Physiotherapy Management of Lumbar Disc Herniation with Radiculopathy: A Case Report

Abstract

: Background: Lumbar disc herniation (LDH) with radiculopathy can cause low-back pain, sensory impairment, muscle weakness, and substantial functional limitation. Physiotherapy plays an important role in conservative and post-operative rehabilitation through exercise, education, mobility training, strengthening, and graded functional activity. Methodology: This single-case report describes the assessment and rehabilitation of an adult male office clerk with work-related onset of low-back pain and left lower-limb radicular symptoms. The recorded diagnosis was left posterolateral L4 – L5 intervertebral disc prolapse with nerve-root compression. Pre-operative and early post-operative findings were assessed using Visual Analogue Scale (VAS), Oswestry Disability Index (ODI), lumbar range of motion (ROM), manual muscle testing, sensory and reflex examination, straight-leg raise, gait assessment, and Berg Balance Scale (BBS). Results: Pre-operatively, the patient reported severe pain (VAS 7/10), moderate disability (ODI 48%), restricted lumbar flexion (30°) and extension (10%), diminished L5 sensation, reduced left ankle reflex, and left ankle dorsiflexor weakness (3/5). SLR, cross-SLR, and slump tests were positive. The patient had an antalgic gait and difficulty sitting for more than 20 minutes and walking beyond 100 m. Conservative physiotherapy included pain-relieving modalities, lumbar traction, manual therapy, mobility exercises, McKenzie/extension-biased exercises, core stabilization, strengthening, stretching, and postural education. Following surgery and early post-operative rehabilitation, radicular pain resolved and VAS decreased to 3/10. Lumbar flexion improved to 55° and extension to 30°, while left ankle dorsiflexion improved to 4/5. However, balance and functional mobility remained limited, with a BBS score of 31/56 and ambulation of approximately 20 m using a walker. Conclusion: Structured physiotherapy contributed to early improvements in pain, neurological symptoms, lumbar mobility, strength, and functional mobility following lumbar disc herniation surgery. Individualized, progressive rehabilitation incorporating education, therapeutic exercise, gait training, strengthening, and functional retraining is important for recovery. Passive modalities and traction should be considered adjuncts rather than substitutes for active rehabilitation.