Using the treatment-based classification approach for a patient with low back pain

A patient with low back pain and left hip pain was seen for physical therapy treatment for 9 sessions over the course of 2 months in an outpatient pro bono physical therapy clinic. Treatment was provided by a student physical therapist under the supervision of a licensed physical therapist. The patient was evaluated during the initial objective examination with: a manual muscle test, lumbar range of motion, a lumbar segmental examination, Numeric Pain Rating Scale, Fear Avoidance Beliefs Questionnaire and Oswestry Disability Index. The evaluation determined the patient to have weakness in the hip abductors, pain and muscle incoordination with prone hip extension, poor sitting posture, intolerance of prolonged sitting and standing, trunk instability with single leg stance, and functional disability due to low back pain. A plan of care was established to meet the patient’s goals of: improving strength, pain, motor control, sitting posture, sitting and standing tolerance, trunk stability with single leg stance and functional ability. The interventions utilized in this patient’s plan of care were stabilization exercises, lumbar spine mobilizations, patient education and a home exercise program. The patient met her goals of improved hip abductor strength, improved pain and motor control with prone hip extension, maintained correct sitting posture, improved tolerance of prolonged sitting and standing, improved trunk stability with single leg stance and improved functional ability. The patient did not meet her participation level goal of being able to provide rehabilitative treatment (while sitting) to children without experiencing pain.