case #6:. history & examination findings 35 yr-old male low back/leg pain following a work...

Case #6:

History & Examination Findings

35 yr-old male low back/leg pain following a work injury:Laminectomy 4th & 5th lumbar, 6 months prior.Narcotic medication (Vicodin), that he took twice daily,LBP 8/10,Oswestry 74%Reduced ROM, 15° Flexion, could not perform Extension,Muscle strength testing- weakness of left leg flexors (4/5), Left achilles reflex could not be elicited, Left L5 dermatome revealed lack of pricking sensation

Orthopedic testing

• Positive orthopedic tests included: Left leg Minor’s signKemp’s signToe walkSLR at 45 degreesWell-Leg raise at 45 degreesMilgram’s test

Case #6: Post-Surgical Laminectomy Posture

Forward head translation (+TzH)Left head translation (+TxH)Left thoracic translation (+TxT)Posterior thoracic translation (-TzT)Right thoracic lateral bending (+RzT)Left posterior pelvic rotation (+RyP)

Case 6: X-ray Findings & Impression (Osteopenic hole)

at L4-5 levels Forward head

posture (47mm) Left head

translation (14mm) Reduced cervical

curve (19 degrees) Reduced lumbar

curve (23 degrees) Left thoracic

translation (16mm)

Initial treatment and outcomeConsisted of mirror image adjustmentsLateral translation traction Mirror image exercise for lateral translationAfter 36 visits an A-P lumbar and lateral

cervical radiograph were taken

Mirror Image® Drop Table & Instrument Adjustment

Mirror Image® & Rehab Exercise:

36 Visit Re-Exam & X-rays• Thoracic translation: 16mm to the left to 1mm right• Chief complaint: now lateral calf pain rated 2/10• Revised Oswestry: 74% to 40% disability• Lumbar ROM: flexion limited to 70 degrees, patient

was able to perform extension• All initial orthopedic tests were now negative• Achilles reflex: now elicited (rated 1/2)• Dermatome testing revealed improved sensation to

pricking along the left L5 dermatome

36 Visit Post x-ray findings

Following first post x-ray: After 36 Visits

Lateral translation traction was eliminatedThoracic extension exercises were added using a

Roman chair at 10-15 repetitionsCervical traction was initiated using the extension-

compression chair for three monthsAt 6 months, cervical traction was changed to

cervical compression extension with a harness for +TzH (8lbs for 12 mins)

Mirror Image® Exercise Drop Table

Did not Have Picture of Actual Roman Chair Exercise

CBP® Mirror Image® Traction

Outcome after 9 months Low back NRS was 0/10 Revised Oswestry scored: 74% to 40% to 24% disabililty All orthopedic tests were negative Achilles reflex: reduced on the left 1/2 Left L5 dermatome revealed normal pricking sensation Patient no longer required narcotic pain medications Lateral cervical x-ray: +TzH from 47mm to 36mm Cervical lordosis increased from 19 to 32 degrees Atlas plane line: 16-23 degrees A-P lumbar x-ray: 1mm to the right (was 1mm left)

108 Visits: ROM Improved, NRS 0/10, Oswestry 24%

Before & After Lateral Cervical