Case Study: left lower back pain Onset and History: The symptoms gradually came on in the beginning of August 2014. She is in a flexed position for prolonged periods of time at work. Previous treatment: chiropractic care and massage therapy without lasting relief Symptoms: This 28 year old female complained of left lower back pain which was constant and aching. It became sharp with certain movements. Pain was rated a 4/10 at its best and a 7/10 at its worst. Initial Function: Prior to coming to Burkhardt Physical Therapy Center, LLC the patient’s sleep quality was poor. She woke up 7-8 times per night due to pain. She experienced moderate pain and difficulty with normal daily activities including moving from sit to and from stand, getting in and out of car, walking, standing still, making meals, housekeeping, and laundry. Occupation: full time Dental Assistant Initial Evaluation at Burkhardt Physical Therapy Center: 9-29-14 She demonstrated increased pain with lumbar flexion and extension. Trunk side bending and rotation to the left was also bothersome. She demonstrated with forward head and shoulders, increased lumbar lordosis, bilateral knee hyper-extension, thoracic spine severe hypo mobility, sacral spine hypo mobility, pubic bone misalignment, and lumbar spine mechanical dysfunction. She demonstrated with severe tightness and tenderness to the occipitals, cervical spinalis, thoracic paraspinals, upper trapezius, levator scapula, rhomboids, intercostal muscles, diaphragm, lumbar paraspinals, quadratus lumborum, iliopsoas, sacral sulci, gluteus maximus, medius, minimus, piriformis, and TFL. Strain Counter-strain screening demonstrated neuromuscular dysfunction present in the fascia of the visceral system, nervous, anterior and posterior lumbar spine, pelvis, hips, and thoracic spine. First treatment: 9-29-14 Strain Counter-strain was performed to the nervous system including the vagus nerve 1-3; the visceral system including the ureter, inferior kidney, superior kidney, duodenum, sigmoid colon, and cecum; and the anterior lumbar spine; Kinesio taping was applied to the left gluteus medius and the lower back; Muscle Energy Technique was performed to improve alignment of pelvis, sacrum, and lumbar spine; Joint Mobilizations were performed the lower thoracic, lumbar, and sacral spine; and Therapeutic Exercise instruction for improved spinal alignment. Following the first treatment the patient reports decreased pain and symptoms for 5 days! Subsequent treatments: The following treatment sessions consisted of decreasing remaining dysfunction through Strain Counter-strain of the anterior lumbar spine; Myofascial Release to the neck, shoulders, back, gluteus maximus, piriformis, gluteus medius, and quadratus lumborum using neuromuscular principles; Intramuscular Trigger Point Release to the bilateral upper trapezius, piriformis, tensor fascia latae, gluteus medius, L5 paraspinals, quadriceps, external obliques; Kinesio taping to the bilateral upper trapezius, levator scapulae, interscapular border, and across low back/SI; Therapeutic Exercise including inner core re-training, scapular mobility exercises, and scapular re-training into retraction and depression to promote improved posture; Patient Education/Self Care Management included instruction to proper sleeping positions, pain relieving strategies, proper bending and lifting mechanics and instruction to patient and patients spouse on application of self Kinesio taping. Discharge: 10-22-14 The patient was discharged after 6 visits with significantly decreased pain rating a 0/10 at its best and 2/10 at its worst! The pain has decreased in intensity, frequency, and duration. She now has minimal to no pain with work, sleep, daily routine, recreational and social activities, moving from sit to and from stand, getting in and out of car, walking, standing still, making meals, housekeeping, and laundry. Sleep quality has improved significantly. Conclusion: This case study demonstrates the effectiveness of listening to the patient and thereby utilizing a combination of techniques including Strain Counter-strain, Kinesio taping, Therapeutic Exercise, Myofascial Release, Intramuscular Trigger Point Release, and Patient Education/Self-management to relieve pain and dysfunction. This patient not only had reduced pain significantly (down to NO pain at times) but improved sleep and well-being. This patient responded very well to a team approach including a Physical Therapist and a Physical Therapist Assistant at Burkhardt Physical Therapy Center, LLC.
Posted on: Tue, 30 Dec 2014 21:24:48 +0000
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