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A 36-year-old male construction worker self-referred to an outpatient physical therapy clinic with a complaint of low back pain and pain radiating from his posterior left hip all the way to his lateral foot. He first experienced pain 3 weeks ago while doing a home maintenance project. The onset of pain occurred when he attempted to lift an air conditioning unit. He reports that as he bent over to lift the unit, he experienced an intense, stabbing pain and immediately fell to the ground. He required assistance from his wife to walk back into the house. For the first 24 hours after the incident, he rested prone on a couch or on his bed. Over the past 3 days, he reports an improved tolerance to walking and standing for short periods. However, he rates his current pain level 5 out of 10 on the visual analog scale and he continues to experience radiating pain distal to his knee. Signs and symptoms are consistent with a lumbar herniated disc. His goal is to return to work as soon as possible.

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Based on the patient's suspected diagnosis, what do you anticipate may be the contributing factors to his condition?

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What examination signs may be associated with this diagnosis?

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What are the most appropriate physical therapy interventions?

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What are possible complications that may limit the effectiveness of physical therapy?

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MUSCLE ENERGY TECHNIQUE (MET): Manual therapy technique in which a muscular contraction (i.e., "muscle energy") by the patient is matched by a physical therapist's unyielding force applied in the opposing direction

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PASSIVE INTERVERTEBRAL MOTION (PIVM) ASSESSMENT: Manual technique used to assess passive physiologic segmental motion between vertebrae

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  1. Understand the anatomy, biomechanics, and function of the lumbar intervertebral discs.

  2. Describe signs and symptoms associated with a herniated lumbar disc and identify potential risk factors associated with this diagnosis.

  3. Describe muscle energy technique and its proposed clinical indications.

  4. Describe the evidence for the efficacy of using muscle energy technique as an intervention for treating an individual with a herniated nucleus pulposus (HNP) in the lumbar spine.

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PT considerations during management of the individual with a diagnosis of a herniated lumbar disc:

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  • General physical therapy plan of care/goals: Decrease pain; increase muscular flexibility; increase lower quadrant strength; increase muscular endurance of the core; prevent or minimize loss of aerobic fitness capacity
  • Physical therapy interventions: Patient education regarding functional anatomy and injury pathomechanics; muscle energy technique; modalities and manual therapy to decrease pain; muscular flexibility exercises; resistance exercises to increase muscular endurance capacity of the core and to increase strength of lower extremity muscles; aerobic exercise program
  • Precautions during physical therapy: Monitor vital signs; address precautions or contraindications for exercise, based on patient's pre-existing condition(s)
  • Complications interfering with physical therapy: Occupational ...

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