Objective: To describe a therapeutic effect using contralateral neurodynamic mobilization and to discuss multimodal management involving manual therapy, neurodynamic mobilization, and exercise in the management of chronic leg paresthesia following lumbar microdiscectomy.
Clinical Features: A 61-year-old male sought chiropractic care for episodic low back pain and persistent left-sided lower leg paresthesia. Symptoms began 20 years prior following lumbar microdiscectomy for a disc herniation. Post-operatively, lower leg and foot paresthesia remained unchanged for 20 years despite non-pharmacologic interventions.
Intervention and Outcome: Chiropractic management included repeated end-range loading, bilateral neurodynamic mobilization exercises, and spinal manipulative therapy of the lumbar spine for 15 visits over 3 months. The patient reported paresthesia symptoms shifting from constant to intermittent to full resolution of leg and foot paresthesia over a course of 15 sessions. Long term follow up at 9.5 months indicated significant improvement of leg paresthesia and continued prophylaxis with performance of exercises.
Conclusion: This case describes non-pharmacological management of persistent leg and foot paresthesia following lumbar spine microdiscectomy. End-range loading, bilateral neurodynamic mobilization exercises, and spinal manipulative therapy of the lumbar spine resolved symptoms in this case.
Author keywords: Distal Paresthesia; Spinal Manipulation; Chiropractic; Manual Therapy; Neurodynamic Exercise; Nerve Mobilization
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