Unlike many medical conditions, physiotherapy conditions present in many different ways that don’t fit with the simplistic model of diagnosis followed by a prescribed treatment.

Physiotherapy is much more about problem solving and adapting - and sometimes inventing! - treatment techniques accordingly.

As your condition and symptoms change, so too should the treatment you receive. Continual reassessment of your movement dysfunction and pain allows this to happen.

The case of one of Caroline Hennigan’s patients, Mrs W, provides a perfect example of how by continually assessing and reassessing a patient’s condition, a positive result is achieved.

How did Mrs W present when she first arrived for her physiotherapy appointment?

This 71-year-old lady had lower back pain radiating down her left leg, which had been making keeping fit and rambling difficult. When Caroline looked at Mrs W’s movement, bending forwards was limited, and when the individual joints moving in the spine were felt, the joints at the bottom of the spine felt stiff.



What did Caroline’s treatment involve at first?

Initially, treatment involved passive accessory movements (see Jenny’s previous article here) to mobilise the stiff joints in the bottom of the spine.

What happened when Mrs W was reassessed?

Reassessment of the forward bending movement showed an improvement in her range, and to allow further progress to take place, Caroline introduced a passive physiological treatment (again, see here for more information) where the patient laid on her side relaxed while her lower back was flexed in the way it does when bending forwards.

What was the effect of combining the two treatment types?

Further improvements occurred, as Mrs W experienced a reduction in her pain and a greater range of movement.

What happened in the second treatment session?

Caroline ‘tweaked’ the original accessory movement technique. Rather than applying a vertical pressure on each of the stiff vertebra, she was able to angle her pressure to have both a vertical pressure and a pressure angling up towards the patient’s head, thus mimicking more closely the motion of the vertebra during the movement of bending forwards.

At this point, reassessment of the patient’s condition revealed further gains in movement.

Mrs W reported feeling that not only had her original problem resolved, but she was in fact feeling better than she had for a while (having previously assumed that lower back grumbles were all part of getting older). With the patient keen to see just how good we could get the lower back feeling, treatment was progressed one final time.

Here, instead of using accessory and physiological techniques separately, the two were combined. This meant getting Mrs W into a position where the lower back was in its problem position of flexion, and then employing the pressure techniques to further enhance the movement.

How is Mrs W now?
The great news is that she is happily enjoying keeping fit and rambling. Now the movement has been restored in her lower back, she is able to maintain the movement with a couple of simple stretches at home.