Clinical Features: A 43-year-old female experienced severe right lumbar, right sacrum, and right acetabular pain and muscle spasms occurring after playing a vigorous tennis match 16 years earlier. Pain intensity was rated as 8 out of 10 on a variable analog scale. Prior treatments included prolonged bed rest, cortisone injection, chiropractic manipulation, stretching, acupuncture, physical therapy, and other rehabilitation interventions. By the time of presentation she also experienced right arm and right upper back pain. A lumbar MRI scan showed an L4/5 disc bulge. Patrick’s, Yeoman’s and Kemp’s tests were positive on her right side. She had an asymmetrical gait pattern with a right hip hike, lateral shift and rotation of the pelvis. Weakness of the left gluteus maximus, gluteus medius, and right erector spinae muscles was present. Motion palpation revealed several fixations. There was tenderness to palpation of the right psoas muscle and a trigger point in the right illiacus muscle.
Intervention and Outcome: Home-based rehabilitation including low-tech muscle-specific patient controlled dynamic spinal stabilization exercises, cardiovascular training and various stretching techniques was incorporated with chiropractic manipulation. Significant improvement was noted within a 40 week treatment course.
Conclusion: Incorporation of active patient participation seemed to be a significant factor in the resolution of the patient’s low back pain. Active patient participation improved the quality of life for this patient.
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