Document Type

Case Report


Physical Therapy & Rehabilitation Science

Degree Name

DPT (Doctor of Physical Therapy)

Session and Year of Graduation

Fall 2018


Laura Frey Law


Background: Directional preference and lumbopelvic mechanics training are two exercise interventions that have demonstrated beneficial effects in patients with chronic low back pain (LBP) and radiculopathy. Research is inconclusive on which intervention is preferred. This case highlights using both interventions to treat a patient with chronic LBP and sacral radiculopathy. Case Description: The patient was a 56-year-old male referred to an outpatient physical therapy clinic. On examination, the patient demonstrated radicular pain, plantar flexion weakness, absent left Achilles reflex and limited, painful trunk flexion. Interventions: Five physical therapy sessions involving primarily directional preference and lumbopelvic exercises were provided. Additionally, single limb plantar flexion strengthening and traction were trialed. Outcome Measures: The primary outcomes assessed were the patient-specific functional scale, numeric pain scale, strength testing, reflex testing and the slump test. After five treatments of physical therapy, the patient had a negative slump test and demonstrated improvement in pain, function and plantar flexion strength. However, he did not regain his Achilles reflex. Discussion: The patient had a variable progression through care, but ultimately demonstrated improvements with the combination of directional preference exercises, lumbopelvic mechanics training and an anti-inflammatory medication. Studies of physical therapy interventions have not been able to clearly identify which exercises are best for patients with chronic LBP. This case presents a practical example of successfully applying two different treatment approaches to address chronic LBP in conjunction with pharmacologic interventions.


Low back pain; LBP; radiculopathy; exercise; orthopedics; neurology; physical therapy; rehabilitation


9 pages


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