Articles in Category: General Health

Case Study: Low Back Disc Complaint

on Wednesday, 06 March 2019. Posted in Newsletters, General Health, Ergonomics, Chiropractic

Case Study: Low Back Disc Complaint

A 39 year old female presented to our clinic complaining of severe low back pain with left leg referral down into the toes. The problem had started ten days previously for no apparent reason; however, it may have been related to a lifting incident. The patient had presented to the hospital for assessment. She was given pain killers and sent her home. She presented two days later to her GP who once again gave her a prescription for pain killers and sent her home.

On presentation at our clinic she was unable to stand on the toes on the left leg. Presentations of leg referral with weakness or loss of ability to stand on the toes or standing on the heels are always a concern to practitioners. “ Hard neuro signs” can indicate significant compression on nerve roots that can create long standing complications if not addressed readily. Further examination revealed a loss of heel reflex and a straight leg raise of 25 degrees on the left hand side. Additionally there was loss of sensation in parts of the foot and lower leg on the left hand side.

The patient was referred for an MRI which showed a significant disc bulge at L5/S1 on the left hand side, compressing the S1 nerve root. Due to the loss of reflexes and muscle weakness, treatment was initiated with the requirement that significant progress needed to be made within a week or otherwise urgent referral for a neurosurgical consultation was required.

Due to lack of progress she was referred to a neurosurgeon who performed a micro discectomy. The patient presented to our clinic 1 week post-operatively for rehabilitation.

We progressed through a range of decompression exercises, re-strengthening and postural re-training exercises to help her return to normal and fortify the system to protect against future injury.

For these types of cases, patients return to work within 4-6 weeks for office work or 6-12 weeks for manual workers. Full resolution is reached within 12 months.

In this instance the patient had a very good outcome and returned to normal work and activities with no long standing disabilities or ramifications.

This type of case highlights the importance of doing affective neurological and orthopaedic testing to identify correctly what is happening. This appropriate imaging and management to ensure that serious problems are not missed and they are cared for in the most appropriate manner.

We have unfortunately seen other cases similar to this that have not been managed well that have ended up with permanent disability as a result of miss-management.

If you have a significant low back and leg referral complaint, it is always advisable to have this analysed affectively by your trusted health care practitioner.

Shockwave Therapy

on Tuesday, 05 March 2019. Posted in Massage, Newsletters, General Health, Sporting Injuries, Training and Performance

Shockwave Therapy

Shockwave Therapy

Shock wave therapy is a low frequency shock wave focused treatment that targets a specific acute or chronic condition. It is classified as a non-invasive treatment that generates acoustic shock waves, via a hand held device. Shock wave is a multidisciplinary device that can be utilised by chiropractors, physiotherapists, remedial massage therapists, sports medicine, urology and veterinary medicine. This hand held device helps kick start the body’s natural healing ability within the tissue, this is done by stimulating the metabolism, and increasing blood circulation. Its main assets are fast pain relief and mobility restoration.

Some of the conditions that can be treated from shock wave therapy are:

-          Plantar fasciitis

-          Heel Spurs

-          Tennis elbow/Golfer’s elbow

-          Chronic Tendinopathy

-          Shin Splints

-          Calcifications

-          Hip pain

-          Hamstring injuries

-          Shoulder pain

-          Muscle, Myofascia & Trigger Points

Shock wave therapy has been said to be an ideal therapy for injuries/conditions that have been unresolved by medications, rest and other therapies, but with the combination of shock wave and other therapies it can be utilised to help speed up injury recovery times. The treatment of shock wave can be a little painful, but depending on the patient and the type of condition being treated the intensity can be changed throughout the session.

Written By Luke Attkins

Dip Remedial Massage, Certificate IV of Massage Therapy

Low Back Pain (LBP) associated with Leg Pain/Discomfort

on Thursday, 14 February 2019. Posted in Newsletters, General Health, Ergonomics, Chiropractic

Low Back Pain (LBP) associated with Leg Pain/Discomfort

Practitioner: “Can you please describe your problem for me?”

Patient: “Yes. I have this Chronic Lower Back Pain that if it triggers, I can feel in my leg(s) as well. I start work from 9am, the pain will start crawling in after an hour of sitting, and then I can feel the pain down into my leg(s) after that. But, if I stand up and walk around a little bit, the pain will ease. This is why I have been putting treatment off for so long.”

 

Does this sound familiar?

The question is why does the LBP sometimes follow with leg pain? If the LBP is already a pain in the backside, why does the leg pain love to join the party?

If we look into the User’s Manual for the human body – lower body in particular, the question can easily be answered.

 

The difference between disc origin and muscular origin is if the pain travels below the knee. This is the reason why most practitioners are critical to the pain below or above the knee. If the pain travels below the knee, it is suggested to be disc lesion. If the pain does not travel below the knee, it is suggested to be muscular-related. Unfortunately, there is a User’s Manual 1.1 that specifies that each person is unique, and there could be an occasional case where the above situation differs.

 

Studies have shown that younger patients experience more discomfort in a sitting position due to increased disc pressure, but gain relief by standing up and walking (Souza, 2014). Whereas older patients have trouble when walking or standing due to gravity pull with a compressive effect that applies pressure onto the posterior (back) aspect of the region (Souza, 2014).

 

The patient sometimes describes the pain only in one leg or both legs at the same time. The difference between the two is disc-related pain for one leg and stenosis-related (narrowing) leg pain for both legs.

 

Pain below the knee is suggested to be caused by a disc lesion; chiropractic treatment usually has a beneficial effect and is able to achieve a good result.

 

Pain above the knee is suggested to be muscular-related. A trigger point is a term used to describe a tender area of the body that is irritated by a particular muscle group and has created a referral pattern to another area of the body. An example such as, an iliopsoas trigger point can cause referral pattern down to the front of the thigh, a piriformis trigger point can cause referral pattern down to the back of the thigh, or a Tensor Fascia Lata (TFL) can cause referral pattern down to the side of the thigh. These three muscles are located either deep inside our lumbar region or on the side of our hip region, which can mimic LBP. If by adding trigger point patterns into the equation, we have a lower back pain associated with leg pain/discomfort symptom.

 

Therefore, finding a practitioner with the advanced ability to diagnose this is essential to determine which type of treatment is most suitable for the patient. Once the partitioner is found, it would be wise to stick with them. If the partitioner provides effective treatment, plus a strong ethical view, it is considered hitting the jackpot.

 

 

Written by David Hsu

Dip Remedial Massage, Bachelor Rn. Diploma Osteopathy (Canada)

 

Reference:

Souza, T. (2014). Differential Diagnosis and Management for Chiropractors. Burlington: Jones & Bartlett Learning, LLC.