A 35-years-old male with 2 years history of lower back pain and left sciatic pain.

【Objective】

This case study discusses management of lumbar disc herniation with degenerative disc disease and facet dysfunction using a program of chiropractic manipulation and an active rehabilitation program.

【Clinical features】


A 35-year-old male presented with a chronic 2 years duration of low back pain. The patient was diagnosed with lumbar disc herniation with facet arthropathy. He complained of pain that originated in his lower back region and radiated all the way down his left buttock region and into the back of his left posterior thigh and lateral calf. He reported his original injury occurred 2 years ago while at gym. The day prior to his injury he had performed an entire day of heavy bending and lifting at gym. The following day, he felt an immediate explosion of pain, originating in his low back and radiating down his left leg. He stated initially his pain levels were 8 or 9 on the visual analog scale, and the pain ran from his low back and radiated all the way down to his left foot. Initially he had numbness that encompassed his entire right lower extremity to the foot. The patient was prescribed pain killer medicines.

【Intervention and outcome】


Treatment plan and intervention consisted of patient education on proper posture and ergonomics, such as proper bending and lifting techniques, for both the home and at gym. An in-office chiropractic and rehabilitative exercise treatment program was commenced, with eventual transition from office based into home based therapy and exercises. The patient was instructed in and placed on McKenzie exercises, to be performed at home 3 times per day at 10 repetitions each session. Within 5 times visits, the patient showed good response ( 30% improvement ) to treatment, reporting a decrease in his signs and symptoms. Active rehabilitation was continued with the goal of restoring normal range of motion, improving core and spinal stability and strength, and returning the patient to original life and work. Upon reaching these goals he was released to home therapy and supportive chiropractic care with continued positive response. It took 20 visits until achieving these goals.

【Conclusion】

This study does suggest that chiropractic and rehabilitative care can relieve lower back and leg pain. Spinal deconditioning and a weakness of the core and spinal stabilization muscles appeared to be the cause of patient's symptoms and reduced physical capacities in this particular case. Management including patient education on proper posture, proper ergonomic lifting techniques, core and spinal stabilization exercises, and chiropractic manipulation were effective in this case.