Case #1 Answers

Here are my answers for Physical Therapy Case Study #1

Is this patient appropriate for Physical Therapy?

Possibly not the lower abdomen, middle lumbar spine and buttock pain could be referred pain from the large intestines. Also her history of osteoporosis means that she could have a vertebral fracture

Is it simple LBP, nerve root pain or a serious pathology?

Could be a serious large intestine pathology. The nerve irritation signs indicate that it could be radiculopathy.  Pain that varies with physical activity and time as well as age between 20-55 indicates that it could be simple backache.

What Treatment Classification are they in?

Manipulation 2/6, Specific Exercise 0/3, Stabilization 3/7, Traction 2/7

What do you expect/how will you change your examination for this patient?

If radiculopathy the patient will have sensory, motor and/or reflex deficits of a specific nerve root.  Would expect a positive prone instability test, positive aberrant movements, and hyper mobility with the spring test, If these are not found then the patient is most likely not in the stabilization treatment classification.

What structures could be involved?

Her symptoms seem to indicate that that it is nerve root damage 

Case #1

Please read the introduction first

Physical Therapy Case Study #1

Gender: Female

Age: 47

Smoker: No

Pregnant: No

Occupation: Waiter

Past Surgical History: Total Hip

Current Meds: Adderall, Soma, Tylenol

Past Medical History: Osteoporosis

During the past month, Have you often been bothered by feeling down, depressed or hopeless? No

During the past month, have you been often bothered  by little pleasure or interest in doing things? No

Currently Experiencing: Headaches

What date did your present pain start? A week Ago

Symptoms are: Getting Worse

Have you received any treatment for this problem? No

How are you able to sleep at night? Moderately Difficult

Rate Average pain on a scale from 0 to 10 for the last 48 hours: 3

Rate Best pain on a scale from 0 to 10 for the last 48 hours: 9

Rate Worst pain on a scale from 0 to 10 for the last 48 hours: 10

Rate your ability to function 0 being none and 10 being normal: 8

Symptoms/Other:

•          3 prior episodes
•          Pain in Lower Abdomen, middle lumbar spine, buttock
•          Straight leg raise ROM above 90
•          Nerve irritation signs
•          Pain varies with physical activity and time

Is this patient appropriate for Physical Therapy?

What is the SINSS (Severity, Irritability, Nature, Stage, Stability)?

Is it simple LBP, nerve root pain or a serious pathology?

What Treatment Classification are they in?

What do you expect/How will you change your examination for this patient?

What structures could be involved?

Introduction

My name is Ben Toolson and I am a current student at Rocky Mountain University of Health Professions (RMUoHP). I am in my third semester of the Doctoral Physical Therapy Program and have found that I study best by making case studies about the things that I have learned and trying to apply my lectures into everyday physical therapy. I figured I might as well share the case studies that I make up and see if I can get some discussion going with other students in physical therapy programs or actual physical therapists. I will share my case study with questions and my answers to the questions feel free to comment and tell me I am wrong (if you do I would like some reasoning behind it though). If you have any suggestions or constructive criticism I'm all ears. THESE CASE STUDIES ARE MADE UP AND NOT BASED ON ACTUAL PATIENTS.