NNNK 3080

VOCATIONAL REHABILITATION

LOW BACK PAIN

PREPARED BY:

CH'NG MEI QI A151002

EUGENE HUANG ZHI XUAN (A148763)

NURUL SHAHIRA BINTI AHMAD MASWAH (A151427)

 DEFINITION
Low back pain is neither a disease nor a diagnostic
Cause of disability and inability to work, as an interference with the quality of life
(WHO 2003)
SIGN AND SYMPTOMS
Episodes of acute pain
Difficulty moving that can be severe enough to prevent walking or standing
Pain that also moves around to the groin, buttock or upper thigh, but rarely travels below the knee
Pain that tends to be achy and dull
Muscle spasms, which can be severe
Local soreness upon touch
PRELIMINARY INFORMATION

NAME : MR. L
AGE : 44 YEARS OLD
SEX : MALE
RACE : CHINESE
RELIGION : KRISTIAN
DOMINANT HAND : RIGHT
OCCUPATION : FACTORY WORKER
DATE OF REFERRAL : 23/3/2016
CASE HISTORY

1.Long term history of LBP

2.Started experiencing the LBP after a day of he
avy lifting approximately 1 year prior
3.Diagnosed his lower back condition as a mus
cle strain
4.Referred to OT on 23/3/2016 for ergonimic te
chnique and excercises to prevent deteriorati
on of LBP
5.The episodes of acute pain had become incre
asingly severe and frequent and were starting
CASE HISTORY

1.The pain was described as achy/stiff/restrictiv

e and was particularly was made worse by ex
ertional activities and after periods of being st
atic such as sitting or sleeping for extended p
eriods of time.
2.He also reported it was difficult for him to str
aighten up after being static. His discomfort s
eemed to get better as long as he was mobile.
His overall health good and he did not report
any other health issues.
 MEDICAL HISTORY

Chronic lumbar posterior spinal joint irritation/inflammation with associated paraspinal muscle hypertonicity
Had a significant degree of inflammation in the joints of his lower back with associated muscle tension/spasm.
Hypertension
FAMILY HISTORY
Lives with his family

Mr. L (pt) 43 y/o
(44y/o)

20 y/o 17 y/o
SOCIAL HISTORY
Premorbidly:
1.Usually going out with his friends.
2.Travel with his family members.
3.Likes to play badminton with his family member
s

Postmorbidly:
4.Rarely going out with friends and family.
5.Did not play badminton anymore.
EDUCATIONAL HISTORY

Education
Studied until degree level
Graduated from UMT at 1996
WORK HISTORY

Work
Premorbidly:
1.Work as a Installation, Maintenance, and Rep
air Workers
2.Transfer tools, parts, equipment, and supplies
to and from work stations and other areas. (C
arry / Lift heavy objects)
3.Install or replace machinery, equipment, and
new or replacement parts and instruments, u
sing hand or power tools. (Long standing)
CONCEPTUAL MODEL OF PRACTI
CE
Occupational
Performance
OCCUPATIONAL
PERFORMANCE
OCCUPATI CLIENT PERFORMA PERFORMA CONTEXT
ON FACTORS NCE SKILLS NCE AND
PATTERN ENVIRONM
ENT
WORK Motor Role: Physical:
Unable to Body Skills: Factory Not every
carry heavy Function: Gross Motor worker workplace
objects LBP - bending have
WORK - lifting / Habit: adequate
Long carrying Likes to bend height to
standing - Long his back perform
standing while lifting lifting and
object repairing
job.
Routine:
- Lifting Temporal:
heavy Work for
euipments or more
tools than 10
everyday. years
- Long
OCCUPATION CLIENT PERFORMA PERFORMA CONTEXT
FACTORS NCE SKILLS NCE AND
PATTERN ENVIRONM
ENT
LEISURE Body Motor Role: Personal:
Badminton Function: Skills: Father Not using
LBP Gross Motor ergonomic
- bending Habits: postur to
Belief: - react Bending collect
Playing rapidly back while badminton
with collecting
children is badminton
a way to from the
improve floor
and
maintain Routine:
good Play
relationshi badminton
p with at least one
family for every
members fourthnight
ADL/IADL/W Body Motor Role: Physical:
SHORT-TERM GOALS

1. The client able to carry object and transfer fr

om one place to another place with maximu
m weight 15kg in 6 therapy sessions.
2. The client able to perform dressing activity w
ith appropriate posture within 3 therapy ses
sions.
3. The client able to cope and reduce the psych
ological problem with relaxation technique i
n 3 sessions of therapy.
LONG-TERM GOAL

The client able to return-to-work with suitable j

ob and compensating strategies within 6 month
s of treatment in order to achieve good quality
of life.
Problem 1 The client unable to carry heavy object.
STG The client able to carry object and transfer from one place
to another place with maximum weight 15kg in 6 therapy
sessions.
FOR Biomechanics FOR
Intervention Client education regarding ergonomic practice during
carrying.
Methods Ergonomic technique during lifting object.
1. Squat
2. Squat and lift with both arms held against upper trunk.
3. Tighten stomach muscles without breathing.
4. Use smooth movement to avoid jerking.

Ergonomic technique during carrying and transfer.
5. Diagonal lift.
6. Squat down.
7. Bring item close to lift.

Precaution.
8. Dont force if feel very pain during the activity.
9. Take break in between the activity.
10.Maintain the body in correct posture.

Duration 45 min per session.
Rationale Ergonomic interventions are effective on return-to-work
Problem 2 The client has difficulties to maintain good
posture during performing ADL.

STG The client able to perform dressing activity with

appropriate posture within 3 therapy sessions.

FOR Biomechanics FOR

Intervention Client education regarding ergonomic practice
during dressing.
Methods Putting and pulling up the socks and shoes.
Sit
Bending up the leg towards chest.
Place the socks and pull up.

Duration 30 minutes per session.

Rationale Ergonomic interventions are effective on return-to-
work of workers long term sick listed due to LBP.
(Anema et al. 2004)
Problem 3 The client has psychological problem due to
intense pain.
STG The client able to cope and reduce the
psychological problem with relaxation technique in
3 sessions of therapy.
FOR Psychodynamic FOR
Intervention Relaxation technique.
Methods Deep breathing.
Imagery.

Duration 15 minutes per session

Rationale Fear-avoidance beliefs and demonstrate that
specific fear-avoidance beliefs about work have
related to work loss due to low back pain and
should be in the management.
(Waddell et al. 1993)
PROGNOSIS

1. Poor medical prognosis.

More than one third of patients with recent ons
et, non-radicular chronic low back pain recover
within 12 months. (Costa et al. 2009)

2. Good rehabilitation prognosis.

REFERENCE

1.
2. Anema, J., Cuelenaere, B., Van Der Beek, A., Knol, D., De Vet, H. & Van
Mechelen, W. 2004. The Effectiveness of Ergonomic Interventions o
n Return-to-Work after Low Back Pain; a Prospective Two Year Cohort
Study in Six Countries on Low Back Pain Patients Sicklisted for 34 Mo
nths. Occupational and environmental medicine 61(4): 289-294.
3. Costa, L. D. C. M., Maher, C. G., Mcauley, J. H., Hancock, M. J., Herbert,
R. D., Refshauge, K. M. & Henschke, N. 2009. Prognosis for Patients
with Chronic Low Back Pain: Inception Cohort Study. Bmj 339(b382
9.
4. Waddell, G., Newton, M., Henderson, I., Somerville, D. & Main, C. J. 1
993. A Fear-Avoidance Beliefs Questionnaire (Fabq) and the Role of F
ear-Avoidance Beliefs in Chronic Low Back Pain and Disability. Pain 5
2(2): 157-168.