Case Report: Male with Acute Low Back Pain, Paresthesia, and Muscle weakness in the lower extremity Mark H. Street, D.C. jet@sonic.net last revision 02/07/96 A 65 year old male entered our office with Left LBP, sciatica, paresthesia along the path of the sciatic nerve, anesthesia of the sole of the left foot, and left foot drop. The patient had lifted a hose 9 days prior and felt a sharp pain in his LB. He complained of constant numbness of the left leg and a limping gait, at the time of our examination the patient stated the pain was mild to moderate, and was slowly improving. A DDX of L5 intervertebral disc disorder w/myelopathy was considered. Lumbar ROM was decreased in all ranges--minimal ROM. Coughing increased the pain, straight leg raise was positive on the left at 70deg. with only mild discomfort, Braggards negative, Yeomans caused pain in the l5-s1 junction, Kemps to the right caused pain on the left-- described as a stretching feeling, left poplitial fossa tender to pressure. Pinwheel, paresthesia noted on L5 an S1 dermatomes on the left, manual muscle test of the Ant. Tib. b/l noted marked weakness of the L ant. tib.. Patient denied any bowel or bladder problems at the time or prior. Reflexes were intact b/l patellar, gastroc. Heel toe walk --- patient could not heel walk --- period , patient would fall and lean left. Marked muscle spasm was noted in the lumbar spine most notably on the left manually graded as an 8 on a scale of 10, graded as a 4 on a scale of 10 on the right. Plan, start a trial of chiropractic adjustments to the Lumbar spine and associated musculature and spinal segments. Close attention was to be paid by the patient as to symptoms of urinary or bowel problems, or an increase in anesthesia, or muscle weakness. Treatment consisted of this doctors version of side posture technique, this doctors version of SOT blocking technique, trigger point therapy, manual traction, and intersegmental traction. Treatment goals were relief of symptoms, strengthen and stabilize the spinal structures. The patient was blocked in the right short leg category 3 position with no board on a flat bench table. An adjustment of the thoracolumbar transition was performed at T10. Manual pressure was applied to the SI joints b/l while the patient was on blocks in a counter clockwise motion. Trigger points in the left quadratus lumborum were addressed, and the muscle was manually tractioned, the sacral base was tractioned inferiorly while the patient took deep breaths and relaxed the muscle in the lower back. Side posture was performed with the involved side down first, a contact on the R PSIS was made, the patient was placed in a flexed position to patient tolerance, and an adjustment was made. Adjustment of the involved side up involved placing the patient in extension and contacting the L5 mammillary (I think),(call it in the area of L4 transverse if you want), adjustment was performed in the normal side posture fashion. The patient had a good response from the trial and continued to be treated approx. 3X per week for about 1 month. The pain and paresthesia improved most rapidly, while the limping gait and anesthesia of the sole of the left foot took a couple months. Strength of the ant. tib was measured by manual resistance and by using a doubled strand of Theraband of spefic resistance and performing repititions until fatigue b/l. At the end of the first month the patients perception was about a 50% improvement in strength. After 2 months strength had improved 100 % objectively using theraband resistance measurements. The patient continued to do exercises at home and was checked monthly with the theraband, approx. 6 months after the initial exam the patient tested strong within 10% of the opposite/dominant leg, with no noticable limping gait. The patient is still active, he has received 26 treatments in 1 year and 9 months, he comes in for maintenance, or if he has felt a twinge when lifting wood into his pickup or weed whacking on a hill all day with an industrial weed whacker.