Here is an interesting case that walked into ChiroCarolina® this week.
A 54 year old white male patient presents to the office with a two week onset of 7 out of 10 right sided lower back pain with radiating symptoms into his right buttocks, right hamstring, and back of his knee. He has no history of trauma to his lower back, but does recall getting back into a regimen of working out and running as he did when he was in his 20’s and 30’s. During his workout routine in the past month he has not felt any pain and all of sudden one morning he awoke with this discomfort. He in the past two weeks has been unable to sit for longer than 20minutes, cannot work out, and has significant discomfort while sleeping.
He went to his primary care physician and was told he had sciatica & muscle spasms, and was prescribed muscle relaxers and anti-inflammatories. X-Ray evaluation demonstrated mild age related arthritis, but no other significant findings. The medications provided only temporary relief and the symptoms would reappear soon as the medication effects wore off. Upon a friends advice he went on for a deep tissue massage and this in fact made the pain worse, causing symptoms to go past his knee into his calf region.
Upon evaluation in our clinic the patient appeared to be slightly overweight, which was a reason for his working out, but otherwise had an unremarkable health history. The diagnosis was confirmed after examination and review of X-Rays. The patient was prescribed a regimen of corrective spinal manipulation to his lumbar/pelvic spine, rehabilitative therapy in the form of ice packs & premodulated muscle stimulation, and myofacial active release. After two treatment visits the patient demonstrated improvement of symptoms with no radiating symptoms, however he still had localized discomfort 4 out of 10 in his right buttocks. Upon further evaluation it was noted that the patient had a hypertonic piriformis and gluteus medius muscle in his right buttocks that was inflamed and causing his pain. He also happened to carry a wallet 3 ½ inches thick on his right back pocket.
The patient was advised his excessively thick wallet was causing compression and irritation to this muscle. It was also pointed out that in order to relieve his pain/discomfort he needed to remove the wallet when he sits and follow a strict regimen of piriformis/gluteus muscle stretches. After the forth treatment of adjustments, therapy, and active stretching of the respective muscles, the patient demonstrated 0 out of 10 pain and was released to a will call status. He currently runs 7-10miles a week, lost 20lbs, and keeps up a regular regimen of stretching after his exercises. He was advised to coordinate adjustments in our clinic whenever his discomfort reappears or flares up, especially if his stretches do not relieve the symptoms. Remarkable how a brief course of care coupled with a modification of certain habits can relieve such unrelenting pain.