Physiotherapy Progress Review Note

Summary// Follow-up physiotherapy review for a 42-year-old male presenting with ongoing mechanical lower back pain. The patient reports a 40% overall improvement since the initial session, with reduced morning stiffness and improved tolerance to sitting. Today's intervention focused on lumbar mobilisation and core stability progressions, resulting in an immediate increase in pain-free flexion.

Subjective// Informed verbal consent was obtained prior to assessment and manual therapy. The patient reports a 40% improvement since the last session. Putting on socks and sitting for 30 minutes at work are now easier, though prolonged standing over 20 minutes remains difficult. Continuing dull ache in the central lumbar spine, rated 4/10 on VAS, lasting up to an hour after heavy lifting or bending. No referred leg pain, paraesthesia, or cauda equina symptoms reported; currently taking ibuprofen 400 mg PO TID PRN.

Objective// Lumbar Flexion: Fingertips to mid-shin, restricted by tightness and 4/10 central low back pain at end-range. Lumbar Extension: 15 degrees, mild stiffness, no pain. Side Flexion (L/R): Symmetric to knee joint line, NAD.

• Central PA spring testing revealed hypomobility at L4 and L5, reproducing concordant local ache at L4.
• Palpation showed hypertonicity and mild tenderness across bilateral lumbar paraspinal muscles and the right quadratus lumborum. SLR: 80 degrees bilaterally, negative for radicular pain (tight hamstrings only). Prone instability test: Negative. Single-leg bridge endurance: 15 seconds on right, 20 seconds on left.

Treatment (Rx)//

• Central PA mobilisations Grade III applied to L4 and L5 spinous processes, 3 sets of 60 seconds.
• Soft tissue massage and myofascial release to bilateral lumbar paraspinals and right quadratus lumborum for 8 minutes. Pelvic Tilts: Supine with knees bent, 2 sets of 15 repetitions, focusing on smooth lumbopelvic control. Bird-Dog (Progression): Quadruped opposite arm and leg lift, 3 sets of 10 repetitions with a 5-second isometric hold at top, maintaining neutral spine. Glute Bridges: Supine double-leg bridge, progressed by adding a light resistance band around knees, 3 sets of 12 repetitions. Lumbar Flexion AROM reassessed: Improved to fingertips reaching ankle level with pain reduced to 2/10 at end-range. Lumbar Extension AROM reassessed: Improved to 20 degrees, stiffness resolved.

Analysis / Problem list//

• Resolving mechanical lower back pain with persistent L4/L5 segmental hypomobility.
• Reduced lumbar flexion ROM and myofascial tightness in lumbar paraspinals.
• Mildly reduced posterior chain endurance limiting prolonged standing tolerance.
• Positive immediate response to Grade III PA mobilisations and soft tissue release, demonstrating a 50% reduction in end-range flexion pain and improved excursion.
• Good motor control demonstrated during progressed core stability exercises without symptom provocation.

Plan//

• Review in 2 weeks to monitor functional standing tolerance and reassess lumbar AROM.
• Progress posterior chain strengthening and introduce functional lifting mechanics.
• Continue current HEP daily to maintain segmental mobility and build core endurance. Cat-Cow Stretch: Quadruped, 2 sets of 15 repetitions daily, moving within a pain-free range. Banded Glute Bridges: Supine with resistance band around knees, 3 sets of 12 repetitions, 3-second hold at the top, once daily. Bird-Dog: Quadruped opposite arm/leg extension, 3 sets of 10 repetitions with a 5-second hold, once daily.