Use of a classification system to guide nonsurgical management of a patient with chronic low back pain

Background and Purpose. This case report describes the use of a classificat ion 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 positi oning and functional movement. Case Description. The patient was a 55-year- old woman with a medical diagnosis of lumbar degenerative disk and degenera tive joint disease from L2 to S1. Rotation with extension of the lumbar spi ne was found to be consistently associated with an increase in symptoms dur ing the examination. Instruction was provided to restrict lumbar rotation a nd 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 Questionn aire scores were 43%, 16%, and 12%, respectively. Discussion. Daily repetit ion of similar movements and postures may result in preferential movement o f the lumbar spine in a specific direction, which then may contribute to th e development, persistence, or recurrence of LBP. Research is needed to det ermine whether patients with LBP would benefit from training in activity mo difications that are specific to the symptom-provoking movements and postur es of each individual as identified through examination.