Allison R. Rhodes, Courtney Meyer, Amy Hand. University of South Carolina, Columbia, SC.

BACKGROUND: The lower extremity posterior chain (PC), including the trunk and lower extremities, is an interconnected system of muscles and fascia that work together during movement and posture. Muscular imbalances of the PC can cause the pelvis to anteriorly tilt, often resulting in low back pain and limited lumbar movement. Occurring when the iliopsoas, erector spinae, rectus femoris, and quadratus lumborum shorten, bringing the attachment sites closer together. A 24-year-old female student, with a left costochondral rib deformity, presented with low back (rated 5/10) pain after standing for > 2 hours at her job or sitting in class. She presents with anterior pelvic tilt, lumbar lordosis, and thoracic kyphosis with 4.2cm of lumbar flexion with the (normal female average 5.8cm). The patient expressed concern with partaking in intense physical activity due to the risk of a collision injury. The costochondral deformity was a birth defect, resulting in the patient’s body dysmorphia at a young age. Using the International Classification of Functioning, Disability and Health (ICF) disablement model, a holistic care plan was constructed to target multiple aspects of the patient’s life. The differential diagnosis included: costochondritis, anterior trunk weakness, poor postural control, and tight hamstrings. METHODS: A conservative stretching plan, designed to lengthen the PC muscles over a 45-day period, was chosen due to the patient’s concerns for high-intensity exercise. The protocol required the patient to perform PC stretches, targeting lumbar erector spinae and hamstring groups (9 stretches 5 times per day). RESULTS: Lumbar flexion increased to 5.2 cm (+1.0 cm) and right-side trunk lateral flexion and rotation increased by 5° each at the end of stretching protocol. The patient reduced her low back pain rating from a 5/10 to a 2/10. The patient is now able to sustain 5-6 hours of standing at work before the onset of pain. The ICF disablement model improved quality of life in work and school by constructing a treatment plan that prioritized the patient’s values in her care. CONCLUSION: Treating a patient with pain needs to have a holistic approach to care plans, not just the pain itself. This case shows the value of applying the ICF disablement model to expand the patient’s views in the eyes of healthcare providers. Complex, interesting, and one-of-a-kind cases need to be seen from every angle of the person.

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