Client Case Study: Lower Back Injury

The client is a 29-year-old scaffolder who sustained a lower back strain at his workplace while lifting steel trusses weighing approximately 30kg in a rotated trunk posture. The MRI scans indicated mild L1/2 and L5/S1 disc degeneration including mild left posterolateral annulus fissure disc bulge abutting the traversing left S1 nerve root. The client was referred to Absolute Balance by the vocational rehabilitation consultant as he was progressing well through his physiotherapy treatment as well as his hydrotherapy programme as directed by the physiotherapist. At the initial consultation, the client had restricted range of movement through his lumbar spine, specifically through forward flexion and extension with reports of 5 out of 10 pain on the VAS. The client reported experiencing radiculopathy causing pins and needles through the sole of his left foot. The client demonstrated musculature slight bracing behaviours and maintaining rigid spine while performing range of movement and functional exercises. The client had a lifting restriction of 5kg.

 Job Specific Programme

Work tasks involves constructing scaffolds; working on narrow and in confined spaces on platforms on average 4m in height. Work tasks are performed in sustained, repetitive forward flexed and outreached postures, occasionally climbing stairs and scaffold tubes. The client is required to lift floor to waist up to up to 25kg, waist to overhead up to 20kg and push/ pulling up to 20kg. The exercise rehabilitation programme initially focused on improving range of movement through his lumbar spine implementing neuromuscular dynamic stabilisation (DNS) exercises and lumbopelvic stability to aid in lower back support. The client progressed to functional lower body strengthening exercises combined with correct manual handling technique necessary for his job role to reduce the risk of re-injury. The client was having concurrent physiotherapy and exercise rehabilitation treatment three times per week. As part of the client’s graduated return to work plan, he undertook a work trial based in Perth for three months to gradually increase his lifting restrictions and hours. This ensured a safe return to his pre-injury role by gradually building up their functional capacity and work tolerance.

Outcome of Exercise Rehabilitation

The client is now at 100% functional capacity following nine supervised sessions, combined with completing the exercise programme independently three times per week. The client showed significant improvements in pain-free range of motion through his lumbar spine, combined with lumbopelvic stability and strength through his lower limbs to perform safe manual handling technique. The client was provided with all the tools to effective self-mange his programme and educated on the importance of pre and post work stretching and myofascial release to relieve his soreness. The client has reached all outcome measures set by Absolute Balance. As a result, the client obtained a final medical certificate following three months of exercise rehabilitation.

 

Daniel Nguyen (B.Sc. Exercise Physiology)

Accredited Exercise Physiologist (AES, AEP)(ESSAM)