The use of neuroscience education in combination with stabilization exercise in a multimodal approach for the treatment of a young adult with chronic low back pain : a case report

A patient with chronic low back that radiated into his left buttock was seen for physical therapy treatment for 12 sessions over two months at an outpatient physical therapy clinic. Treatment was provided by a student physical therapist under the supervision of a licensed physical therapist. The patient was evaluated at the initial encounter with the Oswestry Disability Index, Fear-Avoidance Belief Questionnaire, the Numeric Pain Rating Scale, the modified Thomas test, the straight leg raise test, the passive lumbar extension test, and the prone instability test. Based upon this evaluation, a plan of care was developed. The main goals for the patient were to improve strength and motor control of the trunk and lower extremity, improve range of motion of the hip, decrease low back pain and improve sitting tolerance, return to customary activities with friends, and decrease the patient’s fear of movement. Main interventions used were stabilization exercises, therapeutic neuroscience education, lower extremity strengthening and stretching exercises, and task-specific training. Low back pain was completely eliminated during the course of treatment, moving from a 7 to a 0 on the Numeric Pain Rating Scale. There was an improvement in functional ability as measured by the Oswestry Disability Index, from a moderately disabled score category to a minimally disabled score category. Fear of movement as measured by the Fear-Avoidance Belief Questionnaire moved from a high category in the subscales to a low category. The manual muscle test of the trunk muscles improved, moving from a score of 4/5 to 5/5. The patient was discharged home with a graded home exercise program and instruction on how to progress his exercises properly.