Low Back Pain Differential Diagnosis Case Study
Low Back Pain Differential Diagnosis Case Study
Case Description: Pt. is a 38 y/o female who presented to physical therapy with a ~3-year hx of intermittent flare-ups of lower back pain lasting several days on each occasion. She notes that these flare-ups had been happening every 1-2 months and would nearly relegate her to full bed rest, unable to care for her home or her 3 young children. Over the course of a week or so, her symptoms would subside and she could get back to function, but was always leery that another flare-up would arise. She had been trying to manage through chiropractic adjustments, but was not having consistent success.
Physical Therapy Course of Care: Physical therapy was initiated several days after a reported flare-up and pt. was very hesitant to try any bending/twisting activities and labored with simple bed mobility and basic transfers due to back pain. As the next several weeks passed, she was able to resume all her normal daily activities including housework and lifting her young children. As most symptoms had eased, she was nearing DC at week 4 of physical therapy when she presented with return of severe back pain and signs similar to what brought her to PT in the first place. In discussing the course of her issue, it was determined that her flare-ups often coincided with her menstrual cycle, which had also been very heavy and painful for the past several years. The patient’s care was temporarily placed on hold while she was advised to follow-up on these developments with her OB/GYN.
OB/GYN Follow-up: On further testing with her OB/GYN, she was diagnosed with adenomyosis. This condition occurs as endometrial tissue grows into the muscular wall of the uterus. It can cause very painful, heavy periods. She was beginning formal treatment and her OB/GYN who was hopeful intervention would also reduce her cyclical back pain.
Patient Comments at Discharge: “Thank you both for your helping me figure this out. Without going to see you I would have never known to explore my options further.”
Sincerely,