Musculoskeletal Physiotherapy D

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Background for video vignette .

Diagnosis:
Acute low back pain - Discogenic

Context of assessment:  
Initial musculoskeletal assessment in outpatient setting

Table 7: Background information for musculoskeletal vignette

DEMOGRAPHIC INFORMATION

Setting
Physiotherapy outpatient clinic

Gender
Male  

Patient age
30 ‐ 40

Occupation
Floor Tiler

Patient Build
Medium

Main Presentation
Acute exacerbation of low back pain Discogenic in nature

CLINICAL HISTORY

Reason for attending physiotherapy
Acute episode of low back pain with intermittent posterolateral thigh pain

History of presenting condition
5 days ago while laying tiles at work went to stand up after prolonged flexion and reported severe pain in the low back and buttocks bilaterally. Presented to ED and CT performed. Prescribed Mobic and Panadeine Forte for pain and referred to Physiotherapy for review.

Investigations
CT – L4‐5 broad based disc protrusion without thecal sac compression

Special Questions
No bladder or bowel changes No saddle paraesthesia No unexplained weight loss Pain with cough or sneeze Sleep disturbed due to pain at night – difficult to get comfortable No THREADS No P+N or numbness

Pain Behaviour
Pain and stiffness worse in am Movement dependant otherwise

Past Medical History
HTN medication controlled, History depression

Medications
Coversyl HTN, Mobic and Tramal Current Pain, Panadol IM LBP, ciprimil Depression

Social History
Lives with wife and 2 children - son aged 10 and daughter aged 13 in 2‐level house with 13 internal stairs.   

Occupation
Self‐employed floor tiler and is involved in mainly manual duties.

Functional History
Independent with all daily activities, active occupation but sed entary lifestyle. Not currently involved in any regular exercise and exercise tolerance is able to walk greater than 45 minutes.

Patient Goals
Reduce pain and return to normal function Return to work