LUMBAR SPONDYLOSIS CaseFile
(Keywords: LUMBAR SPONDYLOSIS CaseFile, Chiropractic Help, Femero Acetabular Impingement Syndrome Pincer deformity, hip pain, groin pain, anterior thigh pain ) The word "spondylosis" means basically wear-and-tear in the joints of the spine. The term describes the osteophytes, or bony outgrowths that emerge from the vertebral bodies of the spine. Thus to an extent, in the older person, it is a not unexpected or an unusual finding. They are usually asymptomatic, but give an indication of a spine that has been under stress. They grow to stabilise the back. Only in some people, for one reason or another, it is greatly advanced causing gross changes sometimes affecting the nerves as they exit between the spinal joints, especially when they grow out from the posterior margin of the vertebral body.
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CASE HISTORY
A sixty-two year old woman has had lower back pain for five years. Two years ago pain began on the side of the hip. Within a few months in started to hurt in the groin, with a radiating pain down the front of the right thigh towards the knee. Walking became difficult and painful, both dawdling as when shopping, and when trying to go for a walk. Antiinflammatory drugs brought temporary relief. Treatment by another chiropractor and by a physiotherapist helped only marginally. Exercises aggravated the problem.
ANTI INFLAMMATORY DRUGS ...
LUMBAR SPONDYLOSIS CaseFile: Physical examination
On observation, she clearly had a marked scoliosis (spinal curvature) but no obvious short leg. Forward bending caused mild-to-moderate low back pain, and no pain in the leg. Exension of the spine was rather more painful, but neither caused leg pain. The Sciatic nerve (which comes from the LOWER lumbar spine) stretch test was negative, but the Femoral nerve (UPPER lumbar spine) stretch test was strongly positive with pain in the front of the thigh. There were no abnormal sensory or muscle weakness signs. The achilles reflex (S1) was zero. Sacro-iliac orthopaedic tests were negative. Flexion of the right hip caused pain in the groin, but internal and external rotation were relatively normal.
X-RAYS
CHIROPRACTIC EXAMINATION
No Sacro-iliac joint fixations (probably because of the previous chiropractic treatment).Marked L1 and L5 fixations on motion palpation. Flexion fixation of the right hip. Active trigger points in the Quadratus Lumborum, Pectineus and Adductor Magnus muscles. 3mm heel lift in her left shoe markedly improved the spinal proprioception test.
DISCUSSION
Solving a back problem is in some ways like a game of Su Doku. Having gone thoroughly through all the basics, one has to start looking for polygons and triplets and uniques. Often they are obscure and there may be diversions that only lead down a cul-de-sac. One such cul-de-sac was the lumbar spondylosis seen at L3. The joint looks horrid on the X-ray, but clinically proved irrelevant. Significant findings: Positive Femoral nerve Stretch test (think upper lumbar problem)Limited right hip flexion with pain in the groin (think hip problem)Active trigger points (think muscular problem)Fixations at L5 and L1 (think chiropractic subluxations)Slightly short left leg (too small to be detected by simple observation but seen on X-ray (think leg length inequality). Significant X-ray findings: - Pincer deformity: Femero Acetabular Impingement syndrome.
- Short left leg.
- Left convex scoliosis.
- Lumbar spondylosis. Actually an irrelevant finding.
TREATMENT of LUMBAR SPONDYLOSIS CaseFile
- Chiropractic adjustments of L1 and L5.
- Mobilisation of the right hip.
- Active release technique on the active trigger points and the hip joint capsule.
- 3mm heel lift in left shoe.
- Vigorous appropriate rehabilitation exercises.
PROGRESS @ LUMBAR SPONDYLOSIS CaseFile
Some conditions are bastards and take weeks and even months of struggle on the part of both patient and chiropractor before there is significant improvement. This lady unexpectedly responded positively within the first two weeks.Now, after six weeks, she has almost no pain, and can walk normally. The key point in her case were the grasp that it was a multi-factorial case. - Radiating nerve pain from a high lumbar subluxation (called Maigne's syndrome).
- Appreciating that we were dealing with a latent Femero Acetabular Impingement Syndrome FAIS.
- What completed the picture was the heel lift. Because the leg length deficiency was so marginal, I refrained from providing a heel lift in the first few weeks. But the correction of the short leg, reducing the scoliosis and balancing the pelvis, brought even better positive results.
All in all a most satisfactory outcome. She now comes in every six weeks for maintenance. If possible I hope to extend that to eight or ten weeks. She does her exercises faithfully. Confession: These are very small lumbar spondylosis osteophytes, and the name of this page could perhaps be better Maignes syndrome or Femero Acetabular Impingement Syndrome Pincer, or even a good page for Leg Length Inequality research.
MAIGNES SYNDROME ...
FEMERO ACETABULAR IMPINGMENT SYNDROME PINCER ...
LEG LENGTH INEQUALITY RESEARCH ...
USEFUL LINKS @ LUMBAR SPONDYLOSIS CaseFile
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ERECTILE DYSFUNCTION? FOODS THAT LOWER CHOLESTEROL ...
QUESTIONS
The Pincer deformity is just as evident in the left hip. Why only right thigh and groin pain?It's hard to be sure, but I feel the irritated high lumbar nerve, and the short leg are probably behind it. Only a dedicated research programme can sort out these mysteries. Why the loss of the S1 (lower lumbar) reflex? Probably an old injury, reflexes often do not return. This was not an S1 sciatica, but the subluxation at L5 was (in addition to L1) an important part of the overall treatment. Many medical people believe that a short leg less than 10-15mm is not significant. I heartily disagree, but that too needs to be researched.
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