Depression Case Study
Depression is a mood disorder that affects roughly 16% of Americans at some point during their lifetime. It can result in low mood, feelings of guilt, sleeping issues, as well as lead to issues like arthralgia, chronic back pain, and bilateral neurologic symptoms. Physical Therapy can play a role in treating the musculoskeletal dysfunctions while simultaneously structuring treatment sessions to help alleviate symptoms of depression This case study shows what may be seen in a patient coming in for musculoskeletal pain with an underlying depression disorder.
James is a 42-year-old male who owns his own construction company. He works in both the office as well as on site helping with his crew. 3 months ago James began developing LBP. He denies a MOI and reports that it has become constant and has made his job increasingly difficult. To control the pain he has been taking frequent breaks during the workday to lie down in his truck but feels that his crew is judging him for not pushing through the pain. He also reports that his pain has been preventing him from sleeping, which has been affecting his ability to run his company. He was hoping that the pain would resolve on it’s own but recently he has felt that he should “just give up” on trying to get better. He is starting to find that he is always tired and reports that he “kind of doesn’t care if the business fails” because he believes working is the reason he is in pain. After a friend recommended him to PT, he decided that he would try anything to make the pain go away but he is unsure of how exercise will help him. James currently smokes half a pack of cigarettes a day and has no outstanding past medical history.
- Lumbar Flexion=45 deg
- Lumbar Extension=10 deg with pain
- Lumbar Lateral Flexion=15 deg with pain on R, 20 deg on L
- Lumbar Rotation=15 deg on R, 5 deg with pain on L
- Thoracic Flexion=30 deg
- Thoracic Extension=18 deg
- Thoracic Lateral Flexion=25 deg with pain on R, 30 deg on L
- Cervical Flexion=35 deg
- Cervical Extension=40 deg with pain
- Cervical Lateral Flexion=45 deg on R, 42 deg on L
- Cervical Rotation=60 deg on R, 60 deg on L
- Flexion=105 deg
- Extension=15 deg
- Abduction=43 deg
- Adduction=30 deg
- Internal Rotation=25 deg
- External Rotation=28 deg
Outcome Measures Results:
- 5/5 for all myotomes
- Normal sensation to light tough
- Reflexes: 2+ bilaterally
- SLR: Negative
- Step-Test: Negative
- Quadrant Test: Positive on L
- Lumbar PA PIVMs: Dec backbending and L rot at L3-L4
Based on objective findings, James presents with gross spinal hypomobility. His outcome measures indicate that depression, low pain self-efficacy, and fear-avoidance influence his daily life.
- Lumbar rotation using caudal and cephalic levers at L3-L4.
- Rotation impulse over right L3 transverse process.
- Quadruped lumbar flexion and extension 3 sets of 10 repetitions.
- Supine lower trunk bilateral rotation 3 sets of 10 repetitions.
- Prone press ups 3 sets of 8 repetitions.
- Bilateral quadruped knee lift 3 sets of 10 repetitions.
- 30 minutes of moderate intensity recumbant cycling.
- Incorporating meditative, diaphragmatic breaths throughout whole session
Patient was referred to clinical psychologist. Co-treatment occurred for entirety of physical therapy sessions. Patient was discharged after 5 weeks once back pain resolved but continues to seek mental health treatment.
- Goodman CC, Fuller KS. The Psychological Spiritual Impact on Health Care. In: 3rd ed: Pathology Implications for the Physical Therapist. St. Louis: Saunders Elsevier; 2009: 110-115.
- Centers for Disease Control and Prevention. Anxiety and Depression. CDC Features. March 13, 2009. Available at: http://www.cdc.gov/Features /dsBRFSS Depression Anxiety/. Accessed on March 2, 2010.