The objective of this pilot study was to determine if there is a correlation between the proposed physical testing protocol and low back pain. The proposed physical testing protocol is an attempt to assess muscular asymmetry in the anterior-posterior plane and the lateral plane. Methods A total of 96 volunteers were recruited from Touro University after obtaining IRB approval. Volunteers were initially provided a questionnaire regarding demographics and back pain. After ensuring participants satisfied the inclusion criteria, a physical test protocol was performed. After data compilation, odds ratios as well and linear regression models were generated to assess for correlation with back pain. Results A total of 96 participants were recruited. The odds ratio for asymmetric anterior-posterior balance in relation to back pain is 3.00 with a 95% confidence interval 1.26-7.12. The odds ratio for total ability to tolerate asymmetric loads greater than 50% of ideal body weight is 0.44 with a 95% confidence interval 0.11-1.77. The linear regression coefficient of anterior-posterior balance greater than 25% of ideal body weight in relation to level of pain is 1.96. Conclusions Increased muscular asymmetry in the sagittal plane and lateral plane showed a trend toward increased levels of low back pain; however, there is a weak correlation. This is a correlation and not an association. Future studies to assess the relationship between muscular balance and low back pain are needed to determine if therapy can be targeted to improve muscular sagittal balance, which can improve symmetry and back pain.
An acute ischemic stroke occurring contralateral to a hemorrhagic stroke is an uncommon occurrence that presents unique challenges. Hemorrhages have classically been described as a contraindication for mechanical thrombectomy. However, the natural course of a large vessel occlusion with or without decompressive hemicraniectomy is associated with significant morbidity and mortality. This paper investigates the origin of the contraindication for mechanical thrombectomy, the natural history of large vessel occlusion, risks of craniectomy, and risks of mechanical thrombectomy. Given the likelihood of poor outcomes without intervention, mechanical thrombectomy could be considered in select individuals, but future studies into the natural course of contralateral ischemic and hemorrhagic strokes would better guide management.
Schmorl’s nodes are typically an incidental finding whereby a disc herniates into the vertebral body. The clinical course is rarely symptomatic. Here, we present a 41-year-old male who, following chiropractic manipulation, developed an acute Schmorl’s node. The patient was managed successfully with conservative measures. A 41-year-old male with acute on chronic low back pain following a chiropractic adjustment. Imaging demonstrated the development of an acute Schmorl’s node of the lumbar four-five disc into the lumbar 4 vertebral body after a chiropractic adjustment. He was treated with conservative measures with over 85% relief of back pain. Acute Schmorl’s nodes can develop after the chiropractic adjustment. In the case presented, conservative measures resulted in 85% improvement in pain.
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