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Uncovering Trigger Points Masked by Lumbar Radiculopathy

Journal: The AAO Journal Date: 2022/06, 32(2):Pages: 22-23. doi: Subito , type of study: case report

Free full text   (https://meridian.allenpress.com/aaoj/article/32/2/15/482674/LBORC-NUFA-Poster-Abstracts-2022-Students)

Keywords:

case report [514]
low back pain [413]
trigger point [39]
OMT [2951]
osteopathic manipulative treatment [2973]

Abstract:

Background: From 1990 to 2017, low back pain (LBP) has been the leading cause of years lived with disability. In 2017 alone, the global prevalence of people with LBP was estimated to be $577 million. Case: A 29-year-old female presented to the osteopathic treatment center with 5/10 chronic neck and LBP with pain radiating intermittently down the right lateral thigh to the knee. The patient sustained the injury following a motor vehicle accident in December 2019. Lumbar MRI in January 2020 revealed right facet joint effusion, disc bulge, and facet joint hypertrophy at L3-L4 and left foraminal disc herniation at L5-S1. Physical exam revealed no neurological deficits in the upper and lower extremities bilaterally. Osteopathic structural exam revealed severe right Quadratus lumborum (QL) trigger point, left QL tenderness, right paraspinal hypertonicity, and right piriformis tenderness. Counterstrain was performed on the right QL with adduction to facilitate its attachment to the twelfth rib, as the typically recommended hip abduction provided no relief. Results: After the patient’s first visit, she experienced near complete relief of her LBP. She would experience flare ups between subsequent visits, each with decreasing severity and no radiation. Prior to each inciting event, she remained virtually pain free. Discussion: The initial utilization of OMT can be less invasive and costly than complex diagnostic evaluations. Jones prescribed counterstrain in specific ways; however, osteopathic physicians must understand the complex interactions of muscular anatomy to generate novel treatments for unique cases and improved treatment outcomes. Opportunities for research are present in assessing osteopathic structural exam findings and treatment outcomes in patients with LBP. A limitation is present due to lack of EMG data to further rule out spinal neurological involvement.


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