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.