Manual Correction of an Acute Lumbar Lateral Shift: Maintenance of Correction and Rehabilitation: A Case Report with Video

Abstract

The acute onset lumbar lateral shift, otherwise known as a list or acute scoliosis, is a common clinical observation associated with low back pain. In general orthopaedics, the presence of a lateral shift is associated with a poor prognosis; however, a manual correction method devised by McKenzie is claimed to produce rapid reversal of the deformity and reduction in pain. This single-case report presents the details of the McKenzie Mechanical Diagnosis and Treatment (MDT) management of a major right-sided lateral shift, which includes the manual correction technique, self-correction and management, prophylaxis, pain ablation, and rehabilitation to a high level of athletic function, with long-term follow-up at 9 months. The lateral shift is widely accepted as being associated with disc pathology, but the exact mechanism of shift production remains speculative. hypotheses include muscle spasm, avoidance of irritation of a spinal nerve, and space-occupying or space-deficient disc mechanics. The hypotheses used to explain the lateral shift phenomena are discussed. (Case report is supplemented by video stream, available at jmmtonline.com/).

Inter-rater reliability of a modified version of Delitto et al.’s classification-based system for low back pain: a pilot study

“…35 For example, patients with a visible lateral shift often respond well to repeated and sustained side-gliding movements. 36 It is interesting to note that the original study of Delitto et al 5 described three different syndromes; extension, flexion, and lateral, 5 whereas the follow-up studies of Fritz et al 7 and Brennan et al 18 concentrated on sagittal movements and excluded patients with a visible lateral shift. In previous studies, an incomplete MDT assessment protocol to establish directional preference or centralization may be responsible for reduced reliability in assigning patients to the specific exercises category.…”

Lumbar lateral shift in a patient with interspinous device implantation: a case report

“…The rapid centralisation of symptoms observed in this patient is similar to that reported in previous case reports describing a lateral shift correction. 22,27 Centralisation or peripheralization during repeated movement testing has been positively correlated with pain provocation during lumbar discography. 28 Because our patient had an apparent directional preference towards extension and positive response to her first IDET procedure, an initial hypothesis of discogenic pain was adopted for subsequent treatment.…”

“…After the initial physical therapy examination, the physical therapist chose to immediately introduce a manual LLS correction as detailed by others 3,22 and presented in Figure 2. Because the patient's symptoms were provoked with sustained positions, the therapist performed a sustained hold.…”

Intervertebral Disc Prolapse: Comparison between Two Manual Techniques

“…This produces reduction of the disc disturbances,making impression that the pain moved from unilateral to central position and there is significant reduction in intensity of pain and centralization [21]. As the coronal plane movement is followed by sagittal movement i.e., extension, there is gain in lumbar extension ROM [24].…”

“…Laslett hypothesized that a contralateral shift is caused by space occupying disc herniation pushing the trunk away from the painful side, forcing the vertebrae apart so, the posterior margins cannot approximate [19,21]. Any attempt of extension movement results in pain and thus limitation of extension of lumbar spine.…”