Classification-based approach for management of an adolescent with LBP, lower extremity pain, and a relevant postural...

A 15-year-old female presented to physical therapy 2 months after a traumatic injury with severe low back pain, referred unilateral leg pain below the knee, and a lumbar lateral shift. A classification-based approach, mechanical diagnosis and therapy, was utilized to identify the patient with respect to a particular subgroup, and interventions were applied according to symptomatic response to loading strategies, sustained and repeated movements. Outcome measures included the Modified Oswestry Disability Questionnaire (MODQ) and a visual analog scale (VAS) for pain rating. After nine visits (4 weeks), there was a 60% improvement in MODQ score, 0/10 pain on the VAS, and the patient resumed participation in recreational activities. At the 1-year follow-up, there was a 78% overall improvement in MODQ score with continued 0/10 rated pain. Improvements after nine visits and at the 1-year follow-up both exceeded the minimal clinically important difference for the MODQ.