A 42 year old female presented to the clinic with acute low back pain (LBP) and right leg radiculopathy. She has noticed the LBP for 6 months now, initially sporadic but now more constant.
She bent over to pick up a pen off the ground 3 days ago and felt her back seize and a sharp stabbing pain referred down her right leg. Since then, she has been unable to sit or bend over without pain.
The patient is a sedentary office worker with infrequent breaks from her computer ( 1 per hour).
Past History of LBP that seemed to respond to massage therapy.
On examination: Antalgic posture, poor glute tone was noted, especially on the right side, and pronated feet were most notable postural findings. Forward bending was most painful and reproduced right leg pain.
History and examination determined the patient to be suffering discogenic LBP with an irritated right L5/S1 nerve root.
Treatment strategy:
Acute pain control/symptomatic treatment (weeks1 to 4)
Passive techniques: massage, Muscle Energy Techniques, gentle joint mobilisation/adjustments.
Weeks 2-4 teach patient how to move correctly, brace when lifting, proper breathing mechanics if faulty.
Weeks 4-8 gradually improve stability and endurance of spinal stabilisers
