A 52-year-old male self-refers to physical therapy for evaluation and treatment of low back pain. He states that he has had recurrent bouts of low back pain over the past 12 years and for most of those episodes, the back pain tends to resolve to his satisfaction. On occasion, he has had to see his family doctor for episodes that did not resolve. In most instances, he was given nonsteroidal anti-inflammatory medication and a small booklet describing low back exercises. He feels that these exacerbations of pain now last longer and the bouts seem more frequent. This most recent back pain episode began 7 days ago. He is a university professor and does not want this episode to cause him to miss work as several of his past episodes have done.
What are key questions to ask in order to further clarify the patient's complaints and provide direction for the examination?
What are the most appropriate physical therapy interventions?
What is his rehabilitation prognosis?
ACUTE, SUBACUTE, AND CHRONIC LOW BACK PAIN (LBP): Classic description of the course of LBP using a temporal guideline; acute is typically considered to last 0 to 4 weeks, subacute from 1 to 3 months, and chronic more than 3 months; most common back complaints are exacerbations of a recurrent back condition, which compounds these classic descriptors
CHRONIC PAIN SYNDROME: Syndrome in which the psychosocial and behavioral aspects of pain far exceed the mechanical or chemical nociceptive influences present; chronic pain syndrome is distinct from chronic LBP
CLINICAL PREDICTION RULE: Use of a specific combination of signs, symptoms, and aspects of history and physical examination to predict the probability of success with a particular intervention strategy
MANIPULATION: Physical intervention intended to direct a specific force into a targeted region of the body (often a joint) identified by rate of force application and location within the range of motion (beginning, middle, or end of available range); distinction between mobilization and manipulation is typically related to rate of force application (i.e., manipulation is a high velocity thrust)
RADICULAR PAIN: Pain most often due to an inflammatory state of the nerve root, which lowers the nerve root's threshold to mechanical stimulus (either tension or compression)
REFERRED PAIN: Pain felt at a distance from the actual anatomical source of involvement or injury; due to extensive innervation of spinal tissues, pain can be felt in the lower quarter due to involvement of low back tissues (or in the upper quarter due to involvement of cervical tissues), irrespective of involvement of the nerve roots in the region
SEGMENTAL INSTABILITY: Displacement or aberrant motion between two bony segments that results when a force is applied; it is a biomechanical entity distinct from hypermobility; most typical types ...