An attack of back pain and sciatica 4 months ago took him out of nearly all of his regular activities, resulting in surgery. At his first therapy appointment, he was weak, exhausted, and extremely painful from the car ride over.
He had onset of severe pain and weakness down the left leg and ankle. He was unable to get up and around the house, much less get anything done around his property. Despite his age, he had continued to work as an accountant, but it was hard on his back and health. The severe pain and weakness led to epidural steroid injections that were only minimally helpful, and surgery was recommended. In his case, it was a multiple level laminectomy and diskectomy, which is a very serious surgery, especially given his age and physical condition.
When he came to therapy for the first time, he was so weak (meeting the criteria for frail) that he was unable to perform anything more than very light exercises, designed for residents of nursing homes and assisted living centers. After just a couple of minutes, he would be breathing hard, sweating, and have to take a seat and rest. I was unable to even place him in the positions necessary to perform in-depth strength testing of his hips and lower extremities.
Despite his frail condition and the numerous setbacks he had encountered, his goal was to perform the yard and other work around his property, and (if he took the time off) return to golfing and fishing.
I immediately gave him a few key exercises to start at home, along with a walking program, to improve his overall condition and strength as quickly as possible. While in the clinic, I also worked to increase the flexibility of his back. This chronic stiffness (due to prolonged sitting and chronic low back pain) caused him to have to work twice as hard to get anything done.
After a couple of weeks, we were able to move him into functional strength training – addressing tasks around his property that he wanted to perform – in a gradual fashion. For example, he wanted to be able to lift and carry fairly heavy items, so we started with the task of controlled descent to a chair, then partial squats with body weight only, then squats closer to the floor with hand weights, then finally, box lifting from knee level progressed down to ground level with weights added.
Then we got to the fun stuff – golf and fishing. I initially had him bring a club to the clinic, but that was too easy. We moved to a cane rigged with an ankle weight, so that he could work on the movements with resistance and supervision, and develop power, balance, and safety that translated into his every day activities.
In the end, he was able to go through up to an hour of relatively heavy activity, and with the manual therapy I performed to restore normal motion to his back, he was able to ride and drive without pain.