Introduction: The purpose of presenting this case is to describe the management of an adult male patient with chronic low back pain and right lower extremity weakness with differential diagnosis including lumbar radiculopathy vs conversion disorder. The authors will describe the patient’s presentation as well as their treatment approach, review possible etiologies, and propose mechanisms to explain treatment response. They will also describe the research, however limited, regarding manual therapies for management of conversion disorder.
Case Presentation: 46-year-old male Army veteran presented with low back pain and right lower extremity weakness of approximately 15 years’ duration. The patient’s primary care physician had made a diagnosis of chronic low back pain, lumbar radiculopathy and right foot drop. He had a limited response to conservative care. Advanced testing included lumbar MRI and EMG, neither of which supported a diagnosis of lumbar radiculopathy.
Management and Outcome: Treatment included manual spinal manipulative therapy, manual flexion/distraction, and home care recommendations of lumbar stretches and cutaneous stimulation. Outcome measures included the PROMIS Pain Interference Short Form 6b and VAS. Repeat examination at the 6th follow-up appointment revealed improved right lower extremity strength and increased sensation to pinprick. Functional improvement included patient-reported improved ease of ambulation.
Conclusions: A male patient with chronic low back pain and right lower extremity weakness responded favorably to conservative treatment of lumbar flexion/distraction technique, spinal manipulation, and home recommendations of lumbar stretches and cutaneous stimulation. Given the chronicity of the complaint and the failure of advanced imaging and electrodiagnostic studies to produce correlative findings, it is unclear whether recovery was the result of lumbar radiculopathy responding to manual therapy or a functional neurologic disorder responding to non-specific therapeutic effects.
Author keywords: chronic low back pain, chiropractic, flexion-distraction, spinal manipulation, lumbar radiculopathy, foot drop, conversion disorder, functional neurologic symptoms disorder
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