Abstract
Background and Purpose: This case report describes the treatment of a patient who was diagnosed with degenerative lateral lumbar spinal stenosis and secondary impairments in core and lower extremity strength, range of motion, joint mobility, functional mobility, and pain limiting function. Case Description: The patient was a 71-year-old male treated in outpatient physical therapy following referral for low back pain that radiated into the legs below the knee. The patient presented with impaired core and lower extremity strength, range of motion, joint mobility, functional mobility, and pain limiting function. Based on the initial evaluation, the patient was categorized into the impairment-based classification for low back pain as lumbar and related leg pain that centralizes with repeated movements. He presented with symptoms fitting the flexion-syndrome criteria as symptoms centralized with lumbar forward bending and peripheralized with lumbar backward bending. The patient had positive imaging evidence of lumbar spinal stenosis. Outcomes: Following 6 weeks (12 visits) of intervention, the patient demonstrated improved thoracic and lumbar mobility and range of motion, core and lower extremity strength, pain levels, and scores on the Swiss Spinal Stenosis Questionnaire and the modified Oswestry Disability Index. Discussion: Current evidence-based guidelines typically recommend the use of a multimodal treatment approach including spinal manipulation techniques early in the treatment of patients with spinal stenosis. This case report details the successful physical therapy management for a patient affected by lumbar spinal stenosis with personal goals to return to golfing 5-7 days per week without pain limiting functional mobility. Conclusion: The patient in this case report demonstrated improvements in all outcome measures throughout the duration of treatment and met all his short- and long-term goals. However, no cause and effect can be inferred based on a case report. This case report supports a multimodal approach of treatment that includes manual therapy for the management of LSS. This case patient was unique in that his goal was to return to a high level of functioning which includes playing golf 5-7 days per week, and he was able to achieve this goal.