Site director back and spine Ochsner Health new orleans, Louisiana, United States
Case Diagnosis: Axial instability due to profound spinal weakness
Case Description: Our patient is a 22 year old male college track and field athlete whose functional decline began with innocuous left hamstring tightness. A subsequent MRI revealed lower lumbar degeneration and a synovial cyst at L3-L5. More than a year after his initial presentation, his history evolved into spasms that extended from the left paraspinal muscles down the left lower limb. His pain reached 8/10 with radicular symptoms and fasciculations while seated. Surprisingly, the patient’s gait was unimpeded despite these pervasive symptoms. He was subsequently referred to pain management for synovial cyst lysis and L4-L5 transforaminal epidural steroid injection. These procedural interventions were also paired with a proprietary spine strengthening physical therapy outpatient program. Despite being an athlete, our patient’s spinal strength was found to be 61% below the norms of men in his age group. However, after 16 aerobic therapy visits, his strength improved to 29% below norms.
Discussions: The crux of our patient’s improvement is the foundation of shared patient-physician milestones. Our midpoint goals included a 3 degree increase of lumbar flexion range of motion and an improvement of average isometric strength by 20%. He additionally decreased his “worst pain” score by 1-2 points with an increased sitting tolerance. Our patient doubled his midpoint range of motion and average strength after concluding therapy. He also regained his capacity to run without significant pain while boosting his track and field confidence. Our patient additionally received home exercise education to complement and sustain these advancements.
Conclusions: Our patient exhibited an immense improvement in strength, range of motion, radicular symptoms and fasciculations following a spine-focused physical therapy protocol. This progress ultimately culminated in an improved quality of life and function.
