Physical examination and diagnosis
At the initial examination the patient had a Visual Analogue Scale (VAS)
for pain score of 9/10 and Roland-Morris (RM) score of 13 points.
Magnetic resonance imaging (MRI) of the lumbar spine showed the presence
of multilevel disc bulges with mild spinal canal stenosis (Figure1).
Other diagnoses considered were multilevel lumbar disc disorder with
radiculopathy in the lumbosacral region.
A physical examination was performed to determine the severity of
symptoms and possible causes. Palpation of the patient revealed severe
tenderness in the mid-thoracic and lumbosacral spine area, moderate to
severe limitation of trunk flexion due to pain, and positive straight
leg raise (SLR) test on both sides.
As part of the diagnosis and before each treatment a series of physical
and neurological tests were conducted: (1) range of motion (ROM) of the
cervical spine; (2) degree of tilt (to a quarter degree with a set of
callipers) of the shoulder and pelvis in the coronal plane; (3)
discrepancy of supine leg length; (4) coordinated response to resistance
of arm and leg; and (5) tender lesions assessment with deep spinal
palpation. If results of the assessment before the treatment showed
departure from normal, the indicated assessments were repeated after
each treatment application to determine response. At the initial
examination the patient presented with: (1) normal cervical range of
motion (ROM) to both sides; (2) the shoulder tilt deviation to the right
by one degree and the pelvic tilt deviated to the right by 0.5 degrees;
(3) arm coordination response to resistance was (5/5) bilaterally; (4)
leg coordination was reduced on the left (3/5) and the right (4/5); (5)
supine leg length was 1cm shorter on the right side compared to the left
side; and (6) and painful tender lesions were found at 6 points along
the spine.