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.
Based on the patient's suspected diagnosis, what do you anticipate may be the contributing factors to his condition?
What examination signs may be associated with this diagnosis?
What are the most appropriate physical therapy interventions?
What are possible complications that may limit the effectiveness of physical therapy?
JOINT MOBILIZATION: Manual therapy technique comprised passive motions directed at a joint at varying speeds, amplitudes, and hold times
MANUAL THERAPY: Skilled, hands-on techniques designed to diagnose and treat soft tissue and joint structures
OLA GRIMSBY APPROACH: Norwegian-based orthopaedic physical therapy postgraduate training program that emphasizes manual therapy and exercise prescription
SOFT TISSUE MOBILIZATION: Manual therapy technique comprised directional manual force aimed at improving soft tissue mobility
Describe the Ola Grimsby-based manual therapy approach to the diagnosis of musculoskeletal dysfunction and selection of conservative interventions.
Describe the evidence for the efficacy of using Ola Grimsby-based manual therapy approach to treat the patient with low back pain due to a herniated nucleus pulposus.
PT considerations during management of the individual with a diagnosis of a herniated lumbar disc:
- General physical therapy plan of care/goals: Decrease pain; increase muscular flexibility; increase lower quadrant strength; improve motor recruitment and endurance of global and local stabilizers of the core region; prevent or minimize loss of aerobic fitness capacity; restore normal joint and soft tissue mechanics; improve vascularity to increase blood flow/oxygenation to local soft tissue to aid in tissue repair
- Physical therapy interventions: Patient education regarding functional anatomy and injury pathomechanics and effective body mechanics; manual therapy techniques; neuromuscular facilitation and re-education techniques; muscular flexibility exercises; exercises to increase muscular endurance of global and local core stabilizers ...
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