Mr. M, 40 years old visited the Orthocure clinic complaining of low back pain referring down the left buttock and back of thigh into the calf region. Pain started 8 months back after playing soccer with his kid; he kicked the ball too intensely. Before coming to Orthocure he went to orthopedic and was put on pain medicines and advised lumbar x-rays and MRI. MRI showed a large disc bulge at L5 and S1 that was impinging upon left S1 nerve root. After seeing the MRI orthopaedic referred him to neurologist, neurologist changed some medicines and advised physiotherapy. Mr. M took physiotherapy from some clinic recommended by neurologist. After initial assessment by the physio, he was seen 7 days a week for 2 weeks and was given ultrasound, Pain relieving machine (TENS), exercises including neural mobilization. The patient reported a minor improvement since the onset of pain but was still complaining of 7/10 pain which was initially 8/10. As he was not satisfied with the treatment outcome in that clinic he found out about Orthocure clinic through a friend who had also had treatment with us and was very happy with the outcome.
Mr. M reports a pain level of 7/10 and stiffness in the morning when he gets out of the bed, this eases off after around 1 hour once he is up and moving around. The patient reports awareness of a dull ache and tingling in the leg all the time which is worse with sitting for long periods and lying in bed at night. Patient enjoys playing soccer once a week with his kids and also likes running and body weight exercises which he used to do before the pain started but is unable to do this because of the pain and tingling. He would like to get back to playing, running and exercising but is quite fearful of causing more damage.
Mr. M presented with an altered walking pattern with reduced heel strike on left side. Leg length discrepancy was found, left being longer compared to right, the patient also demonstrated a bilateral overpronation when walking right more than left. On examination, the patient had restricted lower back movements, especially flexion (forward bending), which causes the referring left leg pain to return. He also presented with pain through the belt area of the back. There was a noticeable stiffness and a reduction in movement of the vertebral joints and on palpation, there was significantly increased muscle tension, tightness and pain throughout the left side lower back with major mechanical tension around the fascial structures of lower back muscles, glutes muscle, piriformis, hamstring, calf and plantar fascia. SLR and Cross SLR test was positive on the left side. Slump test was positive on the left side. Sensory and motor pattern of L5-S1 was also altered.
Time was taken to fully explain to Mr. M the treatment and rehabilitation protocols of Orthocure required to achieve the outcomes. We started our customized lower back pain four point treatment program where we diagnosed the Mr. M’s dysfunction and misalignment with our advance diagnostic techniques. Then, we started with our 2nd step of initial pain relief in which we gave him 12 alternate sessions(depending upon his situation, could go up to 24 sessions) of Spinal decompression which will reduce the stiffness and opens up the vertebral space enhancing blood circulation and increasing the nutrient intake of the disc thus promoting healing, along with spinal decompression we used neural mobilization and muscle release technique (twice a week) that included dry needling(in his case) of whole posterior chain muscles, (other techniques used can be cupping, matrix, myofascial release etc) to open up the mechanical barrier so that the nerve can slide and glide easily. We recommended him home exercises to help maintain the pain relief phase, it included extension exercises and portable pain relieving machine (TENS) machine, along with hot packs, back support cushion for sitting and advised correct sleeping posture. As soon as he started feeling better w.r.t pain and tingling in the leg (subjectively), we tested him again after 6 sessions for our special test (objectively). Test were still positive but less intense (pain was 5/10 with mild tingling), then after 12 sessions we tested him again and test came out negative (pain was 2/10 and tingling was almost gone). Mr. M was happy about it but treatment is still incomplete without structural correction, we tested Mr. M on our specialized muscle testing machine called Medx. Medx focuses on strengthening of deep core muscles of the back so that the chances of this happening again should be near to zero. We tested Mr. M’s strength on the machine and it came out below sedentary which was poor because according to him he is a pretty active person. We started with our 3 months protocol of Medx that is twice a week with him along with once in 15 days of spinal decompression to maintain the health of the disc. Every month of Medx focus on different aspect i.e. first month focus more on firing up the muscle and conditioning them, second month focus more on endurance and third month focus on building up the strength. During this three month of programme his pain went from 2/10 to 0/10 and there was no tingling at all. Every month he started feeling better and more active. When he completed his 3 month Medx, we tested him again for his strength that was below sedentary when we tested for the first time; His strength after 3 months of Medx got significantly increased than his actual active lifestyle. Now he is on his 4th point of our protocol i.e. maintenance and wellness. He is on Medx manintainace that is twice a month for 3 months and then once a month for year along with home exercises program with lots of core building and stabilization exercises. Lastly after 1st month of Medx we provided him with our Footbalance insoles to correct his overpronation of the foot which will further lead to less stress on the back.
OUTCOME OF TREATMENT
The patient reported all aggravating factors were resolved. No pain in the back and no radiation in the leg and walking pattern is much better. Sleeping was much improved and the ability to sit comfortably for extended periods of time was regained, though now understands the importance of maintaining good posture while sitting or while playing. Patient returned to playing soccer, running marathon with full energy and no constant dull pain. He is enjoying being able to return to previous activities without back pain and without the fear of back pain which had been hampering him for almost a year now.
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