Case Study – Lumbar Canal Stenosis

January 9, 2014 | By | Reply READ MORE...

– Dr. Hasan Sayed

CASE:

  • 72 year old Mrs.X, came to us with complaints of a dull aching pain in the left leg on walking, originating in the buttocks & thigh, radiating up to the back of the calf, since 1 year.
  • She was not able to walk for more than 10 minutes because of pain and had to stop, sit and wait for the pain to subside (Claudication).
  • Being retired, she spent most of her time sitting in front of the computer for long hours; which used to worsen her pain.
  • She had also discontinued going for her daily walks due to pain.

INVESTIGATION:

  • MRI showed narrowing of L5-S1 foramina on the left side.
  • DEXA scan revealed osteopenia → Taking supplements for same.

SURGEON’S ADVICE:

  • Surgery to relieve narrowing of the foramina.

PHYSIOTHERAPY DONE:

  • Therapeutic ultrasound on the low back.
  • Traction to lumbar spine.
  • Some abdominal training.

Physiotherapy gave a little relief that time but symptoms relapsed.

EVALUATION:

  • Overweight lady with increased arch in the low back.
  • Lax abdomen with poor core and buttock muscle strength.
  • Tight low back and thigh muscles.
  • Sensitive nerve exiting lumbar spine ( Sciatic nerve).

Claudication due to reduced blood supply in the leg was ruled out as –

  • Peripheral arterial pulses were normal in rate, rhythm & volume.
  • The pain was dull aching and not cramping.
  • Also the pain started from the buttocks & migrated distally into calf, whereas in vascular claudication the pain starts in the calf.

In case of Mrs. X, due to a tight low back and lax abdomen, there was an exaggerated lumbar curve, which was putting pressure on the exiting nerve root by narrowing of lumbar canal, causing Lumbar Canal Stenosis.

Lumbar Canal Stenosis

Mrs. X needed a comprehensive exercise program in order to relieve pressure from the nerve root.

TREATMENT APPROACH:

1) Postural Re-education: Mrs. X was advised on how to correct& maintain her standing and sitting posture in functional activities. Sitting and standing with an arched back was further putting pressure on the nerve roots, causing pain.

2) Decompression program: In order to relieve pressure on back by axial elongation.

3) Flexion based exercises to reduce the lordosis.

Core training:
Graduated core muscle training to strengthen abdominal muscle.
First start with basic core exercises to strengthen back → advanced abdominal training.
Lumbar Canal Stenosis

Flexibility training:
In order to stretch tight low back and thigh muscles.
Lumbar Canal Stenosis

4) Desensitization of Sciatic Nerve:
Neural tissue mobilization was given in order to reduce pain in the leg.

After about 6 weeks of treatment, Mrs. X was able to walk for about 1 hour without any symptoms. She also resumed her daily walks & was comfortable in a sitting posture.

An individualized, tailor made exercise program at PHYSIOREHAB helped Mrs. X to be symptom free & resume all her activities at the earliest.

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Category: Case Studies

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