Date of Award

2012

Document Type

Scholarly Project

Degree Name

Doctor of Physical Therapy (DPT)

Department

Physical Therapy

First Advisor

Schawnn Decker

Keywords

Case Reports; Low Back Pain -- therapy; Psoas Muscles -- physiopathology

Abstract

Background and Purpose

Low back pain is a prevalent healthcare issue which has a number of causes. There are many types of treatment with varying levels of success. The psoas is a back muscle which may undergo changes in a patient with back pain. Treatment may have to be modified if changes are seen in the psoas.

Case Description

A 66 year-old woman reported low back and right hip pain, as well as right-sided abdominal pain around a surgical incision. The physical therapy examination revealed adhered scar tissue around the incision, psoas muscle tightness, as well as low back and hip pain which centralized with back extension.

Outcomes

The patient underwent physical therapy treatment to address pain and limitations. Interventions included patient education, home exercise program, manual therapy (soft tissue mobilization over the psoas), electrical stimulation (interferential current), and a strengthening program which included the use of the Lumbar MedX system. The interventions resulted in the abolition of abdominal, hip and back pain. Patient reported that with increased activity she experienced minor back pain, but that she was able to eliminate it by herself within a few minutes.

Discussion

All low back pain patients are unique and it is important to address all possible causes. Most low back pain patients have some muscle atrophy so a strengthening program is an important rehabilitation intervention. The Lumbar MedX has been shown to be an effective tool to isolate the lumbar extensors which are often atrophied with low back pain patients. It is important to take the patient into account when deciding the frequency, resistance, sets and repetitions of strengthening exercises. Muscular imaging may help determine how prevalent psoas asymmetries are among low back pain patients and improve the treatment of these individuals.

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