Conservative Management of a 31 Year Old Male With Left Sided Low Back and Leg Pain: A Case Report
SOURCE: J Can Chiropr Assoc. 2012 (Sep); 56 (3): 225-232
Emily R. Howell, BPHE(Hons), DC, FCCPOR(C)
Ashbridge’s Health Centre,
1522 Queen St. East,
Toronto, ON M4L 1E3.
OBJECTIVE: This case study reported the conservative management of a patient presenting with left sided low back and leg pain diagnosed as a left sided L5-S1 disc prolapse/herniation.
CLINICAL FEATURES: A 31-year-old male recreational worker presented with left sided low back and leg pain for the previous 3-4 months that was exacerbated by prolonged sitting.
INTERVENTION AND OUTCOME: The plan of management included interferential current, soft tissue trigger point and myofascial therapy, lateral recumbent manual low velocity, low amplitude traction mobilizations and pelvic blocking as necessary. Home care included heat, icing, neural mobilizations, repeated extension exercises, stretching, core muscle strengthening, as well as the avoidance of prolonged sitting and using a low back support in his work chair. The patient responded well after the first visit and his leg and back pain were almost completely resolved by the third visit.
SUMMARY: Conservative chiropractic care appears to reduce pain and improve mobility in this case of a L5-S1 disc herniation. Active rehabilitative treatment strategies are recommended before surgical referral.
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From the FULL TEXT Article
Low back pain has been reported as the chief complaint for 23.6% of patients presenting to chiropractic offices.  Disc herniations that lead to nerve-root compromise account for less than 15% of chronic low back pain cases.  Over 95% of lumbar disc herniations occur at L4–5 or L5-S1 levels, and only 2% of herniations require surgery, 4% have compression fractures, 0.7% have spinal malignant neoplasms, 0.3% have ankylosing spondylitis and 0.1% have spinal infections. [2, 3]
Leg pain is estimated to be found in 25–57% of all low back pain cases and accounts for large costs, disability, chronicity and severity. [4, 5, 6] Many conservative treatments have been shown to be effective in the management of this condition and are favorable to pursue before considering any surgical interventions, such as: modalities, soft tissue therapy, spinal manipulations or mobilizations, pelvic blocking, McKenzie/end-range loading exercises, lumbar stabilization exercises and neural mobilizations, patient education, reassurance, short-term use of acetaminophen, and nonsteroidal antiinflammatory drugs. [2, 3, 7–24] The purpose of this case report is to describe the successful management of a patient with low back and leg pain.
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