Abstract
A patient with a 14-month episode of chronic bilateral low back pain was seen for physical therapy treatment for 5 sessions for outpatient physical therapy over a 6-week period. 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 the Patient-Specific Functional Scale, the Oswestry Low Back Pain Disability Questionnaire, the Fear-Avoidance Beliefs Questionnaire, the Numeric Pain Rating Scale, double inclinometery for range of motion of the lumbar spine, the prone lumbar instability test, the straight leg raise for hamstring muscle flexibility, and a plan of care was established. The patient’s primary complaints and problems were pain, inability to run or to work out at the gym. At initial evaluation she was found to have aberrant movement during lumbar flexion, with decreased active range of motion, sitting and standing postural impairments, limited ability to sit due to increased pain, tight hamstrings and an increased body mass index. The goals established for this patient included decreasing pain and fear avoidance, improving lumbar active range of motion, hamstring length, posture, Patient Specific Function Scale, Oswestry Disability Index, sitting tolerance, ability to run, move tables at work, and to increase participation in recreational and traveling activities. The main interventions used were lumbar stabilization exercises, postural reeducation, muscle length interventions (stretching) and education. The patient achieved the goal of decreased pain by achieving a pain free state. She demonstrated a decrease in fear avoidance as measured by the Fear Avoidance Beliefs Questionnaire. The patient achieved increased active range of motion of the lumbar spine, hamstring length, and improved posture. She achieved her goals in impaired function based on the Oswestry Low Back Pain Disability Questionnaire, the Patient Specific Functional Scale, sitting tolerance, ability to jog, and to move tables at work. The patient met participation goals with the ability to participate in recreational activities including golf, and due to her improved sitting tolerance, was able to participate in travel by the end of her treatment. The patient was discharged to home with a home exercise program that included instructions for progression of exercises.