Case Study: Rehabilitation of Acute Low Back Pain

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Managed as a Freelance Physiotherapist- 2019-2020

Patient Overview

Name: Mr. S. (pseudonym for confidentiality)

Age: 40 yrs

Occupation: IT Professional

Presenting Condition: Acute low back pain (LBP)

Onset: Sudden onset of pain after lifting and throwing a bucket of water.

Medical History: No previous history of low back pain or significant medical conditions.

Presenting Symptoms

Mr. S. presented with sudden, severe low back pain following a physical strain from throwing a bucket of water. He described the sensation as "locked" in his lower back, with an inability to sit, stand, or walk without experiencing significant pain. The pain was localized to the lumbar region, and he was unable to perform daily activities without considerable discomfort. He also reported difficulty finding a comfortable position, whether seated or standing.

Initial Assessment

On initial assessment, Mr. S. displayed the following signs:

• Posture: A significant antalgic posture, with noticeable guarding of the lumbar spine.

• Range of Motion (ROM): Markedly reduced in lumbar flexion, extension, and lateral bending due to pain.

• Palpation: Tenderness over the lumbar paraspinal muscles, especially in the lower back, with spasms palpated along the region.

• Neurological Tests: No radiculopathy or nerve root involvement. Straight leg raise test was negative.

• Pain Level: Patient rated his pain at 8/10 on the Visual Analog Scale (VAS), with sharp pain during movement and a constant dull ache at rest.

Mr. S. had been prescribed pain medications by an orthopedist, but these provided minimal relief, and he was unable to return to work or engage in usual activities.

Treatment Plan

Given the acute nature of Mr. S.'s condition and his occupation, a multi-faceted approach was chosen to provide pain relief, restore mobility, and improve long-term function. The primary goal was to reduce his pain and restore the ability to perform activities of daily living (ADLs) without limitations.

Therapeutic Interventions:

1. Shortwave Diathermy (SWD):

SWD was used as a modality for pain relief and muscle relaxation. The heat generated by the SWD helped to alleviate the acute muscle spasms and improve local circulation to the affected area. This facilitated the reduction of inflammation and promoted faster healing of soft tissues.

2. Interferential Therapy (IFT):

IFT was utilized to manage pain and muscle spasm. This modality helped reduce the deep muscular pain and allowed for greater relaxation of the paraspinal muscles. By stimulating the deeper tissue layers, IFT facilitated pain control and assisted in reducing swelling and inflammation.

3. Manual Therapy:

  • Soft Tissue Mobilization: Gentle techniques were applied to release muscle tension and improve flexibility in the lumbar region.
  • Joint Mobilizations: Grade I and II mobilizations were used to gently restore movement in the lumbar spine, aimed at improving joint mobility and reducing stiffness.
  • Manual Traction: Applied to decompress the lumbar spine, manual traction helped to reduce pressure on the intervertebral discs, providing relief from nerve compression, and aiding in the restoration of spinal alignment.

4. Stretching and Strengthening Exercises:

  • Core Strengthening: Exercises were prescribed to target the core musculature, including the abdominal muscles and lower back stabilizers, to improve spinal support and prevent future episodes of back pain.
  • Stretching: Focus was placed on hamstrings, hip flexors, and lower back muscles to improve flexibility and reduce muscular tightness contributing to pain.
  • Spinal Stabilization: Progressively challenging exercises to enhance spinal stability and postural control, helping Mr. S. maintain proper posture during prolonged sitting at work.

5. Ergonomic Education:

Postural correction strategies were introduced, with particular emphasis on Mr. S.'s seated posture at work. Adjustments were suggested to ensure his workstation setup was ergonomically appropriate, thus minimizing the strain on his lower back during long hours of sitting.

Progress and Outcome

Over the course of 7 physiotherapy sessions, Mr. S. showed remarkable improvement. Pain levels reduced significantly, and he was able to resume light activities within the first week of treatment. By the end of the treatment plan:

• Pain Level: Pain decreased from 8/10 to 1/10 (VAS scale).

• Range of Motion: Full lumbar ROM was restored with no pain or stiffness.

• Functionality: Mr. S. was able to return to his IT work without discomfort, and his mobility improved, allowing him to sit and stand without pain.

• Patient Feedback: Mr. S. reported being extremely satisfied with the outcome, particularly appreciating the reduction in pain and the ability to resume daily activities without further discomfort.

Reflection and Clinical Insights

This case highlighted the importance of a multi-modal treatment approach in managing acute low back pain. Early intervention with therapeutic modalities like SWD and IFT provided immediate pain relief, while manual therapy techniques facilitated the restoration of mobility and reduced muscle spasm. The progressive nature of the strengthening exercises, along with ergonomic education, helped ensure long-term recovery and prevention of recurrence.

In this case, the personalized treatment plan and active patient involvement were key factors in the positive outcome. The integration of both passive and active treatments allowed for a holistic approach, addressing the acute pain and working toward long-term functional recovery. It was rewarding to see how quickly Mr. S. progressed, and the case reinforced the importance of tailored interventions to meet the specific needs of each patient.


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