Low Back Pain or a silent killer (AAA)- A case Study

Abstract

Client Characteristics

Patient is referred to physiotherapy after a sailing incident (2 weeks ago) where he felt sharp pain in his back whilst leaning forward and pulling on a jib sheet. Patient is a 65 year old male, South African, working in a boat shop (lots of standing and lifting work). The patient reports seeing a massage therapist and then his GP following the incident. He was prescribed some muscle relaxants and Voltarine as required and referred to physiotherapy. The patient has had previous back sprains, which resolved 100% with physiotherapy. He reports his general health has been good, however takes Aspirin due to his "heart".

Examination Findings Subjectively the patient reports of low back pain which radiate to both hips and bilateral spasms in his legs. These symptoms reportedly are better in the morning and worsen during the day. The patient reports of waking up and night due to his pain. Aggravating activities include standing, twisting, bending activities and sudden movements. Walking and relative rest reportedly eases the patients symptoms. He enjoys fishing and sailing both of which have been difficult to do secondary to his symptoms. He denies any paraesthesia or pain with coughing or sneezing. Objective Examiniation: Observation: The patient mobilises unaided, independently with an antalgic gait. He also has an antalgic movement pattern during sit->stand. In standing he has no lateral shift of his trunk. Asymmetrical mole in central-left low back- site of patients pain, pt unaware of mole, uneven colour shade Increased tone of right Erector Spinae AROM: lumbar spine flexion: bilateral hands to mid-shin, pain with returning to standing Lumbar spine extension: increased pain, reduced range of motion Repeated movements reveal radiating pain to bilateral hips with repeated lumbar extensions Strength: Reduced strength 4/5 with resisted right knee flexion, ankle dorsiflexion and plantarflexion. Full strength 5/5 in L) lower limb. Neurodynamic tests: Reflexes: Nil Abnormalities detected with patella tendon reflex testing, however, slight reduction in right ankle jerk reflex. Slump test: positive test- pain reproduced in low back Active Straight Leg Raise (ASRL)- negative test, nil pain reproduced, normal range of motion in both legs. Other Tests: Spring test: pain at L4/5 with central posterior-anterior glide (PA)

Clinical Hypothesis pt is a 65 year old male who presents to the clinic with low back pain. Due to his mechanism of injury, occupation, aggravating factors, objective assessment this patient initially fits the category of discogenic low back pain +/- nerve root impingement. However, due to his age, day/night pattern of pain, skin observation, symptoms in bilateral limbs suggests patient may require further medical screening.

Intervention The patient was initially treated as a "low back pain" patient with physiotherapy, which included manual therapy- joint mobilisations/massage etc and an home exercise programme. Although the patients symptoms seemed to ease over time, the patient was referred to a specialist for his mole abnormality. The patient was advised to wait in the public medical wait list to see this specialist by his GP.

Outcome The Discussion

References