Structural Diagnosis and Management–Guided Physiotherapy in a Patient with Chronic Low Back Pain and Radiating Symptoms: A Case Report

Abstract

Background: Low back pain (LBP) with radiating symptoms is a common and disabling musculoskeletal condition arising from complex interactions between mechanical loading, movement dysfunctions, and neuromuscular factors. Conventional pathoanatomical diagnoses often show limited association with symptom severity and functional outcomes, necessitating assessment-driven physiotherapy approaches. Case Description: A 40-year-old male presented with a one-year history of chronic LBP radiating to the buttock and knee, associated with prolonged sitting intolerance, movement restriction, and functional limitation. The patient had previously received multiple courses of conservative medical treatment and traditional physiotherapy without sustained improvement. Clinical assessment revealed restricted lumbar mobility, hip–pelvic asymmetry, soft-tissue tightness, reduced lower-limb mobility, and positive neurodynamic tests, consistent with mechanically driven LBP with radiating symptoms.  Intervention: Physiotherapy management was guided by a clinical reasoning framework referred to as Structural Diagnosis and Management (SDM), emphasizing restoration of joint mobility, correction of movement dysfunctions, myofascial flexibility, and lumbopelvic control through individualized manual therapy and therapeutic exercise. Outcomes: Progressive improvements were observed in pain intensity, sitting tolerance, lumbar mobility, neurodynamic responses, muscle strength, and disability scores over twelve treatment sessions. Conclusion: This case highlights that an assessment-based, movement-focused physiotherapy approach informed by SDM principles may effectively improve outcomes in complex, treatment-resistant LBP with radiating pain, supporting the role of structured clinical reasoning in conservative management.