CASE STUDY

DEMOGRAPHIC DATA

Name: Mr Adhar kulkarni Age: 26 yrs Gender: male Address: 1st floor; kharghar Hand Dominance: Right Occupation: Rehabilitation professional

CHIEF COMPLAINTS

Pain in low back Unable to lift heavy weights

PAIN HISTORY

Site of pain: lumbar area L2-L5 Type of pain: dull aching pain Onset: gradual Aggrevating factors: walking, squatting Relieving factors: rest,painkillers,ointments Severity: NRS: 8/10 on activity;

2/10 at rest.

PRESENT HISTORY

Pain started in back which radiated till buttock. Onset: gradual Pain increases after walking for long time and

getting up from sitting position. History of trauma: Present He went to the orthopaedic in DYPH

and took medications ; since no relief he was referred for physiotherapy.

PAST HISTORY : In 2005 he had a fall i.e rolled over from 3rd floor steps and landed himself him on buttocks

2nd episode of trauma in 2012 where he was sitting in the bus ; while another bus from behind crashed causing jerk on the back.

MEDICAL HISTORY : No h/o HTN, DM, TB, asthma

SURGICAL HISTORY : Nothing significant FAMILY HISTORY : Nothing significant MEDICAL HISTORY : Nothing significant PERSONAL HISTORY : Nothing significant SOCIOECONOMIC HISTORY : Fair.

INVESTIGATIONS

X-ray: Lumbar spine shows loss of lumbar lordosis.

Early degenerative changes seen. Rest nothing significant.

OBSERVATION

General condition: fair Built: Endomorph Posture: Sitting: Posteriorly (sitting / standing)

list of neck on left Lateral view: Rounded shoulders

forward head.

Standing : Anterior view

Rt shoulder drop.

List of neck on left with respect to shoulder. Posterior : Mild list on left Attitude : Sitting Swelling : Absent.

SIDELYING

SITTING POST VIEW STANDING POST VIEW

PALPATION

Tenderness : Present over L3, L4, L5 and sacral area.

Oedema : Not present Paraspinal muscle spasm: Mild

EXAMINATION

ROM: Lumbar ranges Flexion: Schobers test- 6 cm Extension: - Sideflexion: Right -53 cm

Left -53 cm

hip left right End feel

Flexion(with knee extension)

60 60 Firm

extension 20 20 firm

abduction 40 40 firm

adduction 20 20 firm

Internal rot 40 40 firm

Knee(flexion) (extension)

1350

1350

firm

ROM

IMTLEFT SIDE RIGHT SIDE

Iliopsoas 4 4

Gluteus Maximus 4 4

Gluteus medius 4 4

Internal rotatorsExternal rotators

44

44

knee-Quadriceps 4 4

Medial hamstrings 4 4

Lateral hamstrings 3 5

Ankle -dorsiflexors 5 5

Plantarflexors 5 5

Abdominals

Upper 3(pre treatment) 4(post treatment)

Lower Back extensors

3(pre treatment)3(pre treatment)

4( post treatment)4(post treatment)

Myotomes :

L2- hip flexion- affected L3 - knee extension -affected

Tightness:Pyriformis: Mild tightness( Rt > Lt) Hams: Moderate tightness Dorsolumbar fascia: Mild tightness. Rectus femoris : Mild tightness.

Gait cycle: Normal Arches : Normal Lumbopelvic rhythm: Normal.

SPECIAL TESTS

Fabers : -ve SLR: -ve Slump: +ve (tissue resistance) Gillet: -ve Quadrant: -ve Trendelenbergs: -ve SI joint tests: Piedallus test: -ve.

SI joint analysis:

No upslip /downslip noted. No anterior or poster or rotation.

Back endurance test: ITO test:

Pre treatment- 80 secs

Post treatment-145 secs

OUTCOME MEASURES

SCALES:

Roland morris questionnaire

Oswestry disability index

Functional rating scale:57.5% (pre score)

40% (post score)

Hendler 10 min screening test

Quebec pain questionnaire:51/100 (pre score)

27/100 (post score)

MANAGEMENT

Short term goals: Patient education Correction of list Relieve pain Increase muscle strength Increase rom Home program.

Long term goals : To continue STG To improve strength To make functionally

active.

Patient education:explained abt the condition,importance of exercise,avoid weight lifting and teaching him correct technique.

Correction of list: mckenzie technique,therapist correction and patient self correction.

PRE TREATMENT POST TREATMENT

EXERCISES

Mckenzie protocol Prone on forearm Prone on palms Prone extension in standing Sphinx position Stretching of tight muscles:

hams ,pyriformis MET pyriformis.

Increasing back endurance and abdominal strength – core stabilization and core strengthening exercises.

Pelvic tilts Abdominal tucks Abdominal curls

Outcome: List corrected. Back endurance incresed (ito test) Outcome measure scales improved. Home program

THANK YOU