Volume 24, Issue 105, November - December, 2020

Effect of psychomotor physiotherapy with individualized physiotherapy program on pain, kinesiophobia and functional outcome following Transforaminal Interbody Lumbar Fusion (TLIF): A case report

Saumi Sinha¹, Rakesh Kumar Sinha^2♦, Pratik Phansopkar³, Sachin Chaudhary⁴

¹Professor & Head, Department of Cardiorespiratory Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India; Email: drsaumi@gmail.com
²Principal & Professor, Ravi Nair Physiotherapy College, Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India; Email: smartphysio@gmail.com
³Assistant Professor, Department of Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India; Email: drpratik77@gmail.com
⁴Vice Principal & Professor, Datta Meghe College of Physiotherapy, Nagpur, Maharashtra, India; Email: drsachin1982@gmail.com

^♦Corresponding author
Principal & Professor, Ravi Nair Physiotherapy College, Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India; Email: smartphysio@gmail.com

ABSTRACT

Introduction: Transforaminal Interbody Lumbar Fusion is a common surgical procedure for lumbar disc herniation. Pain, functional limitation and kinesiophobia are commonly reported after TLIF. Psychomotor physiotherapy has been shown to be effective in modifying the behavioural and cognitive aspects of pain and movement and thus improve functional outcomes. NPMP approach, focusing on strategies to improve body awareness, self confidence, dealing with fear of failure and feeling safe in an environment, when added to the individualized physiotherapy program following TLIF showed significant reduction in low back pain and improved functional independence along with decreased kinesiophobia. Clinical findings: A 53 year old female presented with chief complain of pain in low back with tingling and numbness in both feet since last 3 months after a fall leading to difficulty in walking and performing daily activities. Pain was aggravated by forward bending and relieved by rest, stretching and medication. MRI report of dorsal spine revealed disc desiccation at D10-D11, D11-D12 and D12 –L1 levels, ligamentum flavum hypertrophy at D8-D9 and D10-D11 levels with lumbar canal stenosis at L3-L4 at L4-L5 disc levels (canal diameter D12-L1was 8mm) and degenerative changes at L3, L4 and L5 levels. Muscle strength was 3/3 as per MRC grading. TLIF was done on the patient as advised. Postoperatively the patient presented with pain (8/10 on NPRS), functional disability (Modified Oswestry Disability Index score of 64%) and fear of movement (Tampa Scale of Kinesiophobia raw score of 51%). An individualized physiotherapy program for a duration of 8 weeks was designed incorporating Psychomotor Physiotherapy (Norwegian Psychomotor Physiotherapy protocol was used) once a week for 8 weeks. Conclusion: NPMP along with individualized physiotherapy program was effective in reducing low back pain, improving function and reducing kinesiophobia after TLIF.

Keywords: Case report, Lumbar disc herniation, Transforaminal interbody lumbar fusion (TLIF), Psychomotor Physiotherapy, Kinesiophobia

Medical Science, 2020, 24(106), 4091-4097

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