title: Clinical diagnosis and treatment of a patient with low back pain using the patient response model: A case report.
abstract: The medical management of low back pain (LBP) can be approached in a multitude of ways. Classification via subgrouping is increasingly common in orthopedic literature. Clinical diagnosis and treatment of LBP using the patient response model (PRM) can assist clinicians in hypothesizing the origin of pain and providing beneficial interventions unlike the widely used pathoanatomical model. This case report involved a 52-year-old female with sudden onset of right-sided LBP that radiated to the foot. These symptoms were accompanied by occasional paresthesias in bilateral lower extremities. Magnetic resonance imaging (MRI) confirmed disc bulges at levels T11-T12 and T12-L1. On the first of seven visits, she reported 9/10 on the Numeric Pain Rating Scale (NPRS), scored a 24/50 on the modified Oswestry disability index (mODI), and demonstrated lumbar flexion range of motion (ROM) of 10°. Using the PRM, the patient was classified as an extension responder and was instructed to perform 10 repetitions of standing lumbar extension every 2 waking hours. After 4 weeks of therapy, the patient reported a 1/10 pain localized to the low back, scored 20/50 on the mODI, and improved flexion ROM to 45°. Classification using the PRM yielded positive outcomes with this patient's symptoms and daily function.
authors.affiliation: a University of North Carolina - Division of Physical Therapy , Department of Allied Health Sciences , Chapel Hill , NC , USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Robinson
mesh_terms: D001696:Biomechanical Phenomena; D003937:Diagnosis, Differential; D004185:Disability Evaluation; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D007403:Intervertebral Disc / Q000000981:diagnostic imaging / Q000503:physiopathology; D017116:Low Back Pain / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy*; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D010147:Pain Measurement; D011237:Predictive Value of Tests; D011843:Radiculopathy / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy*; D016059:Range of Motion, Articular; D020127:Recovery of Function; D016896:Treatment Outcome
keywords: Centralization; MDT; McKenzie method; directional preference; low back pain; sciatica