Transcript Case #6: - Berry Translations

Case #6:
History & Examination Findings
35 yr-old male low back/leg pain following a work injury:
Laminectomy 4th & 5th lumbar, 6 months prior.
Narcotic medication (Vicodin), that he took twice daily,
 LBP 8/10,
 Oswestry 74%
 Reduced ROM, 15° Flexion, could not perform Extension,
 Muscle strength testing- weakness of left leg flexors (4/5),
 Left achilles reflex could not be elicited,
 Left L5 dermatome revealed lack of pricking sensation
Orthopedic testing
• Positive orthopedic tests included:
Left leg Minor’s sign
Kemp’s sign
Toe walk
SLR at 45 degrees
Well-Leg raise at 45 degrees
Milgram’s test
Case #6: Post-Surgical Laminectomy Posture
Forward head translation (+TzH)
Left head translation (+TxH)
Left thoracic translation (+TxT)
Posterior thoracic translation (-TzT)
Right thoracic lateral bending (+RzT)
Left posterior pelvic rotation (+RyP)
Case 6: X-ray Findings & Impression
 (Osteopenic hole) at
L4-5 levels
 Forward head
posture (47mm)
 Left head
translation (14mm)
 Reduced cervical
curve (19 degrees)
 Reduced lumbar
curve (23 degrees)
 Left thoracic
translation (16mm)
Initial treatment and outcome
Consisted of mirror image adjustments
Lateral translation traction
Mirror image exercise for lateral translation
After 36 visits an A-P lumbar and lateral
cervical radiograph were taken
Mirror Image® Drop Table & Instrument Adjustment
Mirror Image® & Rehab Exercise:
36 Visit Re-Exam & X-rays
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Thoracic translation: 16mm to the left to 1mm right
Chief complaint: now lateral calf pain rated 2/10
Revised Oswestry: 74% to 40% disability
Lumbar ROM: flexion limited to 70 degrees, patient
was able to perform extension
• All initial orthopedic tests were now negative
• Achilles reflex: now elicited (rated 1/2)
• Dermatome testing revealed improved sensation to
pricking along the left L5 dermatome
36 Visit Post x-ray findings
Following first post x-ray: After 36 Visits
Lateral translation traction was eliminated
Thoracic extension exercises were added using a
Roman chair at 10-15 repetitions
Cervical traction was initiated using the extensioncompression chair for three months
At 6 months, cervical traction was changed to
cervical compression extension with a harness for
+TzH (8lbs for 12 mins)
Mirror Image® Exercise Drop Table
Did not Have Picture of Actual Roman Chair Exercise
CBP® Mirror Image® Traction
Outcome after 9 months
 Low back NRS was 0/10
 Revised Oswestry scored: 74% to 40% to 24% disabililty
 All orthopedic tests were negative
 Achilles reflex: reduced on the left 1/2
 Left L5 dermatome revealed normal pricking sensation
 Patient no longer required narcotic pain medications
 Lateral cervical x-ray: +TzH from 47mm to 36mm
 Cervical lordosis increased from 19 to 32 degrees
 Atlas plane line: 16-23 degrees
 A-P lumbar x-ray: 1mm to the right (was 1mm left)
108 Visits: ROM Improved, NRS 0/10, Oswestry 24%
Before & After Lateral Cervical