Hi everyone, here's a follow-up to the 65 y/o male with L lower leg numbness that sounds like a no-brainer for extension.

RECAP:

Current Symptoms: 6 week history of numbness L>R lower leg and foot lateral and bottom aspect-constantly due to hours of kneeling to lay flooring. Chronic weakness on R LE plantarflexion from previous lumbar surgery-constantly. Not much pain, just increased numbness.

Worse: Prolonged sitting (e.g., long car rides), reclining with feet elevated, and possibly inactivity.

I sent him out with bottom-up lumbar extension and he later messaged me reporting his increased numbness in the L thigh and both feet.

UPDATE:

I sent him the following message.

When I saw him for a follow-up, he reported that everything had felt better for about 36 hours, then leg numbness started to increase again, and he messaged me. He began lumbar flexion in lying as instructed. There was no loss of lumbar motion as a result, no neuroforaminal space occupation, and slump test was tighter on the L (not a true concordant symptom reproduction). He had almost returned to baseline. Also, I sent him out with a MILD neural tensioner (see below). Irritated nerves like a little bit of tension.

Take-away:

From my perspective, he had a low lumbar derangement produced by static forward bending. This reduced rapidly, within 24 hours, then overdosed extension, compressing spinal nerve roots...probably. He messaged me and we were able to counter the compression quickly with flexion. Now it's time to mobilize the nervous system and keep space open.

I'm open to any other thoughts about this patient.

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!

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