The Effect of Soft Tissue Release at the Thoracolumbar Junction in a Patient with Bilateral Leg Symptoms: A Case Report

Abstract

Background: Manual therapists mostly see patients with bilateral leg symptoms. Pain, pins and needles, fatigue, heaviness, lower limb coldness, and loss of neurological conduction are the patients’ symptoms. It is hypothesized to be caused by the sympathetic nervous system. Few publications cover its pathophysiology, diagnosis, and treatment. Limited research has examined the consequences of soft tissue release at the thoracolumbar junction. This case describes STR in a patient with bilateral leg symptoms.Case Report: A 39-year-old female presented with bilateral leg symptoms, especially the left leg, with more intensity at night. The symptoms started without a clear cause almost two years ago. She had clear low back pain 2 years ago. The sacroiliac joint and neurologic tests were normal. The examiner found some stiffness in the hip joint range of motion and SLR, especially on the left side. The patient reported some stiffness during active lumbar ROM, especially in rotation to the right and flexion. Palpation revealed tenderness in the piriformis, biceps femoris, and gastrocnemius muscles and L5, especially on the left side, and hypomobility in the thoracolumbar junction. The patient has been treated for 10 sessions with a 6-week multimodal approach consisting of STR, the Garston technique, and electrical stimulation in the thoracolumbar junction. The patient was assessed four times. She had a significant decrement in the Numerical Pain Rating Scale (NPRS), the Oswestry Disability Index (ODI), the Global Rating of Change Scales (GRC), and the Beck Anxiety Index following the interventions. She could do her personal activities and would sleep without the sedative.Conclusion: T10 to L2 supply lower extremity sympathetic nerve fibers. This case study demonstrates that these treatments could help these clinical presentations. Interventions with STR need more research. Therapists should evaluate the thoracolumbar junction and SNS in individuals with bilateral leg symptoms without a dermatomal pattern.