The Use Of Manual Therapy In The Treatment Of A Patient With Chronic Low Back Pain And Sciatica: A Case Report

Background: Chronic low back pain (CLBP) is one of the most common conditions encountered in an outpatient physical therapy (PT) setting. While there are many different approaches used in the treatment of CLBP, the purpose of this case report is to detail the successful utilization of a short-course of manual therapy (MT) for a patient with CLBP and sciatica. Case Description: The patient was a 60-year-old male who presented to PT with a medical diagnosis of nerve root compression-left sciatica. At the initial evaluation, he presented with radiating left sided low back and lower extremity pain of approximately six months duration. This prevented sleep and limited work duties as well as his sitting tolerance to less than one hour. Prior treatment included over the counter pain medication and self-taught stretches without relief. His primary goal was to perform his job without interference and to be able to fall asleep without pain. Outcome measures included the modified Oswestry Disability Index (ODI) and the Numeric Pain Rating Scale (NPRS). MT intervention included soft tissue mobilization, spinal mobilization, musculature stretching, and passive range of motion, for a period of six weeks to address functional mobility and decrease pain. Outcomes: With MT intervention, ODI score improved from 11.1% to 2.2%, NPRS score at rest reduced from 5/10 to 0/10. Sitting tolerance improved to more than one hour. The patient met his goals of return to pain-free sleep and work duties. Discussion: This case report demonstrated that a MT focused intervention can decrease pain and improve function in a 60-year-old male with CLBP and sciatica. Further studies should investigate the use of MT in a larger population with CLBP