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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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CLINICAL PREDICTION RULE (CPR) FOR TREATMENT: Tool that has been developed from research that may help a clinician select the most effective treatment(s) based on findings from the patient's history and clinical examination

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CROSSED STRAIGHT LEG RAISE: Clinical special test performed to rule in the presence of a herniated nucleus pulposus; a positive test is associated with a reproduction of a patient's symptoms when the "asymptomatic" leg (leg not experiencing radiculopathy) is passively raised1

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LUMBOSACRAL RADICULOPATHY: Collection of signs and symptoms (e.g., radiating pain, numbness, and/or weakness in the buttock or lower extremity) associated with injury to a nerve root in the lumbosacral spine

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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 mechanical traction and its proposed clinical indications.

  4. Describe the preliminary clinical prediction rule for patients with a herniated nucleus pulposus that may benefit from treatment with mechanical traction.

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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; traction, modalities, and manual therapy ...

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