Case Notes - SRLS, Back Pain, Right Sided Lumbro-Sacral & Back Line Lower Limb Symptoms
This client has presented for treatment for the third time in three years. He is a builder and has been doing long days of heavy labouring and construction work for the last twelve weeks. Complains entire back is sore, particularly in the centre of the spine in the lower thoracic, reporting there is a nervy tingly quality and his neck is clicking.
* Left hip in Medium Range anterior rotation...the front is lower than the back where it should be level. This is an anatomical adjustment we unconsciously make pulling the longer leg upwards to reduce uncomfortable pelvic tilt where there is a structural leg length difference.
* Right hip level.
* Sign of mild scoliosis in the middle thoracic with bulging ribcage to the right and flattened to the left.
* In supine, legs straight, right malleolus 0.5mm superior to the left. Left ASIS 15mm superior to the right.
* In supine, legs flexed 90 degrees at the knees, left knee 5mm superior to the right.
* Right shoulder is significantly elevated relative to the left.
* Right QL's tight, sensitive and painful to palpate.
* SIJ's no pain on palpation.
* Backline of right lower limb significantly thicker and tighter than the left which displays completely normal muscle tone.
* On palpation, at approximately T10, the vertebrae is slightly rotated anticlockwise.
I estimate the client has a structural leg length difference of approximately 10mm. The right leg is shorter than the left. He is presenting with two of the three cardinal signs of Short right Leg Syndrome with other associated symptoms. This is not to say he does not have all three, I simply neglected to test for the third: that being right hip rigidity. This is supported too by a leg length assessment clearly indicating a structural difference. He is not showing any sign of the more common left sided lower limb symptoms caused by anterior rotation of the hip. However, pain in the lower back on palpation of the right QL's and significant thickening and tightening through the hamstring and calf of the right lower limb indicates the less common but more worrying right lumbro-sacral dysfunction. This is more serious as it is a sign of possible disk bulging through the right lumbar region.
Prior to a snowboarding injury approximately two years ago when head planting into the snow, he never had neck issues. His ROM is not restricted and he does not complain of pain, just a persistent click. I have suggested previously he seek Chiropractic assessment and treatment for this. It is conceivable that owing to the injury and under the strain of mild scoliosis through the spine, tendon loading and energetic blocking from the injury is sufficient to cause this ongoing low grade dysfunction.
Treatment administered consisted of upper/lower back and glutes massage and full back, glutes and hips cupping session. Hamstrings and calves rubbed down while the cups worked. The client reports tightness and pain relieved, mobility restored in the back.
I expect the right sided llumbro-sacral issues affecting backline of right lower limb will persist. Owing to the potential seriousness of the low back condition and the heavy physical workload, I suggest trialling a 4mm to 5mm heel wedge under the short right leg.
Published 27 October 2020