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78-Year-Old Male PhysicianDiagnosis: Chronic low back pain.Patient history: Patient reported a ten (10) year history of chronic, intermittent low back pain, which had worsened and become constantly symptomatic over the two month period prior to starting physical therapy. Patient had been walking regularly for exercise prior to the symptoms becoming constant. Patient reported that he could no longer walk more than 5-10 minutes without experiencing severe low back pain and right hip pain. Significant findings: Patient presented with severely limited lumbar extension and right hip internal rotation, with increased low back and right hip pain at end range of motion. Patient also presented with palpable hypertonicity and tenderness to palpation in right hip flexors, piriformis, and lumbar paraspinals. Core stability was also poor, especially the ability to isolate tranverse abdominus muscle to stabilize the low back. Intervention: A neuromuscular treatment approach was applied to the hypertonic and tender muscles of the right lower quadrant for the first two (2) visits, after which the patient reported significantly decreased pain and increased tolerance for weightbearing and walking. He was instructed in a home exercise program to isolate the transverse abdominus muscle and abdominal isometric exercise. Outcome: Patient was discharged to an independent home program after four (4) visits. He had resumed his normal walking program for exercise and also resumed all activities of daily living (including seeing patients in his office) without complaint. Six (6) months post discharge, patient reported no return of right lower quadrant symptoms. |
