Introduction repetitive bending, lifting and carrying the


Low back pain (LBP) is a pervasive symptom that affecting the
majority of the adult population in life. (Christopher T et al, 2015) One of
the most common spinal degenerative disorders leading to LBP associated with
radicular leg pain is lumbar disc herniation. (Van Boxem K, 2010) Disk
herniation is a displacement of intervertebral disk material beyond the normal
margins of the disk space usually described as disk “rupture”. (Rhee JM et al,

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According to the scenario, Mr. Khan had recurrent episodes of
stiffness and pain at the lower back region associated with the history of
stiffness and pain at lumbar region 6 years ago and disc herniation at L4-L5 3
years ago. A history of back pain is the factor most consistency that leads to
future back pain. (Frankie et al 1996)G1 G2 G3 G4 G5  Besides, Mr. Khan is a physiotherapist,
his occupation required a series of repetitive bending, lifting and carrying
the patients on the same day. (Dolan P et al 1993) G6 G7 Repetitive bending and lifting for a
prolonged duration will damage the annulus of the disc and cause the
degenerative changes occurred. As the interverG8 tebral disc height falls and reduces its
hydrostatic pressure which develops in the innermost annulus rings and pushes outward
causing bulging of outer annulus. (Adams et al, 1996) If the spine is loaded in
for long periods of time will affect the annulus bulges more posteriorly. Thus, the pain
will restrict patient’s ROM over lumbar flexion and lateral flexion which lead
to stiffness over the lower back region. G9 Evidently, people with stiff spines are
one of the greater risks of developing low back pain and highest risk when the
job involves a lot of bending. G10 (Adams et al, 1999)G11 G12 G13 G14 

Furthermore, Mr. Khan used to be a squash playerG15  which may result from the combination of rotational and sagittal plane
activity of the back motion were increases the risk of LBP. (Farshad
Okhovation, 2009) Also, Mr. Khan experienced radiating pain over left posteriG16 or thigh and dorsum of foot and numbness over big toes of left foot with
positive straight leg raising test (SLR) on the left sideG17 . A nerve root contact with the nucleus pulposus may provoke the inflammation in
mechanical compression to cause pain. (Rhee JM et al, 2006) Of those, SLR
test is most widely used, reliable and valid to detect intervertebral disc
herniations. (Kobayashi S et al, 2010) Sciatica characterized by pain radiating to
below the knee, into the foot and toes andG18  findings of nerve root entrapment such as sensory deficits, reflex
changes or muscle weakness. (Koes BW et al, 2007) However, this type of
herniated disc at L4-L5 can lead to weakness when raising the big toe. G19 G20 

Mr. Khan is an active person who rides the bicycle and walks
around the park and worked as a physiotherapist. So, I hypothesized that he
needs to reduce pain and improve trunk flexibility which already restricted his
ADLs.G21 G22 G23 G24 











Main body

The article that I had chosen is
literature done by Murtezani A, 2015 who studied
McKenzie therapy with electrophysicalG25  agents (EPAs)
therapy for the treatment of work-related low back pain: A randomized
controlled trial with 3 months follow up. G26 The result showed there was a significant improvement of spinal motion,
reduction of pain and disability in both group but the results show the greater
improvement in the McKenzie group (p