After having a month of severe right-sided low back pain – so bad that he had trouble getting out of bed and dressed in the morning – he was referred for physical therapy. It came on out of the blue when he got out of bed one morning. After a steroid pack he was minimally better. He was unable to sit for longer than about an hour, unable to work out, and unable to ride his bike. Unilateral (one-sided) low back pain with rapid onset (starts suddenly) is a common problem. Rapid-onset low back pain many times can be rapidly eliminated as well.
Problem
Sitting and bending (flexion-related) activities were very painful. After sitting for a bit, he had pain getting back up, and had to do so slowly and gingerly. This problem is called Pain During Movement (PDM), Aberrant Movement, or an Instability Sign, depending on which spinal pain classification system is being used. He also had very limited motion and was stiff bending backward, indicating a loss of extension range of motion.
Examination
His complaints and description suggested that he would respond well to extension-biased mechanical therapy. There are many theories as to why this kind of therapy works, but it normally works relatively quickly. With one specific home exercise – altered or changed after each visit – he was able to reduce his pain in just a few visits to the point that he was only having pain in the morning. It was still pretty significant though.
Treatment
During those first few visits we also addressed core strength training and flexibility around the hips and thighs to reduce pressure on the low back and to normalize his mechanics with daily activities. Adding spinal traction and hands-on joint mobilization further reduced his pain to the point that he only had a few minutes of stiffness in the morning.
From there it was all downhill: two visits to restore his ability to bend forward without pain or fear, and his discharge assessment, to provide all of the necessary feedback and documentation to his pain management physician.
Outcome
After 8 visits, he was completely pain-free, able to lift and move in all directions without pain or fear. He can return any time in the next year if he has a relapse, and was instructed to continue his extension exercises to further increase his motion and integrate his core strength training with his regular workout.
