An integrated approach to the examination and treatment of a patient with chronic low back pain

Background and study design: Several physical therapy classification systems exist for low back pain (LBP). Little is known about how these systems could be integrated in clinical practice. This case report describes an episode of care utilizing elements of the mechanical diagnosis and therapy (MDT), movement system impairment (MSI) and treatment-based classification (TBC) systems. Case description: Patient History - the patient was a 40-year-old male presenting to an outpatient musculoskeletal clinic with a complaint of chronic LBP. Examination and diagnosis there was moderate loss of lumbar extension ROM and joint mobility, and excessive lumbar flexion and rotation with active movement tests. Modified Oswestry Disability Index score - 8%. Worst pain was described as 6/10. Intervention - the patient was treated once per week for seven consecutive weeks. Intervention focused on sitting postural corrections (MSI), functional movement corrections (MSI), lumbar mobilization (TBC) and extension-based exercise (MDT). Outcomes - at discharge, the patient reported a decrease in pain intensity (worst pain 0 to 1 out of 10) and demonstrated an improvement in the quality of lumbar movement and overall function. Discussion: Symptomatic response to active movement, observations of quality of movement and joint mobility assessment were key factors in directing a therapeutic program that was successful in helping the patient meet his treatment goals.