Shostakovich was asked in 1968 to provide the score for Grigori Mikhailovich Kozintsev's screen version of Shakespeare's King Lear. The composer had previously provided incidental music for Kozintsev's play on the same subject. By this time, Shostakovich was old and ill— since 1958, he had been gradually losing control of his limbs, especially his right arm—so he initially declined the request. Kozintsev promised the composer that there would be less work required than was necessary for the earlier score. This pledge, along with Shostakovich's love of Shakespeare, the cinema, and Kozintsev, eventually persuaded the composer to take on the task. At the end of 1968, Kozintsev was making the preparations to begin the shooting of the film. The composition of the film score would not have to be started for some time.

Around 1969, Shostakovich was excited to hear accounts of the miraculous healing of an Olympic athlete by a Siberian orthopedic surgeon, Gavriil Ilizarov. The best surgeons in Russia could not help the athlete, but Ilizarov did. Shostakovich hoped that the same could be done for him. The composer was once again hospitalized in the autumn, where he was finally diagnosed with a rare form of a children's disease, poliomyelitis. In January 1970, Shostakovich met with Kozintsev to discuss King Lear. The composer started his regimen with Ilizarov the next month. Once he was ready, he sent for the necessary materials for him to compose the film score. He worked on the score while at the clinic and completed it the following June. Shostakovich was then released from the clinic, with extraordinarily better control of his limbs. He then returned to Leningrad in order to supervise the taping of his music. The film was released in February 1971 quite successfully. Shostakovich and Kozintsev planned to work together on another film, but this did not occur due to Kozintsev's surprising death the following May.

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