He also reported decreased pain and a decreased percent of disability on the Oswestry Low Back Pain Disability Questionnaire. The patient was discharged to home with a home exercise program.