At her initial visit, the patient reported no numbness, tingling, or burning sensations accompanying her pain. She also reported no loss of bowel or bladder control. The patient recalled having low back pain for years during active military duty (2005-2011) and having a recurrence of pain just before her discharge in 2011. At that time, her pain had been successfully managed with high-velocity, low-amplitude OMT. The patient noted that she had been treated for a fracture of the left fifth metatarsal bone 6 months before presentation. She had worn an orthopedic boot and walked with crutches for 8 weeks after the injury to her left foot. She believed that the recurrence of her lumbar pain was a direct result of the difficulty she had ambulating while wearing the orthopedic boot. The patient reported pain when lying on her back, jogging, and performing yoga poses. She believed her low back pain was stable despite a recurrence of aching symptoms while training for a marathon competition. In recent visits to her civilian primary care physician, she had found no relief with nonsteroidal medications, muscle relaxants, heat, or rest.
The initial physical examination revealed lower extremity muscle strength of 5 on a 5-point scale bilaterally, intact peripheral sensation bilaterally, tendon reflexes of 2 on a 4-point scale, and a negative straight leg raise test bilaterally. The patient had no lateralizing neurologic signs. Somatic dysfunction was present within the cervical, thoracic, and lumbar areas of the spine; a prominent gait dysfunction due to leg length inequality and an un-level sacral base were also found. Specifically, the patient was found to have a posteriorly rotated left anterior superior iliac spine, a right-on-right forward sacral torsion, and a physiologic short left leg as determined with palpation.
A plain radiograph (
Figure 1) of the lumbosacral spine revealed a mild left convex scoliosis. All lumbar disk spaces were found to be normal, and no degenerative changes were present. No acute findings were noted. A radiograph of the patient's hips did not reveal any abnormalities.
Fascial release and craniosacral OMT techniques were initiated at the first appointment and reduced the patient's self-reported pain from 7 to 0 on a 10-point scale. High-velocity, low-amplitude was not used in this case. A 6-mm shoe lift was also provided to address the patient's un-level sacral base.