Clinical Case Scenario #2
Decision Making: Management of Herniated Disc
Robert B., 52-year old longtime truck driver, presents to the orthopedist with a 6- month history of progressive back pain, now radiating to his left knee. He is unable to sit comfortably for more than 45 minutes. Following work up, he is diagnosed with a herniated disc at L4-L5.
Searching in Rehabilitation Reference Center (RRC)
Using RRC, the physiotherapist searches Herniated Disc. Reading the Clinical Review (AN 5000007559), he notes that 90% of patients with herniated disc improve with conservative care, although published research and review of the literature state that those patients who choose surgical intervention report greater improvement than those with conservative management alone. The information is shared with Robert and he decides to try conservative management.
The physiotherapist evaluates Robert’s functional mobility, gait and posture. Rehabilitation goals are: reduce the herniation and associated pain, strengthen back muscles and improve range of motion. NSAIDS and using a brace or assistive device for walking may be helpful in the short term, and a home exercise program is developed.
Patient Education printout Herniated Disc (AN 2009543455) is reviewed. The physiotherapist also proposes and prints Acupuncture (AN 2009580499) as as an intervention.
Using the A-Z Exercise Images tab, the physiotherapist chooses Activities of Daily Living and prints Sleeping on Back and Side Lying in Bed. Using the Body Mechanics category, he adds Movement – Avoid Twisting.
Maintenance of rehabilitation gains, prevention of further impairment, and the return to former level of functioning will be a challenge when Robert returns to work as a driver. He will be evaluated on a regular basis.