Case Study: Low Back Pain - 3
Subjective: This patient is 28 year old women who is a full-time house-wife and mother of two young children whose ages are 2 and 4 years. Her chief complaint is pain which she describes as being across the lower portion of her low back. This pain is increased whenever she stands or sits in one position for longer than 10 minutes. She states that she "pops her back" 4 or 5 times a day and that this reduces her pain temporarily. She denies referred pain to the buttocks or lower extremities, she also denies weakness or numbness in her lower extremities. Her current symptoms have been present since her last pregnancy 2 years ago. She denies trauma but states that she twisted her back many times while competing as a gymnast in high school and college. Radiographs were taken of her lumbar spine 2 years ago and the findings were reported to be normal. She states that for the last 2 years she has received weekly spinal manipulation from another health care practitioner but now wishes to discontinue this treatment. She reports no other health problems and is taking Elavil for depression and insomnia. Her goal is to begin an aerobics program however she is concerned about that this will increase her back pain.
Objective: This patient is a thin women who stands with an exaggerated lumbar lordosis. Her leg length is equal. Her range of motion is as follows: All trunk motions are normal or slightly excessive, they are not painful. Both lower extremities are WNL for ROM, SLR is 60 degrees bilaterally and painful in the hamstring muscles. Her motor and sensory function is WNL in the LE's. Her DTR's are normal. During palpation of the L4 and L5 spinous processes, using posterior to anterior pressures, the patient reports a reproduction of her LBP. The SI joint provocative tests are negative.