Introduction
In our last article, we presented the history of lumbar traction for normalization of the lumbar lordosis in chiropractic. In this article, we will present a case report of a patient with a herniated lumbar intervertebral disc, who had been referred to us by a medical neurologist.
Case report
Figure 1A demonstrates the pre-treatment lateral lumbar radiograph of a 28-year-old female travel agent with low back pain and radiating right lower extremity pain secondary to a herniated disc at L4-L5. A line has been drawn across the posterior vertebral body margins of L1 through S1. A solid curved line representing the normal average lordosis derived from measurements taken from an ideal normal population without back pain or spinal pathology1-3 has been superimposed on the radiograph. These markings clearly indicate that, as compared to the normal average lumbar lordosis, this patient is hypolordotic with concurrent loss of disc space height at L4-L5.
Upon examination, the patient’s lumbar range of motion was mildly to moderately reduced in all directions. She had tenderness to digital pressure in the lumbosacral region, reported pain upon bilateral leg lowering in the supine position, and also experienced pain upon sitting up from a supine position. Straight leg raising was positive for the right lower extremity in both the supine and seated positions. All other orthopedic tests were negative, and her neurologic examination was unremarkable.
A program of structural based rehabilitation was initiated including lumbar extension exercises performed at a frequency of 10 repetitions per set and up to 10 sets per day. Standing lumbar extension traction (Figure 3), as described in our last article, was performed on each office visit for up to 20 minutes per session. In addition, spinal adjustments for pain reduction and increased mobility were also performed at each office visit. The frequency of office visits was 5 times per week for the first 2 weeks, and 3 times per week for the remaining 6 weeks of care. The patient reported 80-90 percent improvement in pain upon completion of the second week of treatment.
The rehabilitation program continued for the 6 additional weeks, whereupon a post-treatment radiograph of her lumbar spine was obtained. The normal average lordosis has once again been superimposed on the post-treatment radiograph as the solid curved line extending from the posterior-inferior vertebral body margin of S1. Comparison of the alignment of the posterior vertebral body margins of L1 through S1 to this normal average curve demonstrates a significant improvement. Functionally, her pain resolved, her range of motion normalized, and she was able to resume normal activities without restrictions.
Conclusion
Structural rehabilitation aimed at restoring more normal spinal alignment was demonstrated in this brief case report. In addition to helping this patient achieve better spinal and postural alignment, she also achieved improved function in the form of pain reduction, enhanced range of motion, and improvement in her ability to perform her activities of daily living. Upon discharge, she was given instructions to continue her lumbar extension exercises as a means of maintaining her improved structure and function. This was achieved through the combination of spinal adjustments, active exercise, and lumbar extension traction.
NOTE: This information in not intended as healthcare advice. The determination of the risk and usability of information rests entirely with the attending doctor of chiropractic.
References
1. Troyanovich SJ, Cailliet R, Janik TJ, Harrison DD, Harrison DE. Radiographic mensuration characteristics of the sagittal lumbar spine from a normal population with a method to synthesize prior studies of lordosis. J Spinal Disord 1997;10:380-386.
2. Harrison DD, Cailliet R, Janik TJ, Troyanovich SJ, Harrison DE, Holland B. Elliptical modeling of the sagittal lumbar lordosis and segmental rotation angles as a method to discriminate between normal and low back pain subjects. J Spinal Disord 1998;11;430-439.
3. Janik TJ, Harrison DD, Cailliet R, Troyanovich SJ, Harrison DE. Can the sagittal lumbar curvature be closely approximated by an ellipse? J Orthop Res 1998;16:766-770.
Dr. Roger R. Coleman is a 1974 graduate of Palmer College of Chiropractic, practicing in Othello, WA. He is a member of the Adjunct Research Faculty at Life Chiropractic College West, and on the postgraduate faculty of National University of Health Sciences.
Dr. Stephan J. Troyanovich is a 1987 graduate of Palmer College of Chiropractic, practicing in Normal, IL, and a member of the Adjunct Research Faculty, Dept. of Research, at Life Chiropractic College West. He may be reached at 309-454-5556.