A manual therapy approach to evaluation and treatment of a patient with a chronic lumbar nerve root irritation

Kaiser-Hayward Physical Therapy Residency Program in Advanced Orthopedic Manual Therapy, Kaiser Permanente Medical Center, Hayward, CA 94541.

The purpose of this case report is to familiarize the reader with the basic principles of the approach to manual therapy evaluation and treatment pioneered by Maitland, an Australian physical therapist. This approach involves a complete subjective examination to determine the severity, irritability, nature, and stage of the patient's complaints. In this way, the therapist may reach conclusions as to the amount and vigor of the physical examination and proceed with treatment in an analytical manner. Methodical reassessment is used to justify treatment progression. Comprehensive treatment and the rationale for this approach are discussed. Though most physical therapists are familiar with the straight-leg-raising test as a means of assessing low back pain and chronic lumbar nerve root irritation, they are often not familiar with other tests that examine neural tissues, such as the slump test. The proposed anatomical and biomechanical bases for these tests are discussed. The patient in this case study was a 50-year-old man with a physician's diagnosis of a chronic lumbar nerve root irritation. The patient was evaluated and treated in eight visits using techniques designed to evaluate neural tissues. Reassessment indicated significant symptom reduction, and the treatment was modified accordingly. Patient management, including home exercises, is discussed.

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