(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. These are stock photos, not from the Lumbar spondylosis casefile below.
CASE HISTORY @ LUMBAR SPONDYLOSIS CaseFile
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 she started to experience groin pain, 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. She was unable to garden, her favourite hobby.
Anti inflammatory drugs brought temporary relief. Treatment by another chiropractor and by a physiotherapist helped only marginally. Exercises aggravated the groin pain.
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 groin pain, but internal and external rotation were relatively normal.
She failed the Ten Second Step Test ...
LUMBAR SPONDYLOSIS CaseFile: X-RAYS
LUMBAR SPONDYLOSIS CaseFile:
No Sacro-iliac joint fixations were found (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.
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. Clearly this was an acquired condition, whereas the Pincer deformity is congenital. But they correspond neurologically, both to the Femoral nerve. It's my opinion, that a hip condition, either neurologically, abnormal muscle tension, altered gait can actually cause the lumbar spondylosis, but this actually chiropractic heresy. Is it vice versa?
Other significant findings:
Significant X-ray findings:
TREATMENT of LUMBAR SPONDYLOSIS CaseFile
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 to grasp that it was a multi-factorial case. As we say in Chiropractic education: "Remember the patient can have two diseases."
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 Femoro Acetabular Impingement Syndrome Pincer, or even a good page for Leg Length Inequality research ...
USEFUL LINKS @ LUMBAR SPONDYLOSIS CaseFile
CAUSES OF OSTEOPOROSIS
For a woman of 62-years not to be able to walk easily and freely, is not only painful and disabling. By failing the TEN SECOND STEP TEST her life expectancy was also being cut short. Why? Many reasons but one obvious one is that, not being able to enjoy all the walking benefits, she was failing in one of the prime causes of osteoporosis. Lack of exercise.This however was not a neurological abnormality, but an inability to easily flex the hip. After treatment she could perform the test quite normally.
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Interesting challenges of the day
1. Mr D has very severe midback back. He bent and twisted, feeding his son, and then laughed. Every breath is a nightmare. A sprung rib is every chiropractor's delight. He or she has golden hands. 30 percent better after one treatment.
2. Mrs C has a long history of severe, disabling migraine headaches since having her wisdom teeth removed. She clenches her teeth at night. After six treatments she has no migraines but some jaw joint discomfort remains; a bite plate is in the offing.
3. Mrs U has the trophy for the worst back this year. After major surgery with plates and screws two years later she still had paresis in the lower leg and severe disabling back pain. She's doing far better than expected, in no little part due to a lift in her shoe for a very short leg.
4. Mr V is 86 years old and hurt his back helping his wife into the car. Just one treatment of the sacroiliac joint and he's eighty percent better. It's not always like that.
5. Mr W lay on his back knocking down a pillar. Turning his head causes severe vertigo. He needs the Epley exercises, not pills, research shows. Update, he's fine.
6. I myself had an acute exacerbation of a femoral nerve lesion last year. One immediate treatment by my colleague has fixed the pain in the lower back, but there's some residual numbness in the lower leg; no soaring tomorrow alas.
7. This lady is a 86 year old woman with a 63 scoliosis. Chronic lower back has been her lot in life but she's well pleased with chiropractic and comes for chiropractic help once a month; some conditions you can never cure.
8. She is an 78 year old woman, is doing remarkably well with a bad sciatica. But over 200 pounds she is not losing weight; in fact, gaining despite my suggestions. She's high risk for a stroke. I have referred her to a dietician to crack the whip.
9. A 61 year old man with upper cervical pain yesterday; it's not severe but also not getting better of its own accord. He's afraid it may turn very acute as when I treated him three years ago. Since then it's been fine.
10. A 64 year old woman has had scheuermanns disease; it's left her with a spinal kyphosis and chronic middorsal pain. She responds well to chiropractic treatment provides she come every six weeks or so for maintenance treatment.
11. Mrs C has been having severe headaches, and taking a lot of analgesics. It's a non complicated upper cervical facet syndrome, and she's doing well.
12. Mrs D, a middle aged woman with hip pain of one year duration, despite other treatment. Xrays reveal an impingement syndrome and early hip arthritis. There's much to be done.
13. Mrs B has had one of the nastiest of conditions; vertigo caused by a disturbance in the inner ear. Falling repeatedly and vomiting she consulted her doctor but medication didn't help. After two sessions of the Epley manoeuvres she was 50 percent better. After two weeks 75 percent improved. No longer vomiting all falling. She's not enjoying the Brandt Daroff home exercises.
And so the day goes; chiropractors shouldn't be treating the elderly most medical sites state but that's so much bunkum.
Have a problem that's not getting better? Looking for a different slant on your pain? Want to pose a question?
Bending and twisting
Lower back and leg pain
Lumbar facet syndrome
Greetings, Dr B.
You helped me quite some time back with a soothing and professional response which turned out to be exactly correct. I now consult a local chiropractor. You write a superb newsletter, too.
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