Background: To describe the management of a female patient with lumbopelvic and genital pain who responded to conservative management after ruling out visceral causation.
Case Presentation: A 56-year-old female Army veteran presented with chronic lumbopelvic and genital pain. Her primary care physician ruled out pelvic visceral origin. The patient was diagnosed with an upper lumbar derangement.
Management and Outcome: A directional preference, as defined by Mechanical Diagnosis and Therapy, was identified on evaluation, which guided our home exercise prescription. The patient was treated with mechanical flexion-distraction spinal manipulation in our office. Outcome measures included the Oswestry Disability Index (22%) and numeric pain scale (7 out of 10). The patientwas discharged from an active care plan symptom-free with improved Oswestry Disability Index (2%), and she exhibited confidence in home care to successfully manage potential future episodes.
Conclusions: A female patient with lumbopelvic and genital pain responded favorably to flexion-distraction spinal manipulation and home exercise. A follow-up phone call 3 months later found the patient experienced a single episode of axial lumbar spine pain. She reported she self-managed the reoccurrence to resolution with the use of her home exercise plan. A musculoskeletal origin for lumbopelvic and genital pain should be considered when visceral etiology has been ruled out.
Author keywords: lumbopelvic pain, chiropractic, flexion-distraction spinal manipulation, directional preference, McKenzie, Veteran, derangement
Author affiliation: Physical Medicine & Rehabilitative Services, VA Butler Healthcare
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