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Case-Study 5

 

 
 
“R.S” is a 50 year old, right-handed, female, elementary school teacher.

History:

On April 2006, “R.S” was involved in a motor vehicle accident. She was jolted forward and backward by the impact.

Approximately three-to-four days after the accident, “R.S” experienced back pain for the first time. She located the pain to the midline of the low back, but it spread across both sides of the back. Over time, however, the pain seems to refer more often to the right side. For many months, the back pain remained to the low back but, in the last eight-to-nine months, has begun to refer into both legs. There is pain and numbness in the right leg almost down to the ankle, whereas in the left leg, “R.S” is aware only of numbness. The pain last until she had the PST therapy (23 months).

An x-ray and a CT scan of the lumbar spine were done. It was felt that there was spinal stenosis present at the L4/5 level and a possible interference of the left L5 nerve root by a L5-S1 disc bulge.


Physical Examination:

There was evidence of straightening of the lumbar lordotic curve. There was significant loss of range in flexion and extension due to pain, which occurred both with forward and backward movements. During rotation to the right, “R.S” experienced increased pain and numbness in the right leg. Palpation of the lumbar spine revealed acute sensitivity to even light pressure. Both sets of lumbar paraspinals were in mild spasm.

There was weakness in the right leg and in the L5 myotome (big toe extensor on the right side).


Previous Therapies:

  • Physiotherapy was ineffective.


Diagnosis:

The history and physical findings are consistent with an injury to the lumbar spine. There is evidence of spinal stenosis at L4/5 and a disc bulge at L5-S1. It is likely that the pain is a result of mechanical irritation in the low back due to the spinal stenosis.


Pulsed Signal Therapy (PST):

Pain Scale:


Before PST

Right after PST

6 weeks after PST

6 months after PST

Date of treatment

March 31, 2008

April 10, 2008

May 22, 2008

Oct 10, 2008

Intensity of pain

2

2

2

2

Frequency of pain

4

4

4

2

Rest. of Mov.

1

1

1

0

Swelling

0

0

0

0

Warming

1

1

1

1

Discolouring

0

0

0

0

Paresthesic

2

2

2

1

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

2

2

1

Sitting

3

3

3

0

Standing

4

4

3

0

Driving

3

3

3

1

Walking

0

0

0

0

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 frequency of pain decreased 50%, paresthesiae decreased 50% while the restriction of movement improved 100%.
  • Patient had improvements of 100% sitting, 100% standing, 75% driving, and 50% sleeping.


 

 

 
 
 
 
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