Clinical Reasoning in the Management of a Patient with Low Back Pain in Multiple Classification Categories: A Case Report

Abstract

Low back pain is one of the most common reasons for individuals to seek physical therapy. While prevalent, low back pain can be difficult to classify and treat. Multiple evidence-based classification systems exist with varying approaches to treatment. Case Description: This case report explores the clinical reasoning in the treatment of a patient falling into multiple low back pain classification categories based on the impairment/functional-based classification system. The patient is an otherwise healthy female presenting to physical therapy with a chief complaint of an acute flare-up of persistent low back pain. The rationale behind the sequence in which classification categories were addressed, the decisions behind when to change categories based on emerging data, and the intervention strategies implemented to successfully manage this patient are illustrated. Outcomes: The patient was seen for a total of 13 visits over a span of two months. At discharge, the Revised Oswestry Disability Index for low back pain and the numeric pain rating scale demonstrated improvement with achievement of all patient goals, return of function, and ability to manage symptoms independently. Conclusion: Use of the impairment/functional-based classification system approach to low back pain management proved beneficial and effective. This classification-based approach may assist in clinical decision making when treating individuals with acute flare-ups of persistent low back pain.