Lumbar Disc Radiculitis Resolved With Integrative Manual Therapy (IMT) in Four Visits

Author: Al J. Brown, PTA and Lydia Nierman Cornwall, PT

Abstract: This case study focuses on a 56 year old man with low back pain secondary to a lumbar disc radiculitis. The patient presented upon evaluation with decreased spinal range of motion and postural dysfunction. Patient reported low back pain and paresthesia that radiated to his right hip. Patient was unable to play golf and reported pain during activities of daily living, including standing, sitting, driving, bending, reaching, and lifting. Patient received treatment with Integrative Manual Therapy for a total of four visits. Patient's treatment focused on Biomechanics of his pelvis, sacrum, and lumbar region. Following completion of therapy, patient presented with full restoration of spinal flexion, a total elimination of his pain and paresthesia, and an improvement in posture. Patient also reported that he was able to return to golf without any complaints of pain.

Key Words: Spine, Radiculitis, Disc

History: A 56 year old male presents to therapy secondary to low back pain with paresthesia in right hip (L3 dermatome). He is unable to perform golfing activities at this time.

Past medical history: Laminectomy 1970, hernia repair 1990.

Subjective: The patient notes his pain is increased with certain activities, including standing, sitting, driving, bending, reaching, and lifting.

Objective Findings: Patient presents with asymmetrical static posture in cranium, thoracic, lumbar, sacral & pelvic regions. These include elevated (L) shoulder, torso side bent right, left scapula and gluteals rotated posterior, entire right trunk rotated anterior, one-inch elevation of the left iliac crest, gluteal fold, & popliteal fossa. Dynamic movement shows the following: Forward bending (without compensatory movements) 5 inches to patella, cervical side bending 5 degrees, rotation 5 degrees bilateral. Accessory movements show the following: Caudal sacral movement zero, ascended right ASIS one inch, anterior right pubis ½ in. Sensation shows decreased light touch along the S1-2 dermatomes. Palpation: Tenderness along bilateral paraspinals in lumbar region, gluteals, & right anterior psoas region.

Treatment: Muscle Energy and 'Beyond' Technique (MET), including right inflare, left upslip, left anterior rotated innominate, bilateral flexed sacrum, left vertically rotated sacrum, stuck ascended sacrum. Myofascial Release (MFR) to bilateral PSIS's. Type I to extended L4, & L5 vertebrae. Cranial Therapy (CTS), including type I to all cranial bones.

Results: Observation shows forward bending to floor without compensatory movements, nor pain & paresthesia; symmetrical bony landmarks in trunk & pelvis regions; full accessory joint movements at PSIS & lumbo-sacral junction. Patient returned to goal game without discomfort.

Discussion: In this study, Integrative Manual Therapy (IMT) techniques provided structural corrections of Biomechanical & soft tissue dysfunction impacting the lumbar disc & nerve impingement. "Structural Rehabilitation will change the patient's potential for function."

REFERENCES

1. Myofascial Release for the orthopedic and the neurologic patient. DCR course material by Sharon Weiselfish-Giammatteo Ph.D.,P.T.

2. The Cranial Therapy Series, Course ONE, DCR course material by Sharon Weiselfish-Giammatteo Ph.D.,P.T., Thomas Giammatteo, D.C.,P.T.,

Frank Lowen, ICST, Carol Gordon, P.T., Jay Kain, Ph.D.,P.T.,A.T.C., Kris Albrecht, M.S.,P.T.

3. Integrative Manual Therapy for the Autonomic Nervous System and Related Disorders. By Thomas Giammatteo, D.C.,P.T. and Sharon Weiselfish-Giammatteo Ph.D.,P.T., North Atlantic Books, Berkeley California, 1997.

4. Manual Therapy with Muscle Energy Technique for the Pelvis, Sacrum, Cervical, Thoracic & Lumbar Spine. By Sharon Weiselfish-Giammatteo Ph.D.,P.T. ANA Publishing, West Hartford, Connecticut, 1994.