FEATURE PATIENT CARE CHRONIC LOW BACK PAIN AND BRACING An evidence-based case report C Photo: anut21ng Stock/Adobe stock BY VICTORIA MCINTYRE (HBSC), DEREK KONOPSKI (BA), AND DR. PETER EMARY (DC) used for symptomatic management of CLBP, despite there being limited supportive evidence justifying its use. (4) The objective of this case report is to analyze the effectiveness of bracing as a pain-reducing treatment for CLBP. A 48-year-old female presented with chronic, intermittent LBP of three years’ duration. The patient had re-cently aggravated the pain after gar-dening. She woke up the next day stiff with muscular spasms and pain and this progressed over three more days to a sharp, stabbing pain. Provocative positions included bending at the trunk into flexion and extension as well as walking and standing. Palliative mech-anisms were heating pads and non-ste-roidal anti-inflammatory drugs (NSAIDs) as well as sitting or lying supine with her legs elevated. Her pain at the time of presentation was at 7/10 and she reported that the pain would wake her up at night. The pain was described as a radiat-ing pain across the low back, but it did not radiate down the patient’s legs. The straight leg raise, Hibb’s and Fabere’s orthopedic tests were negative. Kemp’s test and lumbar range of motion, espe-cially in rotation, provoked her hronic low back pain (CLBP) is one of the most widespread mus-culoskeletal disorders experienced by individ-uals worldwide. The lifetime prevalence of LBP is reported to be as high as 84%, and the prevalence of CLBP is approx-imately 23%. (1) Causes of CLBP can be complex with many possible mechanisms. The prevalence of CLBP in adults has in-creased by more than 100% in the last decade and continues to increase dra-matically in the aging population, af-fecting both men and women in all ethnic groups. (2) Chiropractors serve an important role in assisting patients with regaining motion and functional-ity, in turn allowing patients’ bodies to heal themselves and improve or prevent pain naturally. The majority of chiro-practors use “Diversified Technique,” or High-Velocity Low-Amplitude (HVLA) spinal manipulation, to treat musculoskeletal pain and dysfunction. (3) Other common forms of chiropractic interventions for managing patients with CLBP include soft-tissue manip-ulation and mobilization, Cox Technic, Graston, Gonstead, and bracing with lumbar orthoses. Back bracing is often CASE REPORT Chronic low back pain is a leading cause of disability in the U.S. VICTORIA MCINTYRE and DEREK KONOPSKI are 3rd-year chiropractic students at D’Youville University in Buffalo, New York. DR. PETER EMARY is a chiropractor at the Langs Community Health Centre in Cambridge, Ontario. He is a post-doctoral fellow at the Michael G. DeGroote National Pain Centre at McMaster University, and he also teaches in the Chiropractic Department at D’Youville University. www.Cndoctor.ca symptoms. Both Yeoman’s and double leg raise tests also provoked her pain. Palpation revealed tenderness and joint restriction in the right and left L4-5 and L5-S1 facet joints. Neurologic testing was normal bilaterally. Grade I spondylolisthesis was visualized on radiographs at L4 on L5. The history and physical exam findings revealed a working diagnosis of an acute exacer-bation of chronic, recurrent LBP with bilateral lower lumbar facet joint syn-drome and underlying grade I L4-5 spondylolisthesis. (Note: This case report was written as part of a third-year chiropractic course, Evidence-Informed Chiropractic Practice, at D’Youville University. As such, the re-port herein was based on a patient scenario rather than an actual patient.) September/October 2022 Chiropractic and Naturopathic Doctor 9
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