Presentation:
30 y/o female presented with a 4 day history of progressively worsening acute central low back pain and right sided leg pain. The leg pain was described as an intense sharp, burning sensation started in the spine and travelled down the posterolateral thigh into calf.
Her symptoms began after finishing her shift as a kitchen-hand which involved performing repetitive lifting and twisting movements while carrying a heavy load.
She has had difficulty finding a comfortable position to sleep in and performing normal activities of daily living.
Examination:
Postural analysis; towering right antalgic posture with a short shuffling gait
Lumbar range of motion; Flexion = 15 deg. Extension = 0 – 5 deg. Right lateral flexion = 5 deg. Left lateral flexion = 5 deg. Right rotation = 0 – 5 deg. Left rotation = 0 – 5 deg.
Cough/Valsalva; positive (back and leg pain)
Slump; positive (back and leg pain)
Straight leg raise; Right = positive 30 deg. Left = positive at 55 deg.
Palpation; sensitivity and restriction at L4/5 and L5/S1
Neurological examination; patella and achilles reflexes intact however subdued bilaterally. Muscle strength good bilaterally. Sensory testing unremarkable.
Vascular Testing; Hautant’s/Maigne’s (Seated) & VBI (Supine); No abnormalities detected.
Imaging; CT imaging showed L4/5 and L5/S1 right posterior-lateral discs bulges with no nerve compression.
Treatment:
Education & Advice.
Myofascial therapy.
Targeted acupressure.
Seated lumbar facet joint distraction mobilisations
Kinesiology taping techniques
Home Exercise:
Ice therapy
Gentle walking
Supine lumbar decompression techniques
Supine lumbar rotation mobilisation techniques
Glute and hamstring activation exercises
Core stability exercises
Outcome:
After 4 consultations by the end of week 2, the patient reported improved mobility and functionality.
After 8 consultations by the end of week 4, the patient reported no discomfort while sleeping.
After 12 consultation by the end of week 10, the patient returned to work with no restrictions.
After 20 consultation by the end of week 36, the patient reports no return in back or leg pain and she is maintaining her improvements with routine lumbopelvic stability exercises.
Note:
There were no spinal manipulations performed on this patient.
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