title: A three-paradigm treatment model using soft tissue mobilization and guided movement-awareness techniques for a patient with chronic low back pain: a case study.
abstract: It is not uncommon for physical therapists to report difficulty in treating certain subjects with chronic idiopathic low back pain. The purpose of this case study is to present a three-paradigm model of intervention that may be adapted to the treatment of such cases. The model consists of: 1) relaxation paradigm, consisting of pain modulation procedures; 2) corrective paradigm, involving manual techniques and exercise to correct specific faulty biomechanical alignment(s) eg., pelvic asymmetry); and 3) integrative paradigm, utilizing guided movement/mobilization techniques for improving the subject's overall pattern of posture and movement. The case study of a young adult with chronic low back pain correlated with unilateral innominate bone rotation is presented to illustrate the three-paradigm approach. Over six sessions, the subject received a corrective (sessions 1-3) and an integrative treatment protocol (sessions 4-6) consisting of Rolf's method of soft tissue mobilization and Alexander's system of guided movement-awareness techniques. Before and after each session and after a 4-week follow-up, the subject was assessed for sacroiliac joint pain using a compression technique, anterior rotation of the innominate bones, pelvic angle in the standing position, and vagal tone as determined from heart rate variability. The therapist's visual analysis of sit-to-stand movement and the subject's self-reports of pain were noted. A corrective paradigm protocol of soft tissue mobilization and exercise was unsuccessful in eliminating the subject's assessed anterior rotation of the innominate bone and associated low back pain for more than 1-2 days posttreatment. Only after the implementation of a third paradigm movement/mobilization protocol did the subject begin to exhibit sustained improvement through a 4-week follow-up. Interpretations of the results, appropriate selection of corrective and integrative protocols, and physiological mechanisms are discussed.
authors.affiliation: Christie Clinic Association, Department of Sports Medicine and Physical Therapy, Rantoul, IL 61866, USA.
authors.forename: J T
authors.initials: JT
authors.lastname: Cottingham
authors.forename: J
authors.initials: J
authors.lastname: Maitland
mesh_terms: D000328:Adult; D002908:Chronic Disease; D003131:Combined Modality Therapy; D003238:Connective Tissue / Q000502:physiology; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000175:diagnosis / Q000503:physiopathology / Q000534:rehabilitation*; D008349:Manipulation, Orthopedic / Q000379:methods; D008405:Massage / Q000379:methods; D015915:Motion Therapy, Continuous Passive / Q000379:methods; D009126:Muscle Relaxation; D010147:Pain Measurement; D010808:Physical Examination / Q000379:methods; D026741:Physical Therapy Modalities / Q000379:methods*