Hi everyone, here's a new patient, 65 y/o male with L lower leg numbness that sounds like a no-brainer for extension.
FAQs at the bottom
NOTICE: The free trial will expire on August 29th.
History:
Current Symptoms: numbness L>R lower leg and foot lateral and bottom aspect-constantly. Chronic weakness on R LE plantarflexion from previous lumbar surgery-constantly. Not much pain, just increased numbness.
Onset date: 6 weeks ago, improving with recent oral Prednisone.
Method of onset: laying flooring for several hours, kneeling on the floor for several hours.
Worse: Prolonged sitting (e.g., long car rides), reclining with feet elevated, and possibly inactivity.
Historical Obstruction: No significant difficulty rising from sitting, bending, or out of bed is reported.
Work-up: Nerve conduction study: findings consistent with chronic bilateral L5-S1 radiculopathies (acute on chronic cannot be ruled out), mild length-dependent sensorimotor peripheral neuropathy, no evidence of peroneal/tibial neuropathy or lumbosacral plexopathy.
Surgery: Years ago, lumbar decompression/discectomy.
Medical history: insulin-dependent diabetes
Exam:
Lumbar ROM:
Flexion: fingers to toes with bent knees, NE
Extension: 30-40, NE
Side Glide R: 30, NE
Side Glide L: 30, NE
Dural Slump: negative LE
Strength: Chronic R PF weakness from previous lumbar surgery, 5/5 throughout otherwise
No red flags.
Movement Testing:
Lumbar Extension Standing (Bottom-Up): 3 sets of 20 second hold: no effect on constant numbness, loosens-up the low back. I gave him instructions not to elevate his feet when sitting in the recliner and to use a lumbar roll. He's understanding everything, slam dunk, next patient...or so I thought. He sent a message in the Atlas platform 2 days later (direct quote),
"I am experiencing increased numbness in both feet, and the left side is still worse than the right. I would say that the numbness has gotten worse rather than better. Since you thought this would be effective, I was not expecting it to intensify."
Take-away:
From my perspective, this was a low lumbar derangement produced by static forward bending. So, I target low lumbar with bottom-up extension (see video below). I did not get an instant response, but I figured that since he had constant symptoms for 6 weeks, it would take some time for symptoms to calm down post-reduction.
I'll let you know what I responded to his message with and give a report on the next follow-up in Part 2.
Until next time,
Ryan Tauzell, PT, Cert. MDT
ryan@atlashealth.io
atlashealth.io
PS: As always, I'm happy to chat about these patients. I've enjoyed sharing, and thanks so much for your emails!
FAQs
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