Low back pain case report
A 35-year-old gentleman presents with persistent central to left-sided low back pain radiating down his left buttock and intermittently down to the back of his lower leg. He slipped and fell on his buttock 5 months ago. He did not feel much of discomfort at the time and was able to continue his normal daily activities. His left buttock pain gradually increased after a week and began radiating down his lower leg. He then sought medical advice and was diagnosed to have a "slipped disc". An operation was suggested but he preferred trying conservative treatment first. He had a course of physiotherapy treatment including traction, electrotherapy and back exercises. He did not respond to such treatment. His buttock and leg pain persisted and his low back became painful, affecting his ability to sit and stand. He changed to seek chiropractic treatment and his condition began to improve. His symptoms have improved by 80% over the last few months but have not improved further. Symptoms are still aggravated by prolong standing and sitting. His low back is rather painful when he sneezes.
On examinations, he has a poor slouching posture. Lumbar extension (low back backward bending) is restricted to 1/2 range with stiffness and slight pain. Flexion (forward bending) is restricted to 3/4 range by pulling pain at his left leg. Rotations (turning) and lateral flexions (side-bending) are almost full with minor stiffness. Neural (nerve) mobility test is found positive indicating restriction in the sciatic nerve (nerve by the buttock) mobility on the left. On palpations, left L5/S1 intervertebral movements are found very stiff and painful and could very well be the source of his problem. L2 and L3 area is also rather stiff and sore with surrounding muscular tension and soft tissue thickening. No neurological deficit is found. The patient feels fine after the examination, indicating low irritability and that subsequent treatment could be more aggressive.
His clinical presentation suggests residual joint, soft tissue and perhaps neural irritation after his acute disc pathology. Treatment techniques given are: L5 unilateral postero-anteriorly directed pressure mobilizations, deep soft tissue friction massage to L2 and L3 area, lumbar mobility exercise into restoring extension and pelvic left rotation and gentle neural mobility exercises. The patient is reminded not to bend his back and to concentrate on correcting his spinal posture in all positions.
Luck LI
Musculoskeletal Physiotherapist
On examinations, he has a poor slouching posture. Lumbar extension (low back backward bending) is restricted to 1/2 range with stiffness and slight pain. Flexion (forward bending) is restricted to 3/4 range by pulling pain at his left leg. Rotations (turning) and lateral flexions (side-bending) are almost full with minor stiffness. Neural (nerve) mobility test is found positive indicating restriction in the sciatic nerve (nerve by the buttock) mobility on the left. On palpations, left L5/S1 intervertebral movements are found very stiff and painful and could very well be the source of his problem. L2 and L3 area is also rather stiff and sore with surrounding muscular tension and soft tissue thickening. No neurological deficit is found. The patient feels fine after the examination, indicating low irritability and that subsequent treatment could be more aggressive.
His clinical presentation suggests residual joint, soft tissue and perhaps neural irritation after his acute disc pathology. Treatment techniques given are: L5 unilateral postero-anteriorly directed pressure mobilizations, deep soft tissue friction massage to L2 and L3 area, lumbar mobility exercise into restoring extension and pelvic left rotation and gentle neural mobility exercises. The patient is reminded not to bend his back and to concentrate on correcting his spinal posture in all positions.
Luck LI
Musculoskeletal Physiotherapist