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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 signKemp’s signToe walkSLR at 45 degreesWell-Leg raise at 45 degreesMilgram’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 outcomeConsisted of mirror image adjustmentsLateral translation traction Mirror image exercise for lateral translationAfter 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• 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 eliminatedThoracic extension exercises were added using a
Roman chair at 10-15 repetitionsCervical traction was initiated using the extension-
compression chair for three monthsAt 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