Lumbar Spondylosis CaseFile

Keywords; lumbar spondylosis casefile, pincer deformity, hip stiffness.



This jawbreaker word basically means 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 lower back. Thus, to an extent, in the older person, it is a not unexpected or 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.

This is a stock photo, not from the patient below.


Groin pain @ 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

Pincer deformity

LUMBAR SPONDYLOSIS CaseFile:

CHIROPRACTIC EXAMINATION

No sacro iliac joint fixations were found, probably because of the previous chiropractic treatment.

There were marked L1 and L5 fixations on motion palpation.

Flexion fixation of the right hip was found.

Active trigger points in the Quadratus Lumborum, Pectineus and Adductor Magnus muscles were located.

A 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 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 Xray, 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: Hip stiffness

  • Positive Femoral nerve stretch test (think upper lumbar problem)
  • Limited right hip flexion with pain in the groin (think hip problem. Arthritis? FAIS?)
  • Active trigger points (think muscular problem)
  •  Fixations at L5 and L1 (think chiropractic lumbar facet syndrome ...)
  • 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:

  1. Pincer deformity: Femoro Acetabular Impingement syndrome.
  2.  Short left leg.
  3. Left convex scoliosis.
  4.  Lumbar spondylosis. Actually an irrelevant, incidental finding.


Chiropractic Help


TREATMENT of LUMBAR SPONDYLOSIS CaseFile

  1. Chiropractic adjustments of L1 and L5.
  2. Mobilisation of the right hip.
  3. Active release technique on the active trigger points and the hip joint capsule.
  4. 3mm heel lift in left shoe.
  5. 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 to grasp that it was a multi factorial case. As we say in Chiropractic education, remember the patient can have two diseases.

  • Radiating nerve pain from a high lumbar subluxation, called Maigne's syndrome.
  • Appreciating that we were dealing with a latent Femoro 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 foot orthotic 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 Femoro Acetabular Impingement Syndrome Pincer, or even a good page for Leg Length Inequality research ...


 

USEFUL LINKS @ LUMBAR SPONDYLOSIS CaseFile



» 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. 


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. 


Interesting questions from readers


Groin and/or thigh pain?

Do you have a question about leg pain? Share it!

[ ? ]

Upload 1-4 Pictures or Graphics (optional)[ ? ]

 

Click here to upload more images (optional)

Author Information (optional)

To receive credit as the author, enter your information below.

(first or full name)

(e.g., City, State, Country)

Submit Your Contribution

 submission guidelines.


(You can preview and edit on the next page)

What Other Visitors Have Said

Click below to see contributions from other visitors to this page...

Pain at point of hip and burning in front mid thigh Not rated yet
Pain at point of hip and burning in front mid-thigh. Hip pain is worse when lying on that side. Sitting for long periods aggravates hip pain and I will …

Click here to write your own.


Did you find this page useful? Then perhaps forward it to a suffering friend. Better still, Tweet or Face Book it.


Interesting challenges of the day

1. Mr S is a 76 year old man with neck pain of some 9 months duration. Luckily, most of the pain is upper cervical which is only rarely arthritic; his lower cervical spine is a degenerative mess that I've left alone. After seven treatments his pain and stiffness is 50 percent better, and he's happy in the circumstances. He can sleep through the night now and that makes a huge difference.

2. Mr P is 32 year old man with very severe lower back pain radiating to the big toe which is 30 percent numb. He had an episode three weeks ago, took anti inflammatories and was soon better as is typical of the medial disc herniation. But before it healed, after a trivia it came roaring back, much worse. The characteristic crossed sign was evident; sitting in a chair, straightening the right leg provoked severe left back pain and tingling in the leg. He's doing well.

3. Mrs T looked like the leaning tower of Pisa; she had a slipped disc at L5 making her lean towards the opposite side. It's called the postero lateral disc hernia; she's much better after two weeks of treatment and will go back to work next week, part time. Lateral discs are more difficult; both take a minimum of six weeks to heal. In my opinion, antalgic patients need what I call exercising bed rest. Sit and it won't get better.

4. Mr S has had lower back, groin and back of thigh and calf pain for fourth months. He has a pincer deformity in the hip causing the groin pain, and a degenerative facet causing the sciatica. Both are responding well to chiropractic and he's well pleased; sixty five percent better after three treatments.

5. Mr T is a wise man; he's taken a warning TIA seriously and has lost 15 pounds, and has at least as much again to lose. A change to a low starch diet and half hour daily walk has made the difference; but the walking is making his foot and back miserable. The expensive orthotic is hopeless; luckily his hips and back are fine, but he needs a simple heel lift.

6. I too have had serious lower back issues, luckily fixed by my own chiropractor; so I too have to do my exercises, take care when lifting supers full of honey, gardening and using the chainsaw. Regaining the function of your lower back is just as important as the pain.

7. My own granddaughter, only 7 is hypermobile giving her hip, knee and ankle issues. Xrays show a mildly dysplastic hip. Years ago we would have called it growing pains. She too regularly needs chiropractic care and luckily responds well. Hypermobility is more difficult that too stiff in my opinion. Chiropractic is for kids too.

8. This 65 year old lady is a serious gardener; every day is bending, lifting, digging for 2-3 hours a day; it regularly catches her in the sacroiliac joint, so she has a treatment once a month that sorts it out. She does her lower back exercises faithfully.

9. This 88 year old lady is an inspiration; every day she is busy in the community. With a nasty scoliosis she manages very well with a chiropractic adjustment every six weeks and exercises faithfully done.  

10. Mr X is a 71 year old retired man who wants to continue with maintenance care every six to eight weeks; he had suffered from two years of lower back pain when he first came a year ago. He has no discomfort now after 8 chiropractic treatments, but is aware that danger lurks.

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. Mr D is a 38 old year man with chronic shoulder pain after a rotator cuff tear playing cricket. It responded well to treatment, but he knows he must do his exercises every day; for two years he couldn't sleep on that shoulder.

13. Mr D, a 71 year old man, has a severe ache in the shoulder and midback since working above his head. Trapped nerve tests are negative but he has advanced degenerative joints of Luschka; after just two treatments he is 50 percent better. Can we reach 90?

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?


LOW BACK and LEG PAIN


Falls

Bending and twisting


Sitting

Short leg?


Lower back and leg pain


Lumbar facet syndrome


Slipped disc


Sacro-Iliac Joint


Spondylolysthesis


Examination

Interesting questions from visitors

CLS writes:

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.

Your own unresolved problem. Pose a question

Knowing that up to 70% of the time the correct diagnosis is made with no examination, no special tests, no xrays, but just from the history, there's a fair chance I can add some insight to your unresolved problem. But at least 30% of the time, I may be quite wrong! Give plenty of detail if you want a sensible reply.


You visited this chiropractic help site no doubt because you have a problem that is not resolving and want to know more about what chiropractors do.

The quickest and most interesting way is to read one of my ebooks of anecdotes. Described by a reader as gems, both funny and healthful, from the life and work of a chiropractor, you'll love them. Priced right at $2.99, though Kindle fiddles the price without telling me.