Case Study: Acute Lower Back Pain Treated with the McKenzie Method and hands on therapy.

Patient Overview:

• Age: Mid 30s
• Occupation: Chef
• Family: Mother of two children
• Mechanism of Injury: Acute back flare-up following a Pilates exercise involving a flexion-based movement (bending forward)
• Symptoms: Difficulty walking and sitting, pain localized in the lower back, sometimes radiating down the lateral left leg past the knee and sharp in nature on specific

Assessment

Posture:

• The patient experienced pain while sitting, which improved when she placed a rolled-up towel behind her lower back.

Movement Triggers:

• Forward bending (flexion)
• Side bending to the left

Physical Exam:

• Orthopedic tests for disc-related conditions were negative
• Provisional Diagnosis: Left-sided discogenic pain with L5 nerve irritation (radiculopathy)

Treatment Plan

We started with the McKenzie Method, which focuses on a movement that helps relieve irritation of the spine.

McKenzie Side Bending Exercise:

• The patient performed side bending exercises against a wall, which led to improved movement and reduced pain.
• After the patient successfully responded to the first round, we continued with additional rounds of McKenzie side bending exercises to confirm she had a directional preference (her body responded well) to that movement.

Manual Therapy:

• Hands-on treatments included massage, dry needling, and trigger point therapy to release tension in the hip flexors, glutes, and lower back.

Postural Correction:

• We noticed that the patient’s right hip was elevated, so we worked on correcting her posture.

Taping:

• To prevent further aggravation, we applied rigid tape to limit flexion (forward bending), helping to stabilise the area and reduce painful movements.

Education & Home Care

We focused on educating the patient about self-management and recovery.

Limit Flexion-Based Movements:

• Avoid movements that involve bending forward (flexion).

Correct Sitting Position:

• Use a rolled-up towel to support the lower back while

McKenzie Side Bend Exercise:

• Perform the McKenzie side bend exercise every hour for 10 The goal is to gently move into the resistance to loosen up the area and gain more movement
• It’s normal for the pain cycle to take some Your body needs time to retrain and recognize that it is safe to move again.
• Use the McKenzie method even when in pain to help reduce discomfort and “centralize” the pain (move it from the extremities back toward the center of the body)..

Self-Testing:

• Regularly test your pain triggers (forward bending and side bending to the left) to ensure you’re on the right track with your recovery.

Spinal Education:

• Understand how your spine moves on different movements and learn how to avoid overloading it to prevent further injury.

Prognosis

First Week: 

Two treatments in her acute phase, with the focus on pain management and mobility to keep her working.

Strengthening:

As the pain became more centralized, we began strengthening exercises for her glutes. This typically starts around the third treatment.

Long-Term Plan:

• Once pain is manageable (below 5/10), we focus on lifestyle modifications and strength exercises. This helps reduce reliance on treatments.
• Treatment intervals are decreased from weekly to biweekly and then monthly as the patient gains strength and mobility.

Maintenance:

After the patient is pain-free, we recommend periodic maintenance appointments (every 1-2 months) to keep her moving well and prevent future flare-ups.

By Dwan Rosairo – Clinical Myotherapist