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Case #6:

Case #6:. History & Examination Findings. 35 yr-old male low back/leg pain following a work injury: Laminectomy 4 th & 5th lumbar, 6 months prior. Narcotic medication ( Vicodin ), that he took twice daily, LBP 8/10, Oswestry 74% Reduced ROM, 15° Flexion, could not perform Extension,

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Case #6:

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  1. Case #6:

  2. History & Examination Findings • 35 yr-old male low back/leg pain following a work injury: • Laminectomy 4th & 5th lumbar, 6 months prior. • Narcotic medication (Vicodin), that he took twice daily, • LBP 8/10, • Oswestry 74% • Reduced ROM, 15° Flexion, could not perform Extension, • Muscle strength testing- weakness of left leg flexors (4/5), • Left achilles reflex could not be elicited, • Left L5 dermatome revealed lack of pricking sensation

  3. Orthopedic testing • Positive orthopedic tests included: • Left leg Minor’s sign • Kemp’s sign • Toe walk • SLR at 45 degrees • Well-Leg raise at 45 degrees • Milgram’s test

  4. Case #6: Post-Surgical Laminectomy Posture • Forward head translation (+TzH) • Left head translation (+TxH) • Left thoracic translation (+TxT) • Posterior thoracic translation (-TzT) • Right thoracic lateral bending (+RzT) • Left posterior pelvic rotation (+RyP)

  5. Case 6: X-ray Findings & Impression • (Osteopenic hole) at L4-5 levels • Forward head posture (47mm) • Left head translation (14mm) • Reduced cervical curve (19 degrees) • Reduced lumbar curve (23 degrees) • Left thoracic translation (16mm)

  6. Initial treatment and outcome • Consisted of mirror image adjustments • Lateral translation traction • Mirror image exercise for lateral translation • After 36 visits an A-P lumbar and lateral cervical radiograph were taken

  7. Mirror Image® Drop Table & Instrument Adjustment

  8. Mirror Image® & Rehab Exercise:

  9. 36 Visit Re-Exam & X-rays • Thoracic translation: 16mm to the left to 1mm right • Chief complaint: now lateral calf pain rated 2/10 • Revised Oswestry: 74% to 40% disability • Lumbar ROM: flexion limited to 70 degrees, patient was able to perform extension • All initial orthopedic tests were now negative • Achilles reflex: now elicited (rated 1/2) • Dermatome testing revealed improved sensation to pricking along the left L5 dermatome

  10. 36 Visit Post x-ray findings

  11. Following first post x-ray: After 36 Visits • Lateral translation traction was eliminated • Thoracic extension exercises were added using a Roman chair at 10-15 repetitions • Cervical traction was initiated using the extension-compression chair for three months • At 6 months, cervical traction was changed to cervical compression extension with a harness for +TzH (8lbs for 12 mins)

  12. Mirror Image® Exercise Drop Table • Did not Have Picture of Actual Roman Chair Exercise

  13. CBP® Mirror Image® Traction

  14. Outcome after 9 months • Low back NRS was 0/10 • Revised Oswestry scored: 74% to 40% to 24% disabililty • All orthopedic tests were negative • Achilles reflex: reduced on the left 1/2 • Left L5 dermatome revealed normal pricking sensation • Patient no longer required narcotic pain medications • Lateral cervical x-ray: +TzHfrom 47mm to 36mm • Cervical lordosis increased from 19 to 32 degrees • Atlas plane line: 16-23 degrees • A-P lumbar x-ray: 1mm to the right (was 1mm left)

  15. 108 Visits: ROM Improved, NRS 0/10, Oswestry 24%

  16. Before & After Lateral Cervical

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