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Case Study: 22-Year-Old Bartender with Low Back Pain and Gluteal Pain Management

This case study discusses a 22-year-old male bartender and student who presented with low back pain (LBP) that started two weeks prior, exacerbated by activities like prolonged standing and running. The onset followed a flag football game, with accompanying gluteal pain. The assessment involved objective measurements, including lumbar mobility, neurological tests, and pain scales. Treatment focused on exercises and manual therapy, leading to significant improvement in pain levels and functional outcomes over a series of sessions. Insights on treatment efficacy and patient progress are highlighted.

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Case Study: 22-Year-Old Bartender with Low Back Pain and Gluteal Pain Management

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Presentation Transcript

  1. MK Case Study

  2. Patient Profile • 22 year old man: bartender/student • LBP onset 2 weeks ago (15 days) • Spread to R gluteal pain 10 days ago

  3. History • Onset AM after flag football game • Gradual onset with return to work (bartender) • Denies pain during game • Previous Hx of ruptured Left RF • No Rx • No Meds • No radiography

  4. immediate with standing Standing > 1/2 hr spreads to gluteal pain Running immediate increase in LBP stopped activity Prolonged sitting (>30) increases LBP Sitting relieves 5”, immediate return with return to stand Sit 15” to relieve Cannot run Must lay down 30” to relieve Able to sit if on L ischium only Aggravating …………Easing

  5. Observation • Stands WB primarily L LE • Slight L shift (contralateral) • Corrected SB R Upper Lumbar

  6. Objective • Flexion: deviates L, poor unrolling of lordosis limit finger tips to mid tibia No change in LB SM Correction of deviation some increase in pain improves range

  7. Objective • Extension: 0-5 degrees deviates to L Increases his comparable LBP correction increases c/o pain more

  8. Objective • SB R 0-5 degrees -increased his LB pain - flattened curve • SB L 0-15 degrees - painless

  9. Palpation • Hypomobility into extension L4 & L5 • *Stiff & painful with central PA @ L4> L5 • **Stiff & painful with R unilateral @ L4 • Slight decrease pain with R unilateral @L5

  10. Objective • Neurological: clear DTR, Myotome, Sensation • Special Test -

  11. Pain scale • Patient: @ rest “4/10” • Standing > 30”: 8/10 • Sitting > 3”: 3/10 • Running: 0/10 stopped activity • Lifting: 1/10

  12. Hip MobilityR L • Flexion 140 140 • Extension 15 20 • XR 60 60 • IR 40 45 • ABD 45 50 • ADD 20 20

  13. PSFS • Standing: 2 • Sitting: 4 • Running: 0 • Lifting: 2 • TOTAL =8 8/4 activities = 2

  14. ODI & FABQ • Oswestry Score: 20 = 40% • FABQW: 19 • FABQPA: 39

  15. CPR • No Sm distal to knee • < 16 days • FABQW = 19 • Hypomobility 4/5, 5/1 extension • Hip IR >35

  16. CPR • No Sm distal to knee • 15 days • FABQW < 19 • Hypomobility 4/5, 5/1 extension • Hip IR >35 both sides • Woahh ! 5/5 Positive Likelihood Ratio: infinite

  17. Trial Treatment • Supine LS V GPM in RSB Post • painless in standing • Extension: 10 degrees, decreased deviation, painfree

  18. Treatment 2 • Pain: 3/10 at rest in standing • Extension: 10 degrees, then pain dev L • SB R 10 degrees, P+ • Repeat V

  19. Treatment 3Pre-Rx • Painscale: 1/10 rest • Extension: 15 degrees no deviation, no pain • SBR 15-20 degrees P- • Rx -Active extension/active exercise

  20. Initial Re-test • Pain Scale: 6 1 • PSFS: 2 8 • Oswestry: 20 5 • FABQ: 19 6

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