Lateral shift deformity

Crooked patients

1. “A lumbar lateral shift (LLS) is defines as a lateral displacement of the trunk in relation to the pelvis…repeatedly associated with discogenic pathology…McKenzie reported that 90% respond rapidly to manual correction.”

 

In school we learn the theoretical aspect of the shift, but when you see your first patient that is shifted the though process immediately goes to a mixture of “oh shit and piss on yourself excitement”. The shift can be extremely painful and students, if not treating this in a clinical, may not be prepared for a patient in a true 10/10 pain status. After so many years in practice, it is just another puzzle to solve now. The excitement has gone away and lucky for the patients, so has the “oh shit” response.

 

Patients come into the clinic “crooked”. Scott Herbowy once said it is like looking around the corner to see if the dog is hiding.

 

2. “…prevalence of LLS is difficult to establish, but estimates range from 5.6 to 80% of patient with low back pain (LBP).

 

This statistic is so far away from informative, that it shows that it is present in any where from 5-80 out of 100 patients with back pain. I don’t see it in 80% of the patients, but 5% may be more applicable to my population in the clinic.

 

3. “Lumbar spinal fusion, perhaps the most invasive of these (surgical) procedures, is increasingly common in the United States. However, its effectiveness is questionable…”

 

If you are going to have a fusion, go so someone that is either certified or diplomaed in MDT first. Some things can’t be undone, and this is one of those things. Make sure that there are no other options of getting relief prior to undergoing something that may not be effective and can not be undone.

 

4. This article is a case study of a patient that has a lateral shift deformity in the presence of an “X-stop” device, which is typically used to prevent lumbar extension in the case of spinal stenosis. The patient centralized with side gliding mobilizations and was issued side gliding against the wall in order to close the affected side. The patient responded well to this motion within the initial 4 visits and the final 4 visits were used to improve functional performance without the return of the lateral shift. The X-stop makes this case interesting because typically patients that are post-surgical are excluded from most research.

 

5. “The rapid centralization of symptoms observed in this patient is similar to that reported in previous case reports describing a lateral shift correction. Centralization or peripheralization during repeated movement testing has been positively correlated with pain provocation during lumbar discography.

 

Centralization phenomenon is something that trained clinicians are looking for during examination of the spine. When noted, the results are typically great, but if the peripheralizes (opposite of centralization), then the patient’s results are typically poor, at least if it happens with all movements tested.

 

First point to make from this is that if you have back pain, seek out a trained therapist in order to address your symptoms. Always start conservative before going invasive for pain based symptoms. If you have progressive weakness or have a loss of bowel and/or bladder function go the doctor immediately, but aside from this stay conservative first.

 

Second, people get crooked. If the crooked is not associated with pain, it may be that the person has always been crooked. Not all crooked people need therapy.

 

Excerpts taken from:

 

Peterson S, Hodges C. Lumbar lateral shift in a patient with interspinous device implantation: a case report. JMMT. 2016;24(4):215-222.