Patient Overview:
A 64-year-old female presented with lower back and left leg pain. She had experienced intermittent back pain for years, but a specific incident in the summer of 2024 worsened her condition. While walking, she stepped into a pothole, which caused discomfort that escalated by the evening. For the first week after the incident, she experienced pins and needles in her left leg and used ibuprofen for pain relief.
Initial Assessment (15/10/2024):
We conducted a detailed video consultation to rule out serious pathologies, discuss her medical history, and understand her pain presentation.
Symptoms: Severe pain initially, now described as stiffness and discomfort.
Aggravating Activities:Â Climbing stairs, standing from a seated position, and lying on the affected side.
Functional Limitations:Â Struggling to climb stairs (one leg at a time) and difficulty standing up from kneeling, particularly while gardening.
Lifestyle: Retired, working part-time as a cleaner, and living in a two-story house. She enjoys gardening and walking.
Goals:
Climb stairs normally and pain-free.
Stand up from a kneeling position for gardening.
Objective Findings:
Full range of motion in the lower back and hips.
Negative Slump Test.
Functional movements: No pain during a full squat or lunge, but left leg felt weaker.
Single-leg balance: Difficulty maintaining balance during torso rotations; noticeable Trendelenburg sign on the left, indicating weak gluteal muscles.
Diagnosis:
Resolving radicular pain with secondary muscle weakness in the left glutes.
Treatment Plan
Phase 1: Education and Initial Exercises
Education: Explanation of nerve pain, referred pain, and strategies for pain management at home.
Exercises: Introduction of three daily stretches targeting the lower back and glutes.
Observation: The patient’s existing exercise routine was extensive but stagnant, leading to limited progress.
Adjustment:
To make her programme more practical and progressive, we focused on specific strength and functional movements:
Sit-to-stands.
Glute bridges.
Lunges.
Superman exercises.
She was encouraged to do these four times per week alongside the daily stretches and to engage in her full programme as time allowed.
Phase 2: Progress Monitoring (10 days later)
The patient reported reduced stiffness but persistent left leg weakness. She performed the prescribed exercises consistently but in minimal doses (1 set of 6–10 reps).
Intervention:
Corrected exercise techniques and educated her on the importance of gradually increasing reps and sets to build strength.
Phase 3: Significant Improvement (20 days from initial appointment)
The patient reported remarkable progress:
She could climb stairs normally and described feeling more in control, particularly when descending.
Her left leg felt stronger, eliminating the "bunny hop" habit she previously used for stairs.
Her exercises were reviewed, and progressions were discussed to further challenge her strength and functionality.
Next Steps:
The patient will continue with the adjusted programme, focusing on more challenging progressions during the next session in two weeks.
Outcome:
This case demonstrates how an individualised and progressive approach through online physiotherapy can effectively restore strength and improve functional capabilities, even in cases of chronic and recurrent pain. The patient is now closer to achieving her goals, and her quality of life has improved significantly.
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