Heidi Ojha1, William Egan1, Patricia Crane2. 1. Department of Physical Therapy, College of Health Professions and Social Work, Temple University, Philadelphia, PA, USA ; Regis University Manual Therapy Fellowship Program, Denver, CO, USA. 2. Regis University Manual Therapy Fellowship Program, Denver, CO, USA ; Moss Rehab, Philadelphia, PA, USA.
Abstract
OBJECTIVE AND IMPORTANCE: There is a paucity of research investigating the combined interventions of direction-specific lumbar exercise and manipulation for individuals with low back pain (LBP) who exhibit centralization or a directional preference. The purpose of this report was to describe the management and outcomes of a patient with chronic LBP who met two categories of the revised treatment based classification (TBC) approach initially described by Delitto and colleagues. CLINICAL PRESENTATION: A 55-year-old female with a 15-year history of right LBP/leg pain demonstrated centralization of symptoms with repeated extension and met four out of five criteria on the clinical prediction rule for thrust manipulation. INTERVENTIONS: The patient was treated for seven physical therapy sessions, once a week for seven weeks. Lumbar thrust manipulation and extension-oriented interventions were combined throughout the course of care. The patient experienced a decrease on the modified Oswestry disability index score from 26 to 8%, an increase in the patient-specific functional scale score from 5.6 to 9.4, and patient-report of full return to pain-free activity at discharge. CONCLUSION: A patient with chronic LBP reported a clinically meaningful improvement after seven visits of manipulation and extension-oriented interventions. Further research should compare the effectiveness of combining interventions for individuals who meet the two TBC groups of manipulation and extension-specific exercise compared with performing either intervention alone.
OBJECTIVE AND IMPORTANCE: There is a paucity of research investigating the combined interventions of direction-specific lumbar exercise and manipulation for individuals with low back pain (LBP) who exhibit centralization or a directional preference. The purpose of this report was to describe the management and outcomes of a patient with chronic LBP who met two categories of the revised treatment based classification (TBC) approach initially described by Delitto and colleagues. CLINICAL PRESENTATION: A 55-year-old female with a 15-year history of right LBP/leg pain demonstrated centralization of symptoms with repeated extension and met four out of five criteria on the clinical prediction rule for thrust manipulation. INTERVENTIONS: The patient was treated for seven physical therapy sessions, once a week for seven weeks. Lumbar thrust manipulation and extension-oriented interventions were combined throughout the course of care. The patient experienced a decrease on the modified Oswestry disability index score from 26 to 8%, an increase in the patient-specific functional scale score from 5.6 to 9.4, and patient-report of full return to pain-free activity at discharge. CONCLUSION: A patient with chronic LBP reported a clinically meaningful improvement after seven visits of manipulation and extension-oriented interventions. Further research should compare the effectiveness of combining interventions for individuals who meet the two TBC groups of manipulation and extension-specific exercise compared with performing either intervention alone.
Entities:
Keywords:
Chronic low back pain; Clinical decision making; Directional preference; Extension specific exercise; Motor control; Thrust manipulation; Treatment based classification
Authors: Tasha R Stanton; Julie M Fritz; Mark J Hancock; Jane Latimer; Christopher G Maher; Benedict M Wand; Eric C Parent Journal: Phys Ther Date: 2011-02-17
Authors: Mark W Werneke; Dennis L Hart; Steven Z George; Paul W Stratford; James W Matheson; Adrian Reyes Journal: Arch Phys Med Rehabil Date: 2009-05 Impact factor: 3.966