OSTEOPATHY and Lower Back Pain
By Laurence Kirk
Patient: Ms A., a 35yr old female equestrian height 5ft
4ins weight 10stone
Complaint: Acute low back pain of two weeks duration as
a result of mucking
out a stable whilst on holiday.
History
Ms A had suffered acute recurrent low back pain from the
age of 19
years after falling from a horse (X-rays at the time revealed
no fractures).
From that time she developed slight weakness and hypoaesthesia
of the
entire left lower leg diagnosed by a neurologist as "stocking
syndrome"
When she became more active with her equestrian career and
was riding
regularly she had few problems although she was always aware
of the reduced
sensation in her left leg.
Her current pain was described as continuous and sharp
in nature and
localised to the left lower back, there was some referral
of pain into the
posterior left thigh accompanied by pins and needles into
the left lower.
The pain was generally aggravated by activity by changes
in position,
sitting for long periods, and there was impulse pain on
coughing or
sneezing. There was no morning stiffness reported
Ms A was generally stoic by nature and had developed effective
coping
strategies over the years to allow her to work through her
discomfort and
continue to compete at a relatively high level, unfortunately
the recent
exacerbation had proved to be one straw too many.
Examination
Standing examination revealed an asymmetry of posture with
an
elevated left ileum and mild lumbar structural scoliosis
concave to the
left. On palpation the lumbar erector spinae were hypertonic
and tender with
focal areas of tenderness over the left iliac crest and
psis. The left lower
limb appeared to be slightly longer than the right (<1.5cm).
Range of active
motion was reduced and painful in the lumbar spine for flexion
and left
rotation/side bending. Restriction of motion and tenderness
was also noted
in the cervical spine.
Neurological examination was somewhat curious; there
appeared to be complete anaesthesia of the entire left lower
limb other than
the medial border of the foot. Reflexes were normal and
equal but the left
lower limb showed generally reduced muscle strength. Neural
tension tests
interestingly were all negative (although these tests are
acknowledged as
being somewhat unreliable) percussion was unremarkable.
Peripheral pulses
were slightly reduced on the left. Provocative testing for
sacroiliac
involvement appeared positive on the left.
Treatment
Ms A had already seen her GP and had been prescribed diazepam
and ibuprofen. Treatment was directed to restore a degree
of function to the left S/I joint and relieve the acute
pain associated with this. Gentle conservative
approaches were used given the severity of discomfort. This
took the form of
rhythmic oscillatory mobilisation of the S/I and lumbar
spine and soft
tissue treatment of the involved musculature. A knee swinging
exercise was
recommended to improve proprioceptive ability in the lower
back
After the first treatment 5 days later Ms A noted a significant
increase in
mobility and reduction in pain. Of more interest was the
observation that
slight sensations had been noted in the previously anaesthetic
left lower
leg. On testing the L5 dermatome exhibited some sensitivity
to both light
touch, and vibration.
On the third visit Ms A felt very much improved and extremely
grateful that
sensation in her left leg after 16 years was now all but
back to normal
(1 year follow up indicated that the improvement had been
maintained).
Was the actual treatment responsible for the resolution
of her long term
paraesthesia? Could the strenuous exertion of mucking out
the stable and
moving into awkward postures have triggered off some recovery
mechanism? Is
it likely that nerves which have been dysfunctional for
16 years can recover
in a matter of weeks? Was her problem vascular rather than
neurological,
mediated via the sympathetic outflow to the lower limb rather
than somatic
innervation?
Case Courtesy of
Laurence Kirk
THE BRITISH COLLEGE OF NATUROPATHY AND OSTEOPATHY
Lief House
3 Sumpter Close
120-122 Finchley Road
London NW3 5HR
Tel: 020 7435 6464
Fax: 020 7431 3630
Details of training can be obtained from the Registrar
at the above address
There is an out-patient clinic at the College
For further details and appointments, telephone 020 7435
7830
