Small but effective

Hi all

I am on my musculo placement and thought I would share the background on one of my patients. She has had a history of low back pain for 30-odd years, and has suffered from leg pain for 20-odd years. She was referred to the clinic by her new GP. The leg pain affects her sleep, to the point where she wakes hourly when it is severe, and she needs to get up and walk to relieve the symptoms.

Her presenting back pain was 5/10, which is her pain on a good day, and when severe is 9/10. Her leg pain comes on when her back pain is 7/10. Objective findings showed positive slump test bilaterally, and absent reflexes in the S2 distribution bilaterally. CT findings showed degeneration around L4/5 and L5/S1 facet joints and stenosis of the L5/S1 intervertebral foramen. There was some hypomobility in lumbar unilateral PAIVMs, although the patient was very TOP. PAIVM Ax reproduced her leg pain.

My initial treatment consisted of STM to the Lx erector spinae musculature, and unilateral PAIVMs to the L2-5 segments. It didn't feel like much treatment, but at her next session the patient said she slept for 9 hours that night without waking, and the leg pain had disappeared for 2 days. Re-Ax of her * signs showed that S2 reflexes had returned bilaterally.

Just thought I would share that, as a reminder that perhaps sometimes we don't need to provide too much treatment.

Dale.