Case #6:

History & Examination Findings 35 yr-old male low back/leg pain following a work injury:  Laminectomy 4 th & 5th lumbar, 6 months prior.  Narcotic medication (Vicodin), that he took twice daily,  LBP 8/10,  Oswestry 74%  Reduced ROM, 15° Flexion, could not perform Extension,  Muscle strength testing- weakness of left leg flexors (4/5),  Left achilles reflex could not be elicited,  Left L5 dermatome revealed lack of pricking sensation

Orthopedic testing Positive orthopedic tests included:  Left leg Minor’s sign  Kemp’s sign  Toe walk  SLR at 45 degrees  Well-Leg raise at 45 degrees  Milgram’s test

Case #6: Post-Surgical Laminectomy Posture  Forward head translation (+TzH)  Left head translation (+TxH)  Left thoracic translation (+TxT)  Posterior thoracic translation (-TzT)  Right thoracic lateral bending (+RzT)  Left posterior pelvic rotation (+RyP)

Case 6: X-ray Findings & Impression  (Osteopenic hole) at L4-5 levels  Forward head posture (47mm)  Left head translation (14mm)  Reduced cervical curve (19 degrees)  Reduced lumbar curve (23 degrees)  Left thoracic translation (16mm)

Initial treatment and outcome  Consisted of mirror image adjustments  Lateral translation traction  Mirror image exercise for lateral translation  After 36 visits an A-P lumbar and lateral cervical radiograph were taken

Mirror Image® Drop Table & Instrument Adjustment

Mirror Image® & Rehab Exercise:

36 Visit Re-Exam & X-rays Thoracic translation: 16mm to the left to 1mm right Chief complaint: now lateral calf pain rated 2/10 Revised Oswestry: 74% to 40% disability Lumbar ROM: flexion limited to 70 degrees, patient was able to perform extension All initial orthopedic tests were now negative Achilles reflex: now elicited (rated 1/2) Dermatome testing revealed improved sensation to pricking along the left L5 dermatome

36 Visit Post x-ray findings

Following first post x-ray: After 36 Visits  Lateral translation traction was eliminated  Thoracic extension exercises were added using a Roman chair at repetitions  Cervical traction was initiated using the extension- compression chair for three months  At 6 months, cervical traction was changed to cervical compression extension with a harness for +TzH (8lbs for 12 mins)

Mirror Image® Exercise Drop Table  Did not Have Picture of Actual Roman Chair Exercise

CBP® Mirror Image® Traction

Outcome after 9 months  Low back NRS was 0/10  Revised Oswestry scored: 74% to 40% to 24% disabililty  All orthopedic tests were negative  Achilles reflex: reduced on the left 1/2  Left L5 dermatome revealed normal pricking sensation  Patient no longer required narcotic pain medications  Lateral cervical x-ray: +TzH from 47mm to 36mm  Cervical lordosis increased from 19 to 32 degrees  Atlas plane line: degrees  A-P lumbar x-ray: 1mm to the right (was 1mm left)

108 Visits: ROM Improved, NRS 0/10, Oswestry 24%

Before & After Lateral Cervical