AJCC April 2000

Guest Column

Mysteries of the Spine

by W. Dwain Norwood, BA, DC

Dr. Norwood attended Murray State Teachers’ College in Western Kentucky and received a B.A. degree from ÒNew College of California’ in San Francisco. He graduated from Cleveland Chiropractic College, Kansas City, Missouri in 1950 and continues to practice in Panama City, Florida since 1951. He completed postgraduate work in Kinesiology, Gonstead and Upper Cervical Technique, as well as being a student of CBP®¨.

CASE HISTORY

Patient X, a 42 year old male, weighing 165 lbs., standing 5’10’ tall, worked at a local shipyard at the time of his injury. His duties included crawling into confined spaces to inspect for quality. He also was required to move welding equipment and other heavy objects.

On entry, patient’s complaints were Ñ constant left low back pain with radiation into the left buttock, pain also radiated down the left leg to the knee. This condition had existed for approximately one year with increasing intensity over the last three months.

Initial orthopedic examination revealed marked restriction on lumbar flexion. Lumbar extension produced pain in the left buttock and leg. Left Kemp test was positive with 50 restriction in left Laseque’s test, which precipitated pain in the left low back. The Dejerine’s Triad was positive.

Urinalysis, blood count and blood pressure were all within normal limits.

Patient had recently been treated by a local chiropractor for an extended period of time and he had also seen a neurologist. The neurologist had advised against surgery due to the high risk. MRI taken at the request of the neurologist revealed disc herniation at L4-L5 and also at L5-S1.

X-RAY EXAMINATION

AP View of the Pelvis

View of the pelvis and lumbar spine is unremarkable. There is minimal pelvic rotation with questionable slight disc wedging on the left between L4-L5.

Lateral Lumbar Spine

A schematic of the lateral lumbar spine is noteworthy due to disc degeneration at L5-S1 with retrolisthesis of L5 on S1.

TREATMENT

Subjective data from patient’s records shows 50% improvement in the first nine treatments in this office. However, the following 15 adjustments produced no further progress. Techniques used included: Gonstead, knee-chest, and side-roll adjustments. Upper cervical specific, pierce drop- table, kinesiology with respiratory traction, Cox traction Ñ each of these techniques were sequentially used without additional improvement.

With patient X continuing to be unable to return to work with the neurologist recommending against surgery, and insurance company refusing to pay Ñ we, at this point, had reached a dead-end.

If necessity were the mother of invention, this was the time it should happen.

This office had just purchased some new Omni tables, and while discovering the different features, an idea came to me that perhaps there were other ways to increase the intervertebral foraminal space (L4-L5 and L5-S1) by using one of the features on the new table.

Why not have the patient lie on his back with knees bent, then slightly elevate the pelvic section (1 to 1-1/2’) so that the lower one half of the sacrum rest on the edge of the pelvic piece. The idea was to use both anterior and superior crests of the ilium as a contact part, then drop three to four times. The question was, would this maneuver bring about an improvement in the L5-S1 relationship, as well as increasing the intervertebral foraminal space? (See Picture 1)

There was apparently nothing to lose and possibly something to gain, thus this adventure into the unknown was undertaken.

The following day after this adjustment, patient X reported definite symptomatic relief. One week later, he returned to work, and has continued to work as well as hunt and resume full duties.

Later, it was reasoned that other postural imbalances could be addressed by slightly modifying this procedure.

1. Facet syndrome at L5-S1 and retrolisthesis of L5 on S1 (Picture1)
2. Lumbar hyperlordosis and/or anterior pelvic flexion. (Picture 2)
3. Translation
4. Pelvic twist-rotation and/or posterior-anterior ilium. When treating for posterior-anterior ilium, the posterior ilium leg is laying straight while the anterior ilium leg is flexed. (Picture 3)

These concepts are not intended as the utopia for all low back conditions, but rather may serve as an alternative treatment to be utilized in the care of unwieldy patients with spinal imbalances that may be non-compliant with more orthodox procedures.

Click to enlarge:

Pic. 1 Pic.2 Pic.3