Recurrent lumbar posterior derangement 5 associated with lumbar flexion, cervical extension and side-flexion...

Recurrent radiculopathy after lumbar spine surgery, known as failed back surgery syndrome (FBSS), is a challenging condition, especially in individuals who have experienced prolonged stress induced by the postoperative loading of the back in the workplace. Evidence on structured physiotherapy interventions in these high-risk patients remains limited. A male farm labourer in his late 30s had a 2-year history of recurrent low back pain (LBP) radiating down to the left lower limb and a 3-year history of neck pain with upper limb radiation following two prior L5-S1 surgeries. Symptoms were exacerbated by prolonged standing, bending forward and manual farming. The patient's clinical examination showed mechanical LBP and neck pain with radicular features, positive neural tension signs and movement-dependent symptom centralisation. MRI showed recurrent L5-S1 disc pathology with central canal stenosis and multilevel cervical degenerative changes. The patient received a 12-week individual physiotherapy programme guided by Mechanical Diagnosis and Therapy (MDT) principles. It included patient education and activity modification; movement-based directional exercises; manual therapy and spinal mobilisation; neural mobilisation; pain modulation through electrotherapy, including acupuncture-like transcutaneous electrical nerve stimulation (AL-TENS); gradual strengthening of the trunk and lower limb musculature and cervical traction and mobilisation. Occupational ergonomics and self-management strategies were employed to mitigate mechanical loads during farming activities. Patient reported lumbar and cervical pain resolved at the end of the treatment period of 12 weeks (Numeric Pain Rating Scale: 0/10). Objective evaluation showed a normalised movement pattern, negative neural tension signs and full muscle strength (Manual Muscle Testing: 5/5). At discharge, the patient reported resumption of full-time manual farming without symptom recurrence. No long-term post-discharge follow-up data were available. These findings suggest that structured, reasoning-driven physiotherapy may support meaningful short-term functional recovery in selected cases of recurrent postoperative radiculopathy in high-risk occupational cohorts. The contribution of this report lies in the novelty of the integrated application of techniques (systematic MDT classification in postsurgical FBSS, concurrent multiregional spinal management and mechanistically informed selection of AL-TENS over conventional TENS). Mechanical assessment appears valuable for identifying reversible dysfunction and guiding conservative management. Long-term follow-up studies are needed to confirm the durability of these outcomes.