Presentation:
29 y/o patient presented with right sided thoracolumbar pain with associated muscle spasm following an incident at work 3 weeks earlier. She was assisting a geriatric patient (78 y/o and 68kg) into a wheelchair. The seat of the chair gave way and in a effort to prevent her patient from falling, she took their full weight while she was in a slightly flexed and rotated position.
She describes the thoracolumbar pain as a constant grabbing feeling with occasional sharp twinges when leaning forward.
She denies any peripheral pins & needles, numbness, burning sensation, or weakness.
She denies any fecal incontinence or saddle anaesthesia.
Examination:
Neurological examination unremarkable. No radicular signs. Reflexes intact bilaterally. Muscle strength good bilaterally.
Thoracic range of motion; flexion = 15 deg. extension = 20 deg. Left lateral flexion = 10 – 20 deg. Right lateral flexion = 0 – 10 deg.
Lumbar range of motion; flexion = 21 – 30 deg. extension = 15 deg. Left lateral flexion = 10 – 20 deg. R lateral flexion = 10 deg.
Cough/Valsalva; negative
Straight leg raise; negative bil
Siump; positive for right sided muscles tension.
Palpation; sensitivity and restriction at 10 – L2 with hypertonic spinalis dorsi longissimus dorsi and ilio-costalis lumborum.
Vascular Testing; Hautant’s/Maigne’s (Seated) & VBI (Supine); No abnormalities detected.
Treatment:
Education & Advice.
Myofascial therapy.
Targeted acupressure.
Seated lumbar facet joint distraction mobilisations
T12/L1 extension tractional adjustment
T4/5 extension tractional adjustment
Kinesiology taping techniques
Home Exercise:
Ice therapy
Gentle walking
Supine lumbar decompression techniques
Quadruped thoracolumbar rotation mobilisation techniques
Core stability exercises
Outcome:
After 4 consultations by the end of week 2, the patient reported a 75% mobility improvement.
After 8 consultations by the end of week 4, the patient reported no pain with any movements.
After 12 consultations by the end of week 8, the patient reported unrestricted mobility and continues to have no pain with any movement.
The patient has a maintenance/check-up appointment every 6-8 weeks – she reports no pain and full range of motion for the last 12 months.
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