CASE

PRESENTATION
presented by- Anupriya
Registration no. - 11808021
roll no. - 24
DEMOGRAPHIC DATA
 Name- Suresh
 Age – 24 years
 Gender – male
 Address – wadala, Mumbai
 Occupation – software engineer
 Hand dominence – Right hand
 Allergy – None
 Marital status – non married
 CHIEF COMPLAINT: -
 patient complaints pain in his lower back, and radiating towards
posterior of right thigh and into his calf, stopping at ankle.
 Patient complain worse pain in the morning.
 patient feels severe buttock and posterior thigh pain at mid night.
 HISTORY OF PRESENT
ILLNESS
 site-Lower back pain from last 4-5 weeks
 side-right leg pain.
 Nature of pain-
 intermittent pain at lumbar area (6/10)
 constant severe pain in buttock and right side of thigh. (10/10)
 Intermittent pain behind the knee and calf.
 Aggravating factor –
 Trunk forward flexion and side flexion
 Prolonged sitting
 Lying supine
 Prolonged standing
 relieving factor- There was no position or movement that
completely reduced his leg pain. 
 Mechanism of injury- patient lifts heavy weight while doing squats.
 Radiating pain- posterior of right thigh, calf and upto the ankle.
 parasthesia- lateral foot, lateral leg to knee, planter aspect of foot.
 past medical history - Hypertension
 Family history - not relevant
 Surgical history - none
 personal history - No smoking, no alcohol intake
 MEDICATION
 NSAIDs to reduce initial pain and swelling.
 Steroid injections to treat acute pain that radiate to the hip or down the leg.

Image testing-
 Lumbar spine CT shows a L5-S1 disc herniation or protrusion
 MRI resulted S1 nerve root compression.
 OBSERVATION
 body type- mesomorphic
Gait pattern- patient walk with small steps

EXamination –
Active range of motion –
Lumbar flexion- right side low back pain
Extension - right buttock and leg pain
Other movements were not assessd due to severity and
irritability.
 Pain in dermatomes and myotomes are commonly effected

 ON PALPATION-
 tenderness over the L5 level.
 Slight swelling over the sacral region.

 Analysis –
 Presence of pain distribution along the S1 dermatome,
 Absent S1 reflex,
 Weakness of the S1 myotome,
 Positive right sided SLR,
PROVISIONAL DIAGNOSIS –
 lumbar disc herniation with radiculopathy

 differntial diagnosis –
Degenarative spinal stenosis
 spondylolisthesis
 muscle strain
PHYSIOTHERAPY GOALS-
 Increased strength of involved region
 Improve ROM
 improve gait pattern
 pain relief
 Prevent complications
 PHYSIOTHERAPY
TREATMENT
 initial days-
 Application of hot pack for 10-15 min
 After that radiating tens was applied for pain relief.
 Advice the patient to avoid long stride walking.
 Advice the patient to sleep in side lying fetal position.
 Advice the patient while sitting keep your back straight or flat against
the chair, knees at the same level as your hip or slightly above your hip.
 Advice the patient to get up froms his bed from side lying position
instead of supine.
 2-3 week-
 As the pain subsides, slowly progress with the exercises –
 There are as follows –
 Bridge exercise –
 Start on your back with your arms by your side. Your knees
should be bent, and your feet should be flat on the floor.
 Slowly raise your hips off the floor, contracting your glutes
(your buttocks) and your hamstrings as you go.
 Hold 3-5 seconds.
 Repeat 10 times.
 Bend your right knee and hug your knee towards your chest, placing
hands on your right leg. 
 Then breath deeply and hold this position for 10-30 seconds. 
 Now, relax and lower the knee to starting position and repeat on
opposite side.
 lower back rotational stretches-
 Lie back on the floor with bent knees and feet flat on the ground.
 Keeping the shoulders firmly on the floor, gently roll both bent knees
over to one side.
 Hold the position for 5–10 seconds.
 Return to the starting position.
 Gently roll the bent knees over to the opposite side, hold, and then
return to the starting position.
 Repeat 2–3 times on each side twice a day.
 4-6 week-
 Leg extension –
 Your knees will be at about a 90-degree angle in the starting position and a 180-degree
angle in the finishing position.
 Hold for a second at 180 degrees, then lower back to the 90-degree angle. 
 Hold on to the handles that are on the side of the seat so your butt doesn't come off the
seat.
 Back extension –
 Lie on a mat on your stomach and straighten your legs behind you. Place your elbows on
the ground and slide your shoulders down.
 Lift your upper back, pressing your hips into the mat. Keep your head and neck neutral.
Hold for 30 seconds.
 Lower to starting position. 
THANK YOU