Use of Lumbosacral Region Manipulation and Therapeutic Exercises for a Patient With a Lumbosacral Transitional Vertebra and Low Back Pain

Alexander Karl Brenner

DOI: 10.2519/jospt.2005.1769

Study Design: Case report. Background: A lumbosacral transitional vertebra (LTV) is a congenital anomaly that occurs in 3% to 21% of people with and without low back pain (LBP). There is lack of agreement in the literature as to whether or not the presence of a LTV may cause LBP. The objective of this case report is to present the use of lumbosacral region manipulation and therapeutic exercises on a patient with a known LTV and LBP. Case Description: In this case report, an active-duty US Army soldier was referred to physical therapy with right-sided LBP and a lumbar radiograph showing a hemisacralized transitional L5 vertebra on the same side as his pain. The patient was treated with lumbosacral region manipulation and flexion exercises aimed at regaining total spinal motion and reducing pain. The patient responded favorably to spinal manipulation and exercise and was discharged from physical therapy after 4 visits. A modified Oswestry Low Back Pain Disability Questionnaire and inclinometer were used to measure outcome after physical therapy intervention. Outcomes: After a 2-week period of treatment in physical therapy, the patient improved from an initial Oswestry score of 32% to a score of 4%. Forward bending and left side bending improved from 74° to 140° and from 21° to 45°, respectively. Discussion: Lumbosacral region manipulation along with therapeutic exercises appears to have been an effective treatment approach for this patient with LBP associated with a type IIA LTV.

J Orthop Sports Phys Ther. 2005;35(6):368-376. doi:10.2519/jospt.2005.1769

Key Words: lumbar spine, manipulation therapy, Oswestry, sacralization

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