CASE PRESENTATION

PRESENTED BY: MODERATED BY:

R.RAJESWARI
MPT(ORTHO) 1ST YEAR
SRM COLLEGE OF
PHYSIOTHERAPY
SRM INSTITUTE OF SCIENCE AND
TECHNOLOGY
 DEMOGRAPHIC DATA

• Name of patient- Mrs. Lakshmi

• AGE/SEX- 40 Yrs/Female
• UHID-1337816
• D.O.A: 12/02/2019
• Address:- mannivakkam, chennai,TN
• Occupation:- corporation worker.
• Chief complaints:-Patient complaints of severe pain in the low
back region for past 2 month. And pain increasing during
forward bending and weight lifiting.
 HISTORY
• Present History:-patient came to SRM Hospital, case of severe low
back ache with radiating pain in left lower extremity for past 2
months.
• Past History :– Not a K/C/O diabetics mellitus/ hypertension, no
history of trauma and history of tingling and numbness over the
left lower extremity.
• Surgery History:- No relevant surgical history
• Family History:- not significant
• Socio economial history::- lower middle class family, according to
kuppuswamy scale 12/29.
• Personal history:- non-smoker and non-alcoholic mixed diet ,
bowel and bladder function are normal and altered sleep pattern.
 PAIN ASSESSMENT:
• site:L4 to calf region
• side: left
• onset: Gradual
• Duration: 2 month
• Type: Radiating pain
• Severity: VAS- 6
• Aggrevating factor: while doing bending activities,
prolonged sitting and standing.
• Relieving factor: at rest
ON OBSERVATION:
• Body Built: Ectomorphic
• Posture: Increased lordosis
• Gait: altered gait
• mobility Aids: no
ON PALPATION:
• Tenderness: Grade- 2
• present on the back muscles and prensent in the L4 and L5 Spinous
process
• warmth: absent
• spasm: present in the back muscle.( erector spinae)
• odema: Absent
ON EXAMINATION:
• Range of motion:
• LEFT Lower limb ( Active):
• Hip:
flexion –0-100 degree
extension-0-20 degree
abduction- 0- degree
adduction- 20 degree
• Knee:
flexion-0-120 degree
extension-120-0 degree
• Ankle:
planterflexion-0-20 degree
dorsiflexion- 0-15 degree
• lumbar flexion and extension ROM: could not access due to pain
• Muscle power: Left side
• HIP
flexor- 3/5
Extensor-3/5
Adductor-3/5
Abductor-3/5
• KNEE
flexor-3/5
Extensor-3/5
• ANKLE
Dorsiflexor- 3/5
Plantarflexor-3/5
• spine flexors and extensors: 3/5
Deep Tendon Reflexes:
Left side
• Knee: +
• Ankle: +
Superficial reflex:
left side
• Plantar reflex: extensor
SENSORY EVALUATION:
• sensory loss on the side of the legs and dorsum of the foot.
SPECIAL TESTS:
• SLR: positive
• Slump test: positive
• Piriformis tightness test: negative
INVESTIGATION:
• x-ray shows the narrowing of dics space in L4 and L5.
DIAGNOSIS: Intervertebral Disc Prolapse(IVDP)
L4 & L5
DIFFERENTIAL DIAGNOSIS:
• Spondylolysis
• Spondylolisthesis
• Spinal Stenosis
• Piriformis syndrome.
PROBLEMLIST:
• Increased in pain
• Difficulty in sitting for prolonged time
• Reduced range of motion in the spine
• Reduced muscle power
SHORT TERM GOALS:
• To Reduce the pain
• To improve the Range of motion
LONG TERM GOALS:
• To improve the muscle power
• To improve the muscle strength
PHYSIOTHERAPY MANAGEMENT:
Physical Modalities:
• Interferential Therapy
• Moist heat application
• lumbar spinal traction
Intermittent or continuous.
1/3 of body weight used in traction
Exercises:
• strengthen the muscles such as erector spinae, multifidus and
transverse abdominis and quadriceps and hamstring muscles.
Ergonomics: proper sitting advices, frequent break at work and
regular exercises.
DO’S AND DONT’S:
• Don’t bend forward
• Don’t’s bent with trunk to lift weight
• Bent with knee and hip
• Carry weights equally on hands.
• Lie on flat bed, avoid dropping posture.
• keep pillows between knees to relax lumbar curvatures.
• Avoid long travel.
• Sit erect on chair.
• Do regular exercises.
• Don’t stand for long time.
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