Having looked at a recent case study of neck and shoulder pain, I thought that this time we might look at a case study concerning one of our physiotherapy patients who was suffering with what is probably the most common musculoskeletal complaint that we see: low back pain. A huge number of people every year in the UK will suffer with an episode of low back pain and seek help from a physiotherapist, in fact the vast majority of the population will at some point in their lives suffer with this. In this case study we shall examine a patient who was suffering with an episode of acute low back pain.

 As ever with physiotherapy, before we can really understand what might be causing the patient's low back pain it is necessary to first have a reasonable grasp of the anatomy. The lumbar spine is the area that most people would call their low back, in the lumbar spine there are 5 vertebrae each with an intervertebral disk separating them. To the side of the vertebrae are the facet joints which connect the vertebrae above and below with each other.

All around the vertebrae are an array of ligaments which serve to stabilise the spine. The lumbar spine has several important muscle groups: firstly the lumbar erector spinae which are responsible for holding the spine into extension. Deep underneath there is multifidus and to each side there is quadratus lumborum which runs from the low ribs to the pelvis. Finally just to confuse matters psoas which is primarily a hip flexor runs from the lumbar vertebrae to the femur. All in all a fairly complicated area! Now that we have a better idea of the anatomy of the lumbar spine we can look at the example of our patient. 

The patient Mr X, who was in his mid 50s and living in Rugeley, contacted us at ThreeSpires Physiotherapy to request a home visit physiotherapy assessment to help with his back which had unfortunately "gone" the day before. On initial assessment Mr X's pain levels were very high and he had extremely limited mobility in his back, in fact he struggled to just get onto the plinth. As pain levels were so high, this initial treatment session focused on relieving his pain with some soft tissue work and electro-acupuncture. He was also given some gentle stretches and exercises to do until our next session.

At his next appointment he was already recovering well, his pain levels were dropping and his movement was much improved, therefore we conducted a more thorough physical examination. This showed limited range of movement in forward flexion (bending over) and sharp pain on right side flexion. Palpation (touching) revealed a greater level of tension in the muscles on the right side of his back which corresponded well with his greater pain levels on the right side and palpation of the facet joints on the right side at L3 & 4 produced sharp pain. The above assessment combined with the information he provided made me suspect that he had strained one of his facet joints which had lead to a large muscular spasm in his back.

Over the next 2 weeks the patient received approximately 4 further sessions of physiotherapy which included soft tissue massage, spinal manipulation, trigger point needling and electro-acupuncture. He was also given a progressive series of exercises aimed at improving movement, reducing pain and strengthening his back muscles to prevent re-occurrence. A final follow up 1 month later to further progress his exercises and reduce the likelihood of further back pain, found the patient to be completely pain free and very happy!

I hope that you have enjoyed reading this blog post. For anyone reading this blog who hasn't come across our site before: we are a home visit physiotherapy service, based in Lichfield but serving anywhere within a 25 minute drive including areas such as Sutton Coldfield, Tamworth, Cannock, Burton and Rugeley. We offer a wide range of services including paediatric physiotherapy, post-operative rehabilitation, neurological physiotherapy and neck and back pain relief. If you need further information or would like to book an appointment we can be contacted on 0788 428 1623 or via enquiries@threespiresphysiotherapy.co.uk