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Use of a Classification System to Guide Nonsurgical Management of a Patient With Chronic Low Back Pain

KS Maluf, MSPT, is Graduate Student, Movement Science Program, Program in Physical Therapy, Washington University School of Medicine, St Louis, Mo
SA Sahrmann, PT, PhD, FAPTA, is Professor and Associate Director for Doctoral Studies, Program in Physical Therapy, Washington University School of Medicine, St Louis, Mo
LR Van Dillen, PT, PhD, is Assistant Professor, Program in Physical Therapy, Washington University School of Medicine, Campus Box 8502, St Louis, MO 63110 (USA) (vandillenl{at}msnotes.wustl.edu). Address all correspondence to Dr Van Dillen

Background and Purpose. This case report describes the use of a classification system in the evaluation of a patient with chronic low back pain (LBP) and illustrates how this system was used to develop a management program in which the patient was instructed in symptom-reducing strategies for positioning and functional movement. Case Description. The patient was a 55-year-old woman with a medical diagnosis of lumbar degenerative disk and degenerative joint disease from L2 to S1. Rotation with extension of the lumbar spine was found to be consistently associated with an increase in symptoms during the examination. Instruction was provided to restrict lumbar rotation and extension during performance of daily activities. Outcomes. The patient completed 8 physical therapy sessions over a 3-month period. Pretreatment, posttreatment, and 3-month follow-up modified Oswestry Disability Questionnaire scores were 43%, 16%, and 12%, respectively. Discussion. Daily repetition of similar movements and postures may result in preferential movement of the lumbar spine in a specific direction, which then may contribute to the development, persistence, or recurrence of LBP. Research is needed to determine whether patients with LBP would benefit from training in activity modifications that are specific to the symptom-provoking movements and postures of each individual as identified through examination.

Key Words: Case report • Classification • Disability • Low back pain • Motor control

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