LSS BOOTCAMP CONTINUED FROM PAGE 20 During the program, I discovered patients may have various degrees of lumbar spinal stenosis, and not every-one would go on to develop neuro-genic claudication. Those that did had very specific characteristics. They would go on to develop mostly hip or leg symptoms – the back pain was not typically predominant. They found pushing grocery carts more comfort-able than walking upright and found sitting to be a pain-free activity. LSS patients even had the ability to ride a stationary bicycle pain-free, which was key to their success in the program. If fitness and conditioning were in-HOW IT WORKS creased, they could combine the rec-Patients who are referred to our clinic ommended exercises with daily phys-for the LSS bootcamp will undergo a ical activity and the outcome would thorough consultation and examina-tion to determine whether or not they take its course. The course then summarized the meet the criteria for a LSS diagnosis. conditions to be included in the dif-Those that meet the diagnostic crite-ferential diagnosis of lumbar spinal ria will begin to learn about their stenosis such as advanced hip osteo-diagnosis and the required 18 exer-arthritis, which can cause leg pain, as cises through a DVD, workbook, and well as vascular conditions. These their twice-weekly appointments over conditions include intermittent clau-a six-week time frame. It is imperative the patient under-dication and deep venous thrombosis, which is known to produce leg pain stands that the success of the program without the tendency to forward bend depends entirely on their ability to while walking. In the senior age group, complete the exercises, not just for the we were advised to consider another six-week period, but for the rest of differential diagnosis including malig-their lives. The term “bootcamp” is nancy, hip bursitis, neuropathy, and suitable, as it truly defines the patient’s fracture. obligation to fully participate While patients and some in order to be successful. The term physicians may continue to “bootcamp” is The patient’s family physi-cian or referring specialist is herald the MRI and CT scan suitable, as it advised about our program as the method of the lumbar truly defines through our PMP generated spinal stenosis diagnosis, the condition can also be diag-the patient’s “medical doctor reports,” as nosed with plain film X-rays obligation to well as at the beginning and and a thorough examination fully partici-at the end of care. Patients in order to rule out other pate in order have appreciated the inclu-to be sion of their physician, and likely conditions. A diagnosis sucessful. the report becomes an excel-of LSS does not always rely lent clinical summary for the on advanced imaging. Chiro-practors who have acquired boot camp patient’s personal health records. If the patient is pain focused, we training can be central to the diagnosis and treatment of lumbar spinal steno-redirect our bootcamp patients that sis and neurogenic claudication. our main outcome measure will be Previously, the only successful treat-increased function. We explain that the ment documented was lumbar decom-outcome we focus on is mobility, as pression surgeries, which is not measured by the number of steps a 24 Canadian Chiropractor June 2019 A PROFESSIONAL PROGRAM FOR CHIROPRACTORS generally advisable in an older adult due to the risk of complications. One of these surgeries involves anchoring spacers between the spinous pro-cesses, thereby mechanically opening the foramina. Results a few years post surgery were varied, with symptoms often returning two to three years later. Not everyone with significant lum-bar spinal degeneration goes on to develop neurogenic claudication how-ever, it can occur frequently. On occa-sion, lumbar spinal stenosis patients are diagnosed by their family physician through MRI, but upon thorough examination, they are found to have a lumbar facet syndrome or a sacroiliac dysfunction as the main issue. patient can take at one go before they need to stop. Each week, the patient keeps a record of the number of steps taken. It is not unusual to see the numbers double throughout the week. Oftentimes by the end of the program patients find their walking is tremen-dously improved or completely re-stored. When this occurs, the pain is often significantly diminished. We emphasize with patients that although the pain may decrease dramatically, the main goal is to focus on increasing the number of steps that can be taken during their walks. The six-week program is partly based upon eighteen exercises, which follow a gradually increasing intensity. New exercises are added during each appointment, once the previous weeks’ exercises have been reviewed. During the twice-weekly appointments, chiro-practors deliver a variety of interven-tions including mobilizations, flex-ion-distraction adjustments, the Bonyon technique, proprioceptive neuromuscular facilitation and nerve flossing. All of these interventions work to support and enhance the impact of the patient’s daily at-home exercises. The sessions can be somewhat strenu-ous, but patients become excited as their strength quickly returns. Recently, support for this approach was published in the Archives of Phys-ical Medicine and Rehabilitation 2018;99;2408-19. In this randomized controlled study there was significant evidence that supports this approach over self-directed care. More research will be published in 2020. As the baby boomer generation ages, degenerative conditions like lumbar spinal stenosis will become more common and many of those patients will be looking for a natural and effective approach to improve their quality of life while maintaining their independence. The lumbar spi-nal stenosis bootcamp is an excellent solution that afflicted seniors should consider. For more features, and health and industry news, visit our website: www.canadianchiropractor.ca. www.canadianchiropractor.ca
Chiropractic + Naturopathic Doctor June 2019: Page 24
