Physio Follow-up Assessment

Physio Follow-up Assessment Summary// Mrs. Davies presented for a follow-up physiotherapy session today. She reported some improvement in her lower back pain since her last visit, but still experiences discomfort with prolonged sitting. The focus of the session was to assess progress and adjust the treatment plan accordingly. Subjective// Verbal consent was obtained from Mrs. Davies for the treatment plan. Mrs. Davies reports a 20% improvement in lower back pain since the last session. She finds it easier to stand for short periods. Walking is still challenging, and she experiences pain after sitting for more than 30 minutes. Mrs. Davies continues to experience lower back pain, which lasts for approximately 1 hour after sitting. The pain is aggravated by prolonged sitting and bending. Objective// AROM Assessment: * Flexion: 60 degrees, limited by pain * Extension: 10 degrees, limited by pain * Lateral Flexion (Left): 20 degrees, pain * Lateral Flexion (Right): 20 degrees, pain Palpation: * Tenderness over L4-L5 spinal segments * Muscle spasm in the lumbar paraspinals Other Objective Measures: * SLR: Positive at 45 degrees on the left. Treatment (Rx)// Manual Therapy: * Lumbar spine mobilisation: Grade III, 3 sets of 10 repetitions at L4-L5, 2 minutes. * Soft tissue massage: Lumbar paraspinals, 10 minutes. Exercises: * Pelvic tilts: 3 sets of 10 repetitions, hold for 5 seconds. * Cat-cow stretch: 3 sets of 10 repetitions. Reassessments: * Flexion improved to 70 degrees after mobilisation. * Pain reduced from 6/10 to 3/10 after massage. Analysis / Problem list// * Mechanical lower back pain. * Reduced lumbar ROM. * Muscle spasm in lumbar paraspinals. * Positive SLR. Plan// * Continue with lumbar spine mobilisation and soft tissue massage. * Progress pelvic tilts to bridge exercises. * Encourage walking for 15 minutes, twice a day. * Review progress in 1 week. Exercises: * Pelvic tilts: 3 sets of 10 repetitions, hold for 5 seconds. * Cat-cow stretch: 3 sets of 10 repetitions.