Chiropractic rehabilitation of a patient with S1 radiculopathy associated with a large lumbar disk herniation.
OBJECTIVE
To describe the nonsurgical treatment of acute S1 radiculopathy from a large (12 x 12 x 13 mm) L5-S1 disk herniation.


METHODS
A 31-year-old man presented with severe lower back pain and pain, paresthesia, and plantar flexion weakness of the left leg. His symptoms began 5 days before the initial visit and progressed despite nonsteroidal anti-inflammatory drugs and analgesic medication. An absent left Achilles reflex, left S1 dermatome hypesthesia, and left gastrocnemius/soleus weakness was noted. Magnetic resonance imaging demonstrated a large L5-S1 disk herniation.


RESULTS
Initial treatment of this patient included McKenzie protocol press-ups to reduce and centralize symptoms, nonloading exercise for cardiovascular fitness, and lower leg isotonic exercises to prevent atrophy. Counseling was provided to reduce abnormal illness behavior risk. Later, flexion distraction and side-posture manipulation were provided to improve joint function. Sensory motor training, trunk stabilization exercises, and trigger point therapy were also used. He returned to modified work 27 days after symptom onset. A follow-up, comparative magnetic resonance imaging (MRI) study was unchanged. He was discharged as symptomatic (zero rating on both the Oswestry and numerical pain scales) after 50 days and 20 visits, although the left S1 reflex remained absent. Reassessment 169 days later revealed neither significant symptoms nor lifestyle restrictions.


CONCLUSIONS
This case demonstrates the potential benefit of a chiropractic rehabilitation strategy by use of multimodal therapy for lumbar radiculopathy associated with disk herniation.
Cleveland Chiropractic College, Los Angeles, California, USA.
C E
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Morris
D000328:Adult; D002684:Chiropractic / Q000379:methods; D005500:Follow-Up Studies; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000175:diagnosis / Q000503:physiopathology / Q000534:rehabilitation*; D008159:Lumbar Vertebrae; D008279:Magnetic Resonance Imaging; D008297:Male; D020393:Manipulation, Spinal / Q000379:methods*; D010147:Pain Measurement; D011843:Radiculopathy / Q000175:diagnosis / Q000209:etiology / Q000534:rehabilitation*; D016896:Treatment Outcome