Conservative Treatment of Lumbar Disc Herniation: A Case Report

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Lofgren,, Benjamin A.
Intervertebral Disc Displacement -- therapy; Case Reports; Physical Therapy
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Purpose: This case study provides a description of the outpatient physical therapy management of a 55-year-old female with low back pain and sciatica.Case Description: Initially, the patient was diagnosed with illiotibial band syndrome (ITB) syndrome. During physical therapy examination, the patient demonstrated signs and symptoms consistent with a lumbar disc pathology. Interventions were designed to address the lumbar disc pathology and included mechanical traction, therapeutic exercises, and patient education for posture, positioning and proper body mechanics.Outcome: Following 4 weeks of conservative physical therapy treatment, the patient was referred to her primary care physician with a request for imaging. Imaging results confirmed a L5-S1 lumbar disc herniation. Surgical and conservative options were reviewed and the patient agreed to continue conservative treatment for 4 additional weeks. The patient was able to return to her prior level of activity, increase her quality of life, and tolerate work with minimal pain throughout the episode of care.Discussion and Conclusion: Interventions were based upon evidence-based practice for lumbar disc pathology and upon patient responses. Primary care referral and imaging request were used to confirm her diagnosis due to continued intensity of symptoms. The MRI confirmed herniation of the left L5-S1 intervertebral disc which supported the physical therapy diagnosis. More research needs to be done to compare outcomes resulting from physical therapy interventions prior to surgical intervention used for this pathology.