Subjective data
Age: 60 year old male
Occupation: plumber
Postures stresses: bending, twiSting, crawling, lifting
Off work: no

Relevant symptoms: Constant back pain. Constant left back, buttock,
thigh and leg pain. Tingling into outer 3 toes
Leg pain is more severe than back. back pain has been present for many
years. Not worse this episode
Onset: 1 year history of severe leg pain. Unchanging past several months

Commenced as a result of: no apparent reason
Symptoms at onset: same
Worse: bending, sitting, walking, lying -- all make him temporarily
worse but symptoms settle back to base line relativley quickly.  No
varaition in lumbar ROM with pain
Better: Lying -- temporary. Change in positions--temporary.
AM: worse rising, better as day progresses
Disturbed sleep: yes
Cough/sneeze/strain: negative            Bladder: normal
Gait: limps a little on left leg. No tripping, stumbling
Previous episodes: Multiple episodes of back pain and left leg pain over
the years. Leg pain has alsways resolved.  Reports constant back pain x
years.
Treatment: this episode chriopractic manipulation: no help
X-rays: not this episode. MRI 2 years ago bony changes at L4-5 and
L5-S1-- no report available
Gen Health: Type II diabetes
Meds: Glyburide: Tylenol as required
Recent surgery: no
Accidents: no
Weihgt loss: no

First question, previously posted, was:
Question: based on the subjective data what would be your provisional
hypothesis.  List what it is not (giving reasons) and then list what you
cannot rule out (give reasons).  Would your hypothesis change your
mechanical testing procedures?

Eval!
Slouched sitting during history: increased left leg pain. sitting erect: no 
change.
Posture sitting= poor, standing = poor; lordosis =m reduced; lateral shift = 
nil
Movement loss: 
                Flex: min; no deviation
                Extension: major, no deviation (patient reports no relevant 
loss in ext                 ROM this episode, longstanding)
                Side glide: right=left= min, able to cross midline both sides.
Test Movements:
    Standing: Standing symptoms: left leg pain, tingling outer toes
                FIS: inc left leg
                RFIS: Increased, not worse(no change in flexion or extension 
ROM after)
                EIS: Increased
                REIS: Increased, no worse
    Lying symptoms: left leg pain, tingling in toes
                FIL: NE
                RFIL: Increased left leg, no worse (no change in ROM)
                EIL: Increased left leg
                REIL: Increased, worse (no changes in ROM)

Neuro: strength: 
                within normal limits all myotomes
                reflexes intact
                SLR: left 70 degres (increased thigh discomfort); right 70 
degrees.

Question:
Based on your hypothesis from the subjective and these exam findings what 
would be your conclusion (provide reasons). Dose this patient require further 
mechanical evaluation? If so, what would you do and how would that help?
Do you think this patient will respond to mechanical therapy? If so, what 
would be your principle of treatment?




 ANSWER/DISCUSSION/REFERENCES 



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