Isolated lumbar strengthening in the rehabilitation of chronic low back pain.

OBJECTIVE

To discuss the effects of an active care protocol that includes isolated lumbar spine strengthening on a chronic low back pain patient.

CLINICAL FEATURES: A 20-yr-old female college basketball player suffered from a 7-month history of debilitating low back and left leg pain. Four previous independent physicians expressed diagnostic and therapeutic uncertainty. Bone scan, MRI, nerve conduction study, electromyography, CT, discogram and laboratory evaluation had all failed to identify the etiology of the problem. The patient was forced to discontinue basketball and drop out of college as a result of her spinal problem. Treatment by her prior physicians consisted of analgesics and prolonged bedrest.

INTERVENTION AND OUTCOMES: The patient underwent a functional restoration program consisting of isolated lumbar extensor progressive resistance exercise (PRE) on a MedX lumbar instrument, PRE to ancillary musculature, progressive aerobic exercise, static stretching and proprioceptive exercises. She showed a 368% increase in average lumbar isometric strength, 41% increase in isolated lumbar sagittal plane range of motion and decrease in pain. The patient returned to school after 8 wk of care; at 18-month check-up, she remained asymptomatic.

CONCLUSION

Functional restoration, even with uncertain diagnosis, can be effective in the resolution of chronic low back pain.