• Chadwick E
• Dahlke J
• Vier D
• Adejare T
• Debrick M
• DeCorey J
• Howard G
• James J
• Jumper C
• Landeros T
• Odgers T
• Shuler J
• Walzel A
• Parker A
• Roy P
• Winchester B
• Malaya C
• Owen H

• Aged
• Female
• Flexion-Distraction Technique
• Low Back Pain
• Open Access Document
• Pain, Radiating
• Spinal Stenosis

Objective: To describe the clinical course and outcomes of a 67-year-old female with lumbar spinal stenosis (LSS) and neurogenic claudication who was treated with a multimodal approach incorporating chiropractic adjustment, flexion-distraction therapy, soft tissue modalities, therapeutic exercise, and Dynamic Neuromuscular Stabilization (DNS) training.

Clinical Features: The patient presented with a 4-month history of worsening right lower back pain radiating to the right groin, hip, and leg, accompanied by right leg weakness and neurogenic claudication. Her symptoms were relieved by rest and by lumbar flexion but were aggravated by walking. On examination, right lower extremity nerve tension tests were positive, hypoesthesia in the right L4/L5 dermatomes, and gait disturbances were present. Additionally, she had decreased thoracic and hip extension with the inability to differentiate between the 2 movement patterns. In the muscle tone assessment, erector spinae in both the cervicothoracic and thoracolumbar regions, iliocostalis lumborum and gluteal muscles bilaterally were tender to palpation.

Intervention and Outcome: The trial of care was developed to specific patient need and consisted of 2 visits a week for 6 weeks that was followed by 1 to 4 visits a month for maintenance care. The patient experienced a greater than 50% improvement with a decrease in pain from a 7/10 to a 2/10, increased claudication-free walking intervals from 1 to 10 minutes, an increase in pain free range of motion and improved balance. The combination of improvements in function, movement and decrease in pain resulted in a better quality of life with no adverse effects reported.

Conclusion: LSS affects nearly 11% of the geriatric population within the United States and can be a complex condition to treat/manage. Non-surgical treatments are shown to have an overall positive progression in a patient's quality of life, which includes chiropractic/physical therapy, ergonomic adjustments to their lifestyle, and oral medication. For this specific case, a multimodal approach which combined various treatment interventions to address a specific condition, and its associated symptoms has shown to be significantly effective in treating and managing this individual's condition of LSS with neurogenic claudication.

Author keywords: Spinal Stenosis; Multimodal; Geriatric; Spinal Manipulation; Flexion-Distraction; Soft-Tissue Therapy; Therapeutic Exercise; Dynamic Neuromuscular Stabilization; Intra-abdominal Pressure; Claudication

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