Alternating lumbar lateral shift: a case report

ABSTRACT

Background

A lumbar lateral shift (LLS) is a common clinical observation in patients with low back pain (LBP), and a shift contralateral to the side of pain is the most common presentation. An LLS that can rapidly alternate sides presents several treatment difficulties and has rarely been described. The purpose of the current case report was to describe the presentation and management of a patient with an alternating LLS.

Case Description

A 39-year-old male with a 7-week history of LBP and previous lower extremity radicular pain was referred to physical therapy. An alternating LLS was present.

Outcomes

The patient was treated for six visits over 37 days. Treatment included modified self-correction of the LLS, motor control and trunk muscle endurance training, and development of an activity management program. The patient’s LLS resolved, his worst pain improved from 3/10 to 0/10, and the Oswestry Disability Index improved from 26% to 4% disability. The patient reported maintenance of improvement at 6-month follow-up.

Discussion

The current approach produced a positive outcome in a patient with an alternating LLS. The current understanding of mechanisms and optimal treatment of an alternating LLS is limited.

Level of Evidence

4

KEYWORDS:

• Sciatic scoliosis
• radiculopathy
• low back pain
• McKenzie method

Disclosure statement

The authors report no conflicts of interest or potential conflicts of interest.

Additional information

Funding

No funding was provided for this case study.

Notes on contributors

Seth Peterson

Seth Peterson is a physical therapist practicing in Oro Valley, Arizona. He is the founder of The Motive Physical Therapy Specialists and an adjunct faculty member at A.T. Still University’s Arizona School of Health Sciences. Seth is a board-certified orthopedic clinical specialist (OCS) and a fellow of the American Academy of Orthopaedic Manual Physical Therapy (FAAOMPT). He is a coauthor of the Academy of Orthopedic Physical Therapy’s Screening for Referral monographs and has numerous peer-reviewed publications, mostly related to differential diagnosis and management of spinal conditions.

Mark Laslett

Mark Laslett is a New Zealand Board Registered Musculoskeletal Physiotherapy Specialist (NZRPS). He completed doctoral studies at Linköping University (Sweden) in 2005, which were based on diagnostic accuracy research with chronic low back patients. He is a former instructor for the New Zealand Manipulative Physiotherapists Association (NZMPA) and Auckland University of Technology (AUT) and former international instructor for the McKenzie Institute. He has been a tutor in biostatistics and study design for AUT University, and a supervisor advisor for masters and doctoral students undertaking diagnostic accuracy research. He retains an adjunct status with AUT. Mark has about 40 scientific publications, many of which relate to diagnosis and management of low back pain. His book, Mechanical Diagnosis & Therapy: The Upper Limb, was published in 1996. Mark is an honorary life member of the NZMPA, Physiotherapy New Zealand, and the Swedish branch of the McKenzie Institute and is a past president of the NZMPA.

Mark is in part-time specialist musculoskeletal practice and is a triage consultant for the Canterbury Initiative Low Back Pain Health Pathway. In 2015, he cofounded ‘Southern Musculoskeletal Seminars’ with Dr. Angela Cadogan, which provide structured online education courses for clinicians on musculoskeletal diagnostics and clinically focused workshops.