SECTION B: SPINE DISORDERS

PATIENT PRESENTATION

A 33-year-old female presents with complaints of low back pain with insidious onset and duration of over 3 months. She reports that her neck is also stiff, and driving a car has been difficult. She works for a company that provides computer technical support to many local businesses and needs to drive for her work. She has morning stiffness that generally improves with activity and exercise. There has also been a recent onset of swelling in the left knee and heel pain. There are times when the pain wakes her from sleep in the middle of the night; however, if she gets up and walks around or takes a hot shower, her pain is relieved enough to be able to go back to sleep.

She is referred to physical therapy by her rheumatologist, and has the results of several tests. Pulmonary function tests show decreased vital capacity and total lung capacity, although residual and functional residual lung volumes were increased. Hematology tests showed a mild normocytic anemia, and a normal white count. Erythrocyte sedimentation rate and alkaline and creatinine phosphatase were elevated. There was no rheumatoid factor present. Posture shows a flattening of the lumbar lordosis and a dorsal stooping posture with an accentuation of the thoracic kyphosis. There is tenderness over the spinous processes of the lumbar and thoracic vertebrae. A bony spur is palpated at the right heel at the proximal insertion of the plantar fascia. AROM is severely diminished lateral flexion of the spine, forward flexion and extension are decreased by 50%. Left knee ROM is decreased both actively and passively by 10 degrees.