What happened?
A 44-year-old woman had persistent pain for 13 years after lumbar fusion. The report explores how manual therapy was used within a broader plan that also addressed exercise, pain understanding and confidence—not as a stand-alone structural fix.
Clinical findings
- Long history of low-back and thigh symptoms after L5/S1 fusion.
- Pain-related disability and reduced self-efficacy were important treatment concerns.
- The paper discusses the patient within a broader biopsychosocial framework.
Rehabilitation described in the report
- A 12-week multimodal programme combining manual therapy, exercise rehabilitation and pain neuroscience education.
- Care was individualized; the case report does not establish a single optimal manual technique or dose.
Reported outcomes
- The authors report reductions in pain intensity, Oswestry Disability Index and fear-avoidance beliefs.
- The patient returned to running and cycling.
Clinical lessons to consider
- Persistent pain after surgery deserves more than an imaging-only explanation.
- Manual therapy can be a bridge into active rehabilitation and education rather than the whole treatment plan.
- Track participation, confidence and disability alongside pain.
Limitations — what this case cannot tell us
- One case cannot prove manual therapy caused the improvement or determine the best treatment combination.
- The findings may not apply to all post-surgical patients.
Original source
David Toomey, Duncan Reid, Steven White. “How manual therapy provided a gateway to a biopsychosocial management approach in an adult with chronic post-surgical low back pain: a case report.” Journal of Manual & Manipulative Therapy, 2021. DOI: 10.1080/10669817.2020.1813472
View the original publicationThis page is an independently written educational summary, not a reproduction of the full paper. Check the original article for complete methods, outcome tables, references and licensing.