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Chronic LBP patient

Exit forum ID Forum Discussion Chronic LBP patient

This topic contains 1 reply, has 2 voices, and was last updated by   Adam Holen D.C. March 1, 2018 at 12:32 pm.

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  • #5304

    Matthew Ellerbrock

      I had a 36 year old male 5’8″ 195 Pounds present a few weeks ago

      Symptom loc: Right low back pain greater than left, but notices it goes ‘back and forth’ now for years.

      Quality: dull ache, throbbing at times

      Intensity: 2/10 to a 7/10

      Palliative: Inversion table temp relief, good chair with lumbar support

      Provocative: worse after sleeping or sitting in bad posture (sneeze causes pain in both arms) I mention that because he did…. he denies any pain in the legs with sneezing or low back pain

      He is a credit analyst at a bank. He plays soccer recreationally and has had this pain get slightly worse over the past few years, mostly in the AM and then better as the day goes on.

      QLF: 11122 No symptoms or pain with movement

      SLR 65 deg R pos DF for mod/severe post leg pain to knee

      SLR 67 deg L pos DF for Mod/severe post leg pain to knee

      R SHF 2 finger no symptoms just ‘stops’

      L SHF 3 fingers, tight inside thigh moderate intensity

      SLPF full (tips of fingers to floor) with tightness back of knees bil slightly painful

      KHE 10″ bil with no symptoms, just tight

      Tissue/pathology: lumbar disc derangement

      ER on sciatic bil nerve entrapment and posterior capsule adhesion

      adhesion multifidi bil L3-S1

      left adductor adhesion

      Began treatment on the lumbar erectors and used QLF as our test, due to the lumbar complaint and history that gave disc a nod. QLF was quickly 12222 and adhesion minimal. Visits 3-6 have been spent on SLR initially the right and then the left, both improving to upper 70s mid 80s and stabilized.

      After the fourth visit his low back pain was only in the AM and minimal, and his right SLR was 85 deg on post, so we switched to the left side which was 68 degrees. Four days after that appointment he called and said he pulled his left hamstring and could ‘barely walk’.

      He took a couple weeks off soccer and felt pain levels of 1.5/10 in the left leg.

      He started back again to play soccer and notices that now he cannot kick or shift weight on the left leg or he will ‘pull his left hamstring’. His low back pain has diminished but the left posterior leg pain continues. He agrees that the soccer playing is contributing to his issues obviously but wants to finish the final couple weeks of the season out.

      My first question is about the sudden left leg pain. He didn’t have that prior to the treatment. Is it possible that creating more movement via less tension on the sciatic nerve on the right put the left leg at risk… allowing him to increase load?

      My second request is this: Also quite a few times I see this presentation and in my head I call it the elephant presentation, cause you have to start one bite at a time, but its a lot of dysfunction….any communication tips would be great when you guys and gals run into this. Its definitely a challenge going from test to test to test… all while dealing with increase in various symptoms and load factors.

      I still have more adhesion to go, and he is on board for the long haul, but its easy to get ‘lost’ in this much adhesion…

      #5305

      Adam Holen D.C.

        This guy definitely has a lot going on with basically everything except SLPF limited, but even that was more than a stretch (painful). Sounds like you’ve done a good job unloading the back and the first dx of a disc and now you’re running into un-layering the other dysfunction with high load. To your first question, yes I believe what he’s dealing with is a load issue (soccer) especially being more acute, having rested and picked it up again recently. 20-degree change in SLR is huge and my guess would be his hamstrings (post. chain) hasn’t had time to adapt. My first inclination would be to address strength by assessing lunge and implementing the hip lift to get the hamstrings up to speed. However, if he still has a couple weeks of soccer left, this will likely slow progress and potentially complicate things further (communication point). Have you looked at lunge/strength? The remaining dysfunction in SHF and KHE is likely also contributing to this ‘anomaly’ of symptom production in light of overall better function.

        As for your second question, I don’t feel confident enough to answer with specifics other than the general Brady-isms of chipping away at it, high load, and the onion analogy of peeling away the layers to expose other relevant problems. I hope others are better able to help you with the communication aspect. Good work so far though, this guy is very lucky he found you!

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