The use of a modified classification system in the treatment of low back pain during pregnancy: a case report.
METHODS
Case study.


OBJECTIVE
To describe the use of a classification approach in the evaluation and treatment of a pregnant patient with low back pain (LBP).


BACKGROUND
The patient was a 28-year-old primigravida in her 20th week of pregnancy. She presented with a chief complaint of LBP without precipitating trauma. Her pain limited her sitting to 20 minutes or less and restricted her ability to bend forward.


METHODS
This patient was treated 4 times during a period of 2 weeks. The patient was classified as stage 1 extension syndrome. Because of the patient's pregnancy, treatment with active extension exercises commonly prescribed for this syndrome was deemed inadequate. Therefore, manual joint mobilization was applied to the symptomatic vertebral segment. Additional intervention included moist heat, soft tissue mobilization to the thoracolumbar paraspinals, manual stretching of the hip flexors, abdominal bracing, and wall squat exercises.


RESULTS
After 4 treatments, the patient was able to bend forward without pain, sit longer than 1 hour without discomfort, and work with minimal discomfort. She improved from a stage 1 classification to a stage 3 classification.


CONCLUSIONS
This case illustrates the use of a classification system to guide physical therapy intervention. It also demonstrates an effective and safe use of manual techniques in the treatment of a pregnant patient.
Department of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, USA. mais@hsc.usc.edu
Susan Mais
SM
Requejo
Robert
R
Barnes
Kornelia
K
Kulig
Robert
R
Landel
D Susana
DS
Gonzalez
D000328:Adult; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000145:classification* / Q000209:etiology / Q000534:rehabilitation*; D010808:Physical Examination; D026741:Physical Therapy Modalities; D011247:Pregnancy; D011248:Pregnancy Complications / Q000145:classification* / Q000534:rehabilitation*