CASE STUDY 2:

Patients History:

Diagnosis: Spinal derangement, Central Disc protrusion at L4, L5,

Mr. Jones is 45-year-old truck driver, he stated that after unloading a heavy cargo he
started to feel pain in his low back. The pain tends to radiate from his low back down to his
buttocks on both sides, he stated that this pain is new and that it had developed over time and
using the on the pain scale his pain is a 6 out of 10. He also states that he is in extreme pain
while sitting down and getting up. He has no other previous medical history.

Given the health condition of Mr. Jones who is a 45-year-old truck driver who seems to spend
most of his time on the road driving and does not get the right amount exercise as well as the
proper nutritional needs would impact his health condition in a negative way. For example, truck
driver has to deliver goods within a certain time frame so if our truck driver is spending 8-12
hours driving that would impact his muscle tone. Driving a heavy truck and controlling a large
steering wheel the driver is required to sit in an upright position for a long period time which
would cause stiffness in the muscles, as well as musculoskeletal effects to sitting for a
prolonged period in a typical flexed posture (Benstwoe, 2008). Motor vehicles where the
vibration forces add to the stress on the discs, as it does in commercial heavy equipment driving
(Benstowe, 2008).

Assessment findings:

In order to properly find out what the issue is with Mr. Jones using the McKenzie method helps
to distinguish a proper Ax and findings. In this case using the McKenzie method taking in the
patients Hx as to where his job is a truck driver, sitting in a truck for 8-12 hours a day driving.
Moving his foot from the fuel pedal to the brake, and in a stick-shift vehicle, the left foot
manages the clutch. Mr. Jones feet are active which cannot be used to support and stabilize his
lower body as to sitting in a normal chair (Benstwoe, 2008). Mr. Jones must also be alert for
traffic at all times, which requires a static head and neck posture. To maintain this steady driving
posture, internally the back, neck, shoulder and arm muscles maintain a static muscle tension
over a prolonged period of time. A steady low level muscle contraction can lead to localized
muscle fatigue (Konz et al 1998) given all these health factors and that the problem started
occurring after Mr. Jones picked up a heavy cargo leads us to believe that a posterior central
disc protrusion has occurred.

The McKenzie approach is based on the direction and focuses on centralizing the pain, when
Mr. Jones was put into trunk flexion he started to experience pain, putting him back to neutral
than moving him into trunk extension he felt discomfort, putting him back to neutral than moving
him into a lateral shift once again he was in a slight discomfort.

posture: using the plumb line helps to indicate proper posture looking at a lateral view the plumb
line mainly goes through the
● Ear lobe
● Shoulder joint
● Midway of the trunk
● Greater trochanter
● Slight Anterior to the knee joint
● Slight Anterior to the ankle joint

Mr. jones posture maybe affected by many factors such as his, weight, age, pain, spinal
derangement, as well as prolonged sitting in a chair due to driving a truck for long periods of
time.

Mr. Jones seems to present himself in a slight flat back posture when using the plumb line on
Mr. Jones his posture would look more like
● Ear lobes are anterior to the plumb line
● Shoulder joint are slightly anterior to the plumb line
● The trunk is in a slight flexed position slight anterior to the plumb line
● The hips are in posterior pelvic tilt position
● Slight anterior to the knee joint
● Slight posterior to the ankle joint
ROM:
Mr. Jones seems to lack Rom in all ranges but he seems to be able to flex into 40 degrees
when he starts to complain about pain, going back to neutral position than moving into only 15
degrees of extension, and presents 15 degrees of lateral flexion.

Strength:
Muscle Muscle Grade

Abdominals 3-/5

Low back region (lumber) 3-/5

Gluteal 3+/5

Lower extremities 3+/5

Balance:
Because of Mr. Jones condition is an acute injury it may have some effects on his balance such
as walking for a long period of time, and he may become fatigued due to the pain and may
result in a fall but his balance is not significantly impacted unless it becomes a chronic injury.

Outcome measure:
Mr. Jones stating that his pain is a 6/10 on the pain scale and recently filling out the outcome
measure Roland Morris experienced difficulty’s in doing most of his task’s due to the acute
injury so he received a score of 15/24 resulting in a 62.5%.
Activity Participation limitation:
Due to the disc protrusion and the bilateral pain that is radiating down Mr. Jones leg, he is
unable to do a number of activities that are affecting his ADL’s and IADL’s. Using the chart to
break up the activity limitations into two categories ADL and IADL.
ADL Restrictions:
Bathing - due to having Transferring - severe trouble from going from lying in bed to
extreme low back pain, side of the bed
getting in out of the bath is
painful

Dressing - having trouble Walking - unable to walk for a long period of time due to lower
bending down to put on back
pants, socks, and shoes,

IADL Restrictions:
Driving - Driving being a huge IADL
restrictions since his profession is a truck
driver
Grocery Shopping - unable to shop due to
pain, cannot stand and walk for long periods
of time and cannot pick up items that are
closer to the ground

Laundry - unable to able pick up a heavy load Cooking - may have issues with grabbing
pots and pans and standing for a long period
of time

Mr. Jones activity is fairly limited due to his condition applying the ICF model where the
● Health condition = Central Disc Protrusion
● Body Functions & structure = low back (lumbar vertebrae L4, L5)
● Activity = Driving a truck
● Participation = Work
● Environmental factors = truck being too high to get into
● Personal factor = unhealthy 45-year-old male

Having an acute injury that is resulting in a pain scale that is a 6/10 the biggest activity and
participation limitation is where Mr. Jones cannot drive a truck due to his pain and is unable to
go back to work. Without Mr. Jones working puts him an in a huge financial crisis limiting his
opportunities.
Smart Goals:
● S = To get back to work, driving the truck again
● M = being able to drive a truck pain free
● A = doing all prescribed exercises
● R = going to physiotherapy to help improve symptoms
● T = being able to drive a truck again within the next 6 weeks

To reduce the patients pain from a 6/10 to a 1/10 within the next 6 weeks by coming to
physiotherapy and doing all of the prescribed exercises so that Mr. Jones will be able to go back
to work and be able to drive a truck again.

Treatment Plan:
Education - educate Mr. Jones on his current condition that in a disc protrusion the inner gel
has expanded backwards from the normal position when he went to lift something heavy and
that maybe sitting on a nerve that is causing the irritation in both legs, also to explain to Mr.
Jones how the McKenzie approach will benefit him and help him and to prevent further issues.

Aids/Adaptations - some temporarily aids I would give are Reacher, long handled shoe horn,
sock aids, and cushions,

Interventions:
● Prone lower back extension with bent arms
● Prone lower back extension with bent arms (Progression to Sloppy pushups)
● Plank with knees on the floor
● Bridging
● Standing back extension

All these exercises focus on strengthening the back extensors, abdominals, and glutes. Doing
these exercises help Mr. Jones to strengthen his trunk so that he will be able to get back to work
and increase his independence. These exercises have been proven by the McKenzie method
as to which the whole purpose of the McKenzie method is for education and prevention, by
teaching Mr. Jones on how to do these exercises it will help him to minimize any further damage
to his lower back and so it is important for Mr. Jones to keep doing these exercises even after
when he is discharged.
Bibliography:

Benstwoe, S. J. (2008). LONG DRIVING HOURS AND HEALTH OF TRUCK

DRIVERS(Unpublished master's thesis). New Jersey Institute of Technology. Retrieved

from http://archives.njit.edu/vol01/etd/2000s/2008/njit-etd2008-006/njit-etd2008-006.pdf

Bloomington / Normal, IL. (n.d.). Retrieved April 04, 2018, from

http://www.healthycellsmagazine.com/articles/chronic-back-pain-and-its-effect-on-

balance

Chai, H. (n.d.). Retrieved April 04, 2018, from

http://www.pt.ntu.edu.tw/hmchai/Kines04/KINapplication/StandingPosture.htm

Romano, A. (n.d.). McKenzie Method Physical Therapy Treatment for lower back pain.

Retrieved from

http://www.mccc.edu/~behrensb/documents/MckenizeMethodARomano.pdf