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Nathan Hinkeldey
James Leonard
Trevor McArthur


Depression; Mental Health; Post-Traumatic Stress Disorder


Objectives: TO demonstrate the benefit that a strong patient-provider relationship can have in treating a patient with chronic low back pain and mental health conditions using manual therapy and therapeutic neuroscience education.

Clinical Presentation: A 32-year-old male veteran had dull, central low back pain. Clinical testing revealed the back pain was predominantly mechanical; however, an affective component to pain was also identified. His symptoms responded favorably to an end-range loading exam and had a directional preference for lumbar extension. He was also involved in outpatient mental health treatment.

Intervention and Outcome: The classification using the McKenzie Method of Diagnosis and Therapy (MDT) was found to be a lumbar posterior derangement. Treatment included spinal manipulative therapy, repetitive end-range loading, and therapeutic exercise for 6 visits over 5 months. Mechanically, the patient experienced complete functional improvement, 3 months of little to no pain, and a decrease on the PROMIS Pain Interference Scale 6B of 8 points (14 to 6). Initially, he believed his suicidal ideations were a result of his pain presentation; however, reduction of his pain did not alleviate the ideation. He voluntarily reported to the emergency department and received appropriate mental health care.

Conclusion: There is a strong relationship between depression, PTSD, and low back pain. Therefore, healthcare providers treating low back pain need should be aware of mental health diagnoses that impact pain presentations when making treatment recommendations.


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