Chiropractic and rehabilitation management of a patient with extraforaminal entrapment of L4 nerve with balance problem

Subtitle:

Article type: Case Report

Authors: Alagha, Babak^*

Affiliations: Department of Aerospace and Subaquatic Medicine, Aja University of Medical Sciences, Tehran, Iran

Correspondence: [*] Corresponding author: Babak Alagha, MD, DC, CAsP (Board Certified in Aerospace Physiology). E-mail:babak.alagha@gmail.com

Abstract: BACKGROUND: Disc herniation is one of the most common causes of low back pain with radicular pain. Among various types of disc herniation, the extraforaminal disc herniation is a rare cause of lumbar radiculopathy. The aim of presenting this case study is to demonstrate the benefits of Chiropractic care including spine and extremity manipulation and rehabilitation in the treatment of a rare case of extraforaminal L4 nerve entrapment causing severe L4 radiculopathy and chronic mild low back pain (LBP). OBJECTIVE: The aim of presenting this case study is to demonstrate the benefits of Chiropractic care including spine and extremity manipulation and rehabilitation in treatment of rare case of extraforaminal L4 nerve entrapment which caused severe L4 radiculopathy and chronic mild low back pain (LBP). METHOD: A 45-year old female patient arrived at the clinic with chronic mild low back pain and right buttock pain, all of which had presented for two years' duration. During the preceding month, the radicular pain initiated in medium to high intensity, radiating to her right leg following the L4 dermatomal pattern with a periodic tingling sensation in her right foot. A neuro exam demonstrated a proprioception deficit in her right leg. A Romberg test was positive. The patient was treated by low amplitude high velocity spinal and extremity manipulation for 10 consecutive sessions (2 weeks), followed by rehabilitation and exercise therapy including advanced myofascial release therapy for an additional 12 sessions (4 weeks). RESULTS: After treatment, the patient reported a significant improvement in her low back pain and radiculopathy. In addition, she achieved some improvement in balance. CONCLUSION: It seems that Chiropractic care and rehabilitation therapy may be a safe and effective modality in treatment of an L4 radiculopathy in a patient with an extraforaminal L4 nerve entrapment. Although it is rare, an L4 extraforaminal disc herniation should be considered as a possible cause of symptoms in patients with chronic mild low back pain and severe L4 radiculopathy.

Keywords: Chiropractic care, L4 extraforaminal nerve entrapment, L4 radiculopathy, low back pain, extraforaminal disc herniation

DOI: 10.3233/BMR-140557

Journal: Journal of Back and Musculoskeletal Rehabilitation, vol. 28, no. 3, pp. 603-607, 2015