A 20-year-old female from the Gondia district's Magardoh hamlet visited the Acharya Vinoba Bhave Rural Hospital (AVBRH), Sawangi (Meghe), Wardha, India with the chief complaints of diffused low back pain that had been plaguing her for the last two years and had crept up on her slowly at first. Additionally, the patient also reported a loss of sensation in the front and back of the distal lower limb. The patient gave a negative history of any other comorbidities. The patient had already been referred to a few private hospitals where she underwent a few investigations which revealed the presence of an abscess in the pre- and paravertebral space of the lower spine. After magnetic resonance imaging (MRI) and biopsy were carried out, the patient was diagnosed with TB of the spine L4-L5 and L5-S1. The patient was prescribed anti-TB medications and physiotherapy.
On observation
The patient was seen in a supine position with upper limbs by the side and lower limbs extended. An abscess was seen on the lower spine region.
On palpation
Grade 3 tenderness (patient winces and withdraws the affected part) was present on the lower lumbar region of the back. On examination range of motion (ROM) and manual muscle testing were taken (Tables 1 and 2).
Sensory examination
The assessment was done using American Spinal Injury Association (ASIA) impairment scale. All the motor functions were intact. There was a sensory deficit in the L5 and S1 segments with both pinprick and light touch impaired. Loss of sensation over the lateral and posterior calf and dorsum of the foot was noted.
Intervention
The main goal of physical therapy is to minimize the symptoms. The primary goal is to improve respiratory function, relieve back pain, increase muscle strength, increase ROM, improve sensory function, improve quality of life and prevent secondary complications.
Before initiating the treatment, it is essential to educate the patient about her condition, its complications, the prognosis, and the benefits physical therapy will have in easing her symptoms, relieving pain, and early recovery.
Strengthening exercises included isometrics initially, followed by resistive exercises first by manual resistance later using weights and mechanical resistance with 10-20 repetitions. Low back pain was managed with the application of transcutaneous electrical nerve stimulation (TENS) and moist heat. ROM exercises (both active and passive) up to full range were given to improve mobility. Mobility exercises for the trunk were given with proper assistance. Breathing exercises included pursed lip breathing and thoracic expansion exercises with five and ten repetitions respectively twice a day. Sensory re-education was done once a day. Postural correction techniques were taught. Aerobic exercise training was started in the fourth week using a static cycle and treadmill (Table 3).