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Case-Study 3

 

 
 
“P.H.” is a 36 year old, left-handed, female, hairstylist who owns her own hairdressing salon.

History:

On April 2005, “P.H.” was involved in a motor vehicle accident. She was jolted forward and backward by the impact. She started feeling back pain immediately after the accident. The back pain was more on the left side than on the right. The pain referred sporadically into the left leg, but most of the time the pain tracked down through the left buttock and down the side of the left leg to the knee and, on occasion, to the foot. Her pain levels were at their lowest after a chiropractic adjustment or after an analgesic or anti-inflammatory medication. She sometimes wakes up at night due to intense pain. She has noticed occasional numbness and tingling in the left foot. The pain last until she had the PST therapy (34 months).

An x-ray of the lumbar spine was read as normal, except for minor facet joint sclerosis at L5-S1.

A CT scan of the lumbar spine revealed a small left postero-lateral broad-based disc bulge at L3/4, but no central canal or intervertebral foraminal stenosis was noted. At L4/5 a similar left postero-lateral broad-based disc bulge was noted, this time indenting the thecal sac. Mild-to-moderate degenerative changes were noted in the facet joints. The combination of the disc bulge and degenerative changes in the facet joints had led to a moderate stenosis of the left lateral recess at L4/5. The radiologist felt there was sufficient stenosis present that the traversing left L5 nerve root could be compromised. At L5-S1 there was a right postero-lateral disc herniation, but the exiting right L5 nerve root did not appear to be compressed.


Physical Examination:

  • The inspection of the spine while standing did not reveal any scoliosis or kyphosis, but only weakness in the low back muscles. The pelvis was level.
  • Movements of the lumbar spine were fluid and pain free, with the exception of extension. During lumbar extension, “P.H.”complained of pain localized to the lumbar spine. Palpation of lumbar muscles was well tolerated. Palpation of the lumbar spine itself caused pain.
  • The neurological examination of the lower extremities was normal, with the exception of a mild sensory loss in the S1 dermatome of the left foot and weakness in the L5 myotome.


Previous Therapies:

  • Chiropractic adjustments and physiotherapy were temporarily helpful in managing the pain.


Diagnosis:

Injury to lumbar spine – There is CT scan evidence of multi-level disc bulging and degenerative changes and an indication of narrowing of the left lateral recess at L4/5. The physical findings are indicative of some irritation/compression of both the L5 and S1 nerve roots on the left side.


Pulsed Signal Therapy (PST):

Pain Scale:

* on the left leg


Before PST

Right after PST

6 weeks after PST

6 months after PST

Date of treatment

Feb 04, 2008

Feb 12, 2008

NA

Sept 15, 2009

Intensity of pain

2

2

NA

1

Frequency of pain

3

3

NA

1

Rest. of Mov.

2

2

NA

1

Swelling

0

0

NA

0

Warming

3

3

NA

1

Discolouring

0

0

NA

0

* Paresthesic

1

0

NA

0

Explanation of ratings: 
0 = none or never
1 = slight or seldom
2 = moderate or sometimes
3 = severe or often
4 = extreme or always 
NA= Not applicable


Daily Function Scale:


Before PST

Right after PST

6 weeks after PST

6 months after PST

Sleep

2

1

NA

0

Sitting

2

2

NA

1

Standing

2

2

NA

1

Driving

2

2

NA

NA

Walking

1

1

NA

1

Mood

NA

NA

NA

NA

Explanation of ratings: 
0 = six or more hours before the pain increases and disturbs function. 
1 = around 4 hours before the pain increases and disturbs function. 
2 = around 2 hours before the pain increases and disturbs function. 
3 = 20 min to 1 hour before the pain increases and disturbs function. 
4 = 5 min to 20 min before the pain increases and disturbs function. 
NA = not applicable


Conclusions:

  • Six months after PST, the intensity of the pain decreased 50%, frequency of pain decreased 75%, paresthesiae decreased 100% while the restriction of movement improved 50%.
  • Patient had improvements of 50% sitting, 50% walking and 100% sleeping.


 

 

 
 
 
 
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