Provider Name & Treatment Location: Winback Clinical Case Study Series (provider and treatment location not specified in source documentation)
Key Words: Subacute low back pain; L5-S1 disc involvement; sacroiliac dysfunction; lumbar radiculopathy; TECAR therapy; dry needling; movement retraining
Summary (Abstract)
This case study describes the rehabilitation of a male patient in his early 30s presenting with subacute low back pain following a work-related lifting injury. The patient demonstrated lumbar pain, sacroiliac dysfunction, movement restriction, neurological weakness, postural asymmetry, muscle guarding, and impaired functional mobility. MRI findings demonstrated disc involvement at the L5-S1 level, and neurosurgical consultation recommended conservative treatment prior to consideration of surgical intervention.
A comprehensive rehabilitation program was implemented including spinal mobilization, sacroiliac joint mobilization, dry needling, neuromuscular re-education, movement retraining, and Winback TECAR therapy. TECAR therapy was specifically utilized to reduce lumbar muscle guarding, decrease pain, improve tissue mobility, facilitate spinal movement, improve tolerance to manual therapy, and assist transition from protective movement patterns toward functional loading and mobility restoration.
The patient demonstrated progressive improvements in posture, spinal mobility, movement confidence, and overall functional capacity. What is unique about this case is the use of TECAR alongside dry needling, spinal manipulation, and neurological-symptom monitoring in a patient with confirmed disc pathology and nerve root involvement being managed conservatively prior to potential surgery.
Key take-away lessons:
- TECAR therapy was used to reduce protective lumbar/gluteal guarding and facilitate spinal mobility in a patient with confirmed L5-S1 disc involvement and L4-L5 nerve root signs, supporting a conservative-care pathway recommended by neurosurgery.
- Combining TECAR with spinal/SI mobilization, manipulation, and dry needling addressed both the mechanical (hypomobility, asymmetry) and neuromuscular (guarding, fear-avoidance) components of the presentation.
- Patient-reported functional goals (“to get my body back to the way that it was”) and milestones (“I feel like I can move a lot more than I could”) tracked alongside objective gains in posture and spinal mobility.
- TECAR was positioned here primarily as a movement-facilitation and guarding-reduction tool, supporting restoration of spinal mobility and functional movement in a patient with confirmed disc pathology and nerve root involvement.
Introduction
Subacute low back pain following lifting injuries is frequently associated with muscular guarding, segmental hypomobility, altered movement patterns, sacroiliac dysfunction, and neurological irritation. Persistent protective muscle tension and movement avoidance may significantly contribute to reduced spinal mobility, pain amplification, impaired functional movement, and delayed return to work activities.
Patients with lumbar disc involvement and neurological symptoms often develop compensatory movement strategies, fear of movement, altered loading mechanics, and reduced tolerance to bending and lifting activities. This case highlights the integration of TECAR therapy within a multimodal rehabilitation approach for management of subacute lumbar dysfunction with neurological involvement.
Patient Information / Diagnosis
Demographics: Male, early 30s; occupation: home fencing vendor involving repetitive lifting and bending.
Diagnosis: Low back pain with L5-S1 disc involvement and sacroiliac dysfunction. MRI positive for L5-S1 disc involvement.
Date / Mechanism of Injury: 09/09/2025 — work-related lifting injury. The patient sustained the injury while lifting a fencing board, feeling a “pop” in his lower back. Following injury he developed persistent lumbar pain, difficulty standing upright, movement restriction, sleep disturbances, and neurological symptoms affecting the left lower extremity.
Relevant Medical/Family History: Not specified in source documentation.
Past Interventions and Outcomes: Previous chiropractic treatment provided limited relief. A neurosurgeon recommended conservative rehabilitation prior to consideration of surgical intervention.
Clinical Findings
Subjective
| Location | Pain Description | Pain Severity | Aggravating Factors | Alleviating Factors |
| Lumbar spine; L5-S1 region; posterior pelvis; intermittent posterior leg symptoms | Sharp; stabbing; dull/aching; numbness/tingling | Current: 6/10; Worst: 7/10; Best: 5/10 | Bending; sitting; standing; walking; lifting; positional changes | Medication; relative rest |
Functional limitations: inability to tolerate normal lifting, difficulty standing upright, reduced walking tolerance, sleep disturbances, impaired work capacity, and movement apprehension. The patient specifically stated his goal was “to get my body back to the way that it was.”
Objective
Neurological findings: weakness of left foot dorsiflexion, weakness of left extensor hallucis longus, positive straight leg raise, and intermittent paresthesia-like sensations in the anterior thigh — findings clinically consistent with L4-L5 nerve root involvement, mechanical neural irritation, and sacroiliac dysfunction.
Postural and movement findings: significant pelvic asymmetry, inability to stand upright, protective movement patterns, and severe lumbar muscle guarding. Forward bending revealed compensatory movement strategies, inability to properly utilize lumbar movement, and excessive trunk compensation. Clinical observation identified increased lumbar paraspinal tension, gluteal guarding, and restricted lumbopelvic mobility.
Lumbar active motion:
| Motion | Findings |
| Forward Flexion | Severely restricted and painful |
| Extension | Severely restricted |
| Rotation | Painful bilaterally |
| Left Side Bending | Significantly restricted and painful |
Joint mobility findings: significant hypomobility identified at L2-L3, L4-L5, L5-S1, and the left sacroiliac joint, with the left SI joint demonstrating near-complete movement restriction. These restrictions contributed to altered pelvic mechanics, asymmetrical loading, neural irritation, and impaired lumbar movement.
Detailed Treatment, Timeline, and Outcome
1. Timeline
| Date / Stage | Event |
| 09/09/2025 | Work-related lifting injury (felt a “pop” in lower back while lifting a fencing board). |
| Following injury | Persistent lumbar pain, difficulty standing upright, movement restriction, sleep disturbances, and left lower extremity neurological symptoms developed. |
| Prior to PT | Previous chiropractic treatment provided limited relief; neurosurgical consultation recommended conservative rehabilitation prior to consideration of surgery. |
| During rehabilitation | Progressive improvements in posture, spinal mobility, and tolerance to bending, including ability to stand upright without forward lean and improved forward flexion and rotational mobility (see Results). |
2. Diagnostic Assessment
Diagnostic methods: clinical interview and pain characterization; neurological examination (dermatomes, myotomes including foot dorsiflexion and extensor hallucis longus, straight leg raise); postural and movement assessment; lumbar active motion testing; segmental and sacroiliac joint mobility assessment; MRI imaging (externally obtained) positive for L5-S1 disc involvement; neurosurgical consultation.
Diagnosis: subacute lumbar dysfunction with L5-S1 disc involvement, sacroiliac hypomobility, neurological weakness (L4-L5 distribution), severe muscle guarding, impaired movement mechanics, and functional limitation. A major contributor to dysfunction involved persistent lumbar muscle tension, movement-related fear, and protective guarding behaviors limiting spinal mobility and functional loading.
Prognostic characteristics: neurosurgical recommendation for a trial of conservative care prior to consideration of surgical intervention; positive prognostic factors included a clear functional goal and engagement with movement retraining despite initial severe restriction.
Therapeutic Intervention
1. Type of Intervention
The rehabilitation strategy emphasized reduction of pain and guarding, restoration of spinal mobility, improvement of sacroiliac mechanics, neuromuscular re-education, movement retraining, and gradual return to functional movement. Treatment interventions included dry needling, spinal mobilization, SI joint mobilization, manipulation, stretching, movement retraining, and TECAR therapy.
2. Protocol Steps
- Manual therapy: sacroiliac mobilization, pelvic mobilization, lumbar segmental mobilization, lumbar rotational mobilization, and manipulation techniques targeting L2-L3, L4-L5, and L5-S1 segments.
- Dry needling performed to piriformis, gluteus maximus, and gluteus medius musculature to reduce active trigger points and associated guarding.
- TECAR for muscle guarding and movement restoration: this case emphasized use of TECAR for reduction of protective lumbar guarding, facilitation of spinal mobility, improvement of movement tolerance, and support of progressive functional movement restoration. A major component of the presentation involved excessive lumbar paraspinal tension, gluteal guarding, postural asymmetry, and fear-based movement restriction — the patient demonstrated inability to stand upright, painful forward bending, compensatory trunk mechanics, and restricted spinal extension. TECAR was utilized to improve local circulation, reduce muscular hypertonicity, decrease pain sensitivity, improve soft tissue mobility, and facilitate improved spinal movement, particularly prior to spinal mobilization, movement retraining, and lumbar loading activities.
- Integration with functional rehabilitation: TECAR therapy was integrated with spinal mobilization, neuromuscular re-education, postural retraining, and movement correction strategies. Patient education focused heavily on reducing guarding behaviors, improving hip movement strategies, and restoring normal bending mechanics — transitioning the patient from pain-avoidant movement patterns toward controlled functional movement and eventual return to work activities.
3. Changes in Therapeutic Intervention
As rehabilitation progressed, the patient demonstrated improved posture, improved spinal mobility, improved tolerance to bending, and reduced lumbar tension — reporting “I feel like I can move a lot more than I could.” Later in rehabilitation, the patient demonstrated ability to stand upright without forward lean, improved forward flexion, improved rotational mobility, and improved daily functional tolerance. Throughout, TECAR therapy was utilized to improve tissue relaxation, decrease lumbar tension, reduce pain-related guarding, facilitate mobility restoration, and improve tolerance to spinal loading.
Treatment Protocol and Follow-Ups
Session Frequency / Techniques: Spinal/SI mobilization and manipulation, dry needling (piriformis, gluteus maximus, gluteus medius), stretching, movement retraining, and TECAR therapy — frequency not specified in source documentation.
Clinician- and patient-assessed outcomes: Postural assessment, lumbar active motion, neurological screening (foot dorsiflexion, EHL strength, SLR), and patient-reported pain, mobility, and functional tolerance.
Important follow-up diagnostic and other test results: Not specified beyond clinical progression described in Results.
Intervention adherence and tolerability: Patient reported subjective improvement following TECAR sessions and demonstrated improved movement confidence and postural control following treatment.
Adverse and unanticipated events: None reported.
Results after Treatment Completed
During follow-up sessions, the patient demonstrated improved posture, improved spinal mobility, improved tolerance to bending, and reduced lumbar tension, specifically reporting, “I feel like I can move a lot more than I could.” Later in rehabilitation, the patient demonstrated ability to stand upright without forward lean, improved forward flexion, improved rotational mobility, and improved daily functional tolerance. The patient reported subjective improvement following TECAR sessions and demonstrated improved movement confidence and postural control following treatment.
Discussion
This case highlights the importance of addressing protective muscle guarding, movement fear, and dysfunctional loading patterns in patients with subacute lumbar spine dysfunction and neurological involvement. In this case, TECAR therapy functioned primarily as a movement facilitation modality, a muscle relaxation intervention, and a supportive tool for restoration of spinal mobility and functional movement.
The integration of TECAR therapy with manual therapy, movement retraining, and neuromuscular re-education appeared clinically beneficial in reducing guarding behaviors and improving movement tolerance. Rather than functioning solely as a passive modality, TECAR therapy was incorporated into a progressive rehabilitation strategy emphasizing movement restoration, spinal mobility, neuromuscular control, and return to function.
Limitations include the absence of repeat objective neurological and ROM measures at discharge, and the single-patient design with a confirmed structural diagnosis (L5-S1 disc involvement) that prevents isolation of TECAR’s independent contribution from spinal manipulation, dry needling, and movement retraining. Take-away: a comprehensive rehabilitation program including spinal mobilization, sacroiliac mobilization, dry needling, neuromuscular re-education, movement retraining, and Winback TECAR therapy played an important role in reducing lumbar muscle guarding, improving spinal mobility, facilitating movement restoration, decreasing pain sensitivity, and supporting progression toward functional recovery and return to work activities — in a patient managed conservatively ahead of potential surgical intervention.
Patient Perspective
The patient’s stated goal at the outset of care was “to get my body back to the way that it was.” As rehabilitation progressed, he reported, “I feel like I can move a lot more than I could.”
Informed Consent
Not specified in source documentation. Patient consent for use of de-identified clinical data in this case report should be obtained and documentation made available on request.