This topic contains 3 replies, has 2 voices, and was last updated by Andrew Wengert April 15, 2018 at 4:59 pm.
April 12, 2018 at 9:59 am #5265
45 year old female. Bilateral low back pain. Not currently radiating down the leg but has in the past (2 years ago). Pain is stiff when sitting, but if patient stands for 15 minutes it will start to hurt and get up to a 9/10. Palliative is sitting. Provocative is standing and lumbar extension.
Patient has done Crossfit but recently stoped because of symptoms although crossfit was only painful with heavy squats + deadlifts, and overhead squats+snatches.
Lumbar and hip tests were slightly limited but after 3 visits everything is 100 percent. Moved down the chain and found that dorsiflexion was 2 inches on the right and 3 inches on the left. Two treatments in the right is 3.5 and the left is 4.25
We have no symptomatic improvement.
Patient has seen at least 5 other providers for this. Patient has had 2 MRI’s that she came with on the initial. On the imaging she has annular tears at 3 different levels, a spondlyolisthesis at L5, mild scoliosis and mild dural ectasia.
I overlooked the dural ectasia the first time, probably because it wasn’t in the impression. As I looked into it I found that people with this condition feel worse when standing up. Can this be the reason the symptoms feel better when sitting? Or am I not respecting the three annular tears?April 13, 2018 at 9:16 am #5266
Carl Nottoli, DCParticipant
She has a lot of pathology going on here. Don’t get distracted by looking for things to fix.
What’s the grade of the spondylolisthesis? See if you can post a screen shot. A spondy + dural ectasia in this case is acting like central canal stenosis. Then add 3 annular disc tears to the equation! Any symptomatic improvement will be slow.
Clean up the adhesion, add exercise to any weakness, and do some homework on any outlying pathology that may make her more prone to these pathologies. Ehlers Danlos comes to mind for example.April 13, 2018 at 9:18 am #5267
She has a lot of pathology. Make sure that is clear and that load management is very necessary.
Then get her focused on the rehab exercises (hip lift and progress to Goodmornings)
Also, I would check RFLT (rectus femorus length test). When limited, this has often cleared up lower back cases in my office especially when standing, walking, running are provocative.April 15, 2018 at 4:59 pm #5268
Thank you both for the responses.
Carl, I do not have the MRI anymore, but I can get it back. It was a Grade 1 spondylolisthesis.
I will also look into the potential connective tissue disease
Brian, I didn’t think to check Rectus but will next visit.
Thanks again guys
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