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Case Study: Resolving Low Back Pain

A 58 year old male was evaluated at Back In Action Physical Therapy for intermittent low back pain that started 6 weeks prior for no apparent reason. Symptoms reported as worse in AM, when getting up from chair, when lifting or bending and when stretching hamstrings. Symptoms better on the move, as the day progressed and when walking. Self pain rating at 4/10 on day of assessment.

Findings on assessment: decreased lordotic curve (natural forward curve) in the lumbar spine (low back) and range of motion restricted in extension. Repeated movement testing revealed a direction of preference for extension stretching and posture.

Home program assigned included sitting with lumbar roll (support), avoid forward bending or slouching, and perform backward bending or press-ups every two hours (every hour would be assigned if symptoms reported as constant).

2nd visit: follow up after 5 days. Patient reported less frequent episodes of low back pain rating 0-1/10. Physical findings show that posture was still fair in sitting, lordosis still reduced and repeated extension in standing and lying was pain-free. Home program: continuing extension exercises as needed to maintain pain-free, add back strengthening exercises in prone lying, and after 5 days pain-free, start knees to chest for recovery of function.

3rd visit: 18 days later, patient returned due to exacerbation of pain when rolling over in bed while sleeping. He had had no pain for several days prior, and had done some work where he had to squat and twist the day before. Patient reported he had stopped exercises since pain returned and rates pain at 4/10. Physical exam shows that there is min/mod loss of back extension and repeated movement testing still reveals a direction of preference for backward bending exercises. Home program: resume extension exercises in standing or lying every hour until symptoms decrease to intermittent.

Phone consult 5 days later: pain decreased 50%. Still has soreness center of low back, has decreased frequency of back bending to 6x/day. Discussed option to try L side-bending prior to bending back to improve effectiveness of exercise. Plan to see in 2 days.

4th visit: Patient reports pain 3-4/10 and reports that back continues to improve with extension in standing with hips off center. Physical findings: minimal loss of lumbar extension, repeated extension not painful in lying or standing without hips off center. Encouraged patient to avoid all forward bending or slouching and resume extension principle without hip shift.

5th visit: Patient presents with min loss lumbar extension and pain 0/10 with continued press ups and standing back extension with hips off center.

This case represents how most low back pain conditions resolve over time with the correct direction specific exercises. This takes discipline and motivation to pay attention to the symptoms and perform the exercises for complete resolution of the derangement.