18 y.o. male with a 5-year history of chronic pain throughout his LEs that limits him from walking more than 5 minutes. Had to be home-schooled due to pain. Any significant physical activity caused a severe increase in his LE pain, requiring him to rest for multiple days. History included some physical childhood trauma related to falls but nothing extreme. Patient treated with chiro, massage, PT with modalities, work with spinal mechanics, LE neural tension stretching, multiple physicians, and medications without benefit. Imaging normal.
A physical exam revealed severe LE neural tension with SLR positive at 30 degrees bilaterally. Pelvic and spine osseous mobility/biomechanics mild restrictions with most significant at L4. Evaluation of the spinal dura revealed the 2nd tightest dural system I had seen in over 30 years of practice. Locus of the dural tension was at L4. L4-S1 compaction present. Cranial mobility is suppressed with severe tension inferiorly at the occiput.
This patient was treated previously by some very good people. As such, I decided not to address the LE neural tension directly, as it had resulted in flares in the past. I focused on the most severe finding: the spinal dural tension and compaction from L4 to the sacrum. Treatment at the occiput and sacrum for access to the spinal dural tension started to loosen things up. It took multiple treatments, as the situation here was pretty severe. As the system started loosening up, I focused more on the dura from L4 to the sacrum. This, again, took a lot of effort, and change happened over time. LE neural tension with SLR is now approximately 70 degrees.
As this patient historically wasn’t a very good reporter of change with treatment when asked, I started to probe about his activity levels as treatment progressed. The patient started to report significant pain relief, and he was hiking with friends, shopping with his mother and just started working out in a gym. Very good indicators.
Takeaways: when patients have tried other forms of treatment, branch out and treat in a manner that hasn’t been tried…..look for the zebras. In this case, it was the spinal dural tension. Also, LE neural tension can result from more proximal tension, again, the spinal dura.
I hope these case studies help you on your path to helping more people with more and more challenging cases. Have fun with this work, it’s amazing stuff!
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