Abstract
Patients with lumbar radiculopathy are often managed with manual therapy. The aim of this single case study was to describe the outcome of manual therapy treatment of a patient with lumbar radiculopathy. A 47-year-old female presented with acute, severe left buttock and postero-lateral thigh pain. Symptom provocation occurred during lumbar flexion, coughing, sneezing, driving and prolonged sitting. her left straight leg raise neurodynamic test was limited and reproduced her pain, as did trigger points in the left lumbar and gluteal muscles. clinical neuro-conduction testing revealed weakness of the big and other toe extensors, as well as eversion and plantar flexion of the left ankle, and a diminished left ankle reflex. This indicated possible involvement of both the l5 and S1 nerve roots. A manual therapy treatment approach including lumbar rotation mobilisations (Maitland approach), massage, trigger point pressure release and Transversus Abdominus muscle activation was used. The patient was symptom free, had full pain-free range of all lumbar movements, a full pain-free left straight leg raise neurodynamic test and normal neurological conduction six weeks after onset, following seven manual therapy treatments. Although the results of this case report cannot be generalised, it describes the successful outcome of a patient with severe radicular pain and neurological deficits, whose signs and symptoms had completely resolved following manual therapy treatment.
Highlights
Radiculopathy is a disorder involving compression, impingement, irritation or inflammation of a spinal nerve root, which may be due to a disc protrusion or any local degenerative disorder com promising the intervertebral foramen (Maitland et al 2005)
Several questions remain for the best evaluation and treatment of lumbar radiculopathy with disc herniation, it has been sug gested that a course of conservative treatment should be completed before the consideration of surgery (Rothoerl et al 2002)
There is strong support for the use of manual therapy for patients with cervical radiculopathy (Young et al 2009; Waldrop 2006), only moderate data support the role of manual therapy in the conservative treatment of lumbar radiculopathy patients (Schäffer et al 2007; Rhee et al 2006; Santilli et al 2006)
Summary
Radiculopathy is a disorder involving compression, impingement, irritation or inflammation of a spinal nerve root, which may be due to a disc protrusion or any local degenerative disorder com promising the intervertebral foramen (Maitland et al 2005). The patient experienced unilateral, sharp, severe pain, together with a neuro logical deficit (motor weakness and a decreased ankle reflex), which is indica tive of nerve root compression Her positive straight leg raise neurodynamic test was indicative of a disc disorder which was compressing a nerve root (Maitland et al 2005 & Brodke and Ritter 2004). L5/S1 grade II right rotation mobilisations were per formed three times for thirty seconds and massage and trigger point pressure release was performed as previously This improved her lumbar flexion to a level where her fingers reached five centimetres below her patella before buttock pain (P1) was reproduced. A telephonic follow-up three months thereafter revealed that the patient had not attended Pilates or continued with her prescribed exercises, she had not experienced any further pain
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