PREFERRED PRACTICE PATTERNS
4B: Impaired Posture1
4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and ROM Associated with Localized Inflammation2
4F: Impaired Joint Mobility, Motor Function, Muscle Performance, Range of Motion, and Reflex Integrity Associated with Spinal Disorders3
A 45-year-old female presents with complaints of low back pain with insidious onset and duration of 4 months. She reports that she has pain while trying to sleep and is very stiff in the morning after waking up. As she walks around and gets ready for work, she notes that the stiffness subsides. She notes that the pain comes and goes throughout the day, and at the worst it is a 7/10 and at best it is a 1/10. She mentions that she works as a secretary for a local business and sits at her desk answering phones most of the day. She also notes that her daily walks of 3 miles with her dog are becoming more difficult even though the back pain is not present on the walks. Finally, she mentions pain in her right heel and a stiff right hip.
She is referred to physical therapy by her primary care physician. The physician tested her pulmonary function and noted that she showed decreased vital capacity and total lung capacity, while residual and functional residual lung volumes showed an increase. The PT examination revealed decreased ROM in the lumbar spine with flexion and extension. Mobility scale of 2 at T10 to T12 and 2 at L3 to S1 was revealed during joint play assessment. Tenderness at the SI joint was noted with palpation. MMT of the lower extremity (LE) reveals strength 5/5 in the left LE and the right hip adductors, 4/5 in the right hip flexors, right hip extensors, right hip abductors, and right dorsiflexors, and 4-/5 in the right plantarflexors.
X-ray of Spondylitis/Spondyloarthritis. (From Lawry GV. Systematic Musculoskeletal Examinations. www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)
Inflammation of one or more spinal vertebrae
Can be localized due to infection of a certain spinal area, degenerative arthritis, or following a traumatic injury
Most characterized with sacroiliac (SI) joint pain and dysfunction
Acute, painful flare-ups
Chronic, persistent pain
Pain for longer than 3 months
Relief with nonsteroidal anti-inflammatory drugs (NSAIDs)
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