Narrowing of the spine manual#
Narrowing of the spine full#

Moderate tenderness is noted during palpation of the L4–5 and L5–S1 spinal segments.

Narrowing of the spine full#

Hip examination reveals full and painless ROM. No atrophy of the calf muscles are noted and during palpation of the lower extremities pulses appear present and bilaterally equal and her feet appeared warm.

There is an absent left Achilles reflex with no evidence of lower extremity sensory or motor deficits. End range SLR with dorsiflexion of the foot 6 reproducing moderate calf pain bilaterally. Supine SLR 6 is mildly limited by tight hamstring muscles bilaterally. Sitting straight leg raising (SLR) 6 is full and painless bilaterally. Lumbar extension is moderately limited and reproduces lumbo-sacral back pain but not lower extremity symptoms.

Range of motion (ROM) of the lumbar spine is full and painless during forward flexion. She can toe-heel walk and squat without difficulty. On examination, she is slim built, stand with a flattened lumbar lordosis and has difficulty with balance testing. She had a previous arterial Doppler ultrasound test of the lower extremities, the results were equivocal.

AK had a previous history of Raynaud’s Syndrome involving the upper extremities, and was under the care of a rheumatologist for Sjogrens Disease which was in remission. She takes high blood pressure and cholesterol lowering medication. She is normally a very active person but frustrated with her limited ability to walk.

Narrowing of the spine manual#

She has had previous chiropractic treatment that included manual therapy, acupuncture, and flexion exercises with no help. She was being treated for a recurrent infection of the right toe. She reports three bouts of severe sciatica over the past three years and otherwise experiences recurrent low grade backache. The calf pain is immediately relieved with sitting or lying down. The calf pain comes on after a few minutes of walking and intensifies as she continues to walk. AK is a 73 year old retired public health nurse who presents with chronic episodic lower back pain and a two year history of increasing bilateral calf pain. Signed informed consent was obtained from three patients whose cases are presented in this study. The purpose of this study is to demonstrate using three case studies the challenges when presented with an elderly patient who presents with back pain, lower extremity symptoms, and limited walking ability. The ability to accurately diagnose DLSS and the various other conditions that give rise to similar symptoms and limitations is paramount for appropriate treatment. 4, 5 Often more than one condition can be present at the same time which makes diagnosis even more challenging. 4 There are many other common conditions in the elderly that also give rise to lower extremity symptoms and limited walking ability. Limited walking ability is the dominant functional impairment caused by DLSS. Lower back pain is not necessarily associated with neurogenic claudication. It is characterized by bilateral or unilateral buttock, lower extremity pain, heaviness, numbness, tingling or weakness, precipitated by walking and standing 3 and relieved by sitting and bending forward 4, 5. 2 The clinical syndrome of DLSS is known as neurogenic claudication. It is a chronic disease caused by age related degenerative narrowing (stenosis) of the spinal canal that can lead to compression and ischemia of the spinal nerves (neuroischemia). 1 The prevalence and economic burden of DLSS is growing exponentially due to the aging population. Degenerative lumbar spinal stenosis (DLSS) is a leading cause of pain, disability, and loss of independence in older adults.