Patient No. 3: Low Back Pain

A 49-year-old lady presented with a 12-month history of worsening back pain. At the time of the evaluation she rated her pain as severe. The pain was generally localized to the left lower back area. Bending or prolonged standing activities would worsen her problems. She would be very uncomfortable after lying in bed for more than six hours, and therefore had difficulty getting a full night's sleep.

Her posture was not too bad, with only minor protraction of the head and neck over a mildly flexed thoracic spine. Major mechanical dysfunction was found and treated in the pelvic region. Muscles throughout the trunk and the pelvis were extremely weak and very poorly recruited. Her overall trunk range of motion was mildly limited. There tended to be too much backward bending isolated to the very lower part of the back. Her initial session included an evaluation, manual therapy, and instruction in home exercises.

One week after her initial evaluation the patient noted substantial improvement. Manual therapy was applied to correct a mild mechanical dysfunction in the trunk and the pelvis, and her home exercise program was reviewed and minor upgrades were made.

By the fourth week the patient had sufficient strength and recruitment in the gluteal musculature that were able to add in closed chain hip exercises. Her overall home program was modified to suit her improved abilities.

Good overall progress was being made by the fifth visit. By the seventh week the patient reported that she had been pain-free for ten days. At that time her exercises were reviewed and further upgraded. No mechanical dysfunction was found.

The patient's final visit was nine weeks after her initial session. She reported only very mind intermittent problems with pain and these occurred only after strenuous physical activities. With this visit we reviewed all of her exercises. We went over basic upper body exercises that she could carry out at home. She was strongly advised to continue with all of her exercises on a three-day per week maintenance schedule.