Case study series
Limp & Wasting From Lumbar, 76 yr
As a follow-up report from the case study previously, the patient has continued to improve. Her drop foot is not so obvious. Muscle power has improved to about 50% on the right and 20% on the left. Her weakness and tiredness feeling has much reduced. I am also seeing another patient with the same condition but with different symptoms that is worthwhile mentioning.An otherwise healthy 76-year-old woman gradually developed right groin pain pulling down the front of her thigh 3 years ago. She was limping due to her pain initially. X-ray findings to the spine and hip were negative and no definite diagnosis was given. Medications did not help. No other physical treatment was given and she had only been resting from her normally active daily activities. Her groin and thigh pain gradually reduced and was replaced by a stiff/ache/weak feeling. She found it difficult to lift her knee towards her chest, especially after walking more than 20 to 25 minutes. Her limp markedly worsened over the last few months as she had been developing a drop foot (unable to lift the foot upward). She constantly tripped on her toes making her very worry that she would need to be wheelchair bound. Once again, this patient had never felt any discomfort in her low back.
On examinations, her limp was mainly due to her drop foot (unable to lift the foot upward) and very weak hip forward bending muscles. Her hip joint movements were otherwise normal. Detail examinations to the low back revealed very much reduction of the normal lordosis (forward/inward S-curve of the low back). Backward bending was not possible with pain. The low back was found to be the main area of injury, probably due to her poor sitting posture. The nerve was irritated, causing radiating pain to her groin and the front of her thigh and progressing to hip muscle weakness. As her low back problem was left untreated and that she was forced to rest/sit more because of her limp, the low back continued to worsen. Similar to the previous patient, direct palpation/mobilizations to the affected spine to restore any local mechanical dysfunction such as soft tissue thickening and restriction of spinal motions are important. The patient had 2 days’ of treatment soreness that had settled quickly after deep frictions, localized mobilizations to the low back, stretches, postural and mobility exercises and her low back S-curve and backward bending had very much improved over 3 weeks. Despite her age, fairly strong localized treatment could be given with caution. Once again, the patient’s home exercises and awareness of her condition was crucial to her recovery. She had been reminded that sitting was certainly not resting her back but actually causing further damage to her back and nerves.
Luck LI
Musculoskeletal Physiotherapist
On examinations, her limp was mainly due to her drop foot (unable to lift the foot upward) and very weak hip forward bending muscles. Her hip joint movements were otherwise normal. Detail examinations to the low back revealed very much reduction of the normal lordosis (forward/inward S-curve of the low back). Backward bending was not possible with pain. The low back was found to be the main area of injury, probably due to her poor sitting posture. The nerve was irritated, causing radiating pain to her groin and the front of her thigh and progressing to hip muscle weakness. As her low back problem was left untreated and that she was forced to rest/sit more because of her limp, the low back continued to worsen. Similar to the previous patient, direct palpation/mobilizations to the affected spine to restore any local mechanical dysfunction such as soft tissue thickening and restriction of spinal motions are important. The patient had 2 days’ of treatment soreness that had settled quickly after deep frictions, localized mobilizations to the low back, stretches, postural and mobility exercises and her low back S-curve and backward bending had very much improved over 3 weeks. Despite her age, fairly strong localized treatment could be given with caution. Once again, the patient’s home exercises and awareness of her condition was crucial to her recovery. She had been reminded that sitting was certainly not resting her back but actually causing further damage to her back and nerves.
Luck LI
Musculoskeletal Physiotherapist