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Introdução: neste estudo foi avaliado um caso de lombociatalgia com hérnia discal lombar através de exame clínico confirmado por ressonância magnética. Foi efectuado um tratamento com terapia manual durante 4 semanas até à abolição dos sintomas e recuperação total da função. Objectivos: realizar um tratamento de terapia manual num paciente com lombociatalgia com hérnia discal lombar num período de 1 mês. Métodos: foi realizado um estudo num paciente de 40 anos do sexo masculino que apresentava um quadro de lombociatalgia com hérnia discal lombar. Para a avaliação foram utilizados testes palpatórios com movimento (teste de Mitchell lombar, teste de Gillet sacroilíaco); observação de assimetrias posturais; teste de mobilidade activa em pé; EVA para avaliação da dor; testes de compressão lombar na posição de sentado; testes de condução neurológica; testes neurodinâmicos. Os testes foram aplicados no início e final das 4 primeiras sessões de tratamento com terapia manual, com intervalo de uma semana e um follow-up realizado uma semana após a 4ª sessão. Resultados: após o tratamento de 4 sessões, verificou-se a ausência de postura antálgica. A dor diminuiu de 5/10 para 0/10 (EVA) nos movimentos de flexão, extensão, rotação esquerda e inclinação esquerda do segmento lombar, em pé, com amplitudes normais de mobilidade. A dor diminuiu 3/10 para 0/10 (EVA) no teste de compressão lombar sentado e de 6/10 para 0/10 (EVA) para o teste de compressão lombar sentado com inclinação esquerda. O teste de Mitchell lombar inicial (FRS L5; NSR lombar) ficou negativo assim como o teste de Gillet sacroilíaco; teste de SLR ; SLR + neck flection ; testes de condução de L5 que se encontrava positivo com hipostesia no dermátomo de L5 e grau 3+ de força nos dorsiflexores à esquerda ficou negativo para a hipostesia e grau 5 de força nos dorsiflexores. Conclusão: neste caso o conjunto de técnicas de terapia manual aplicadas juntamente com exercícios terapêuticos, concelhos posturais e de estilos de vida ajudaram o paciente a recuperar totalmente a função e ver abolida a dor.
Introduction: in this study was evaluated a case of low back pain with lumbar disc herniation by clinical examination confirmed by MRI. Was performed with a manual therapy treatment for 4 weeks before the elimination of symptoms and full recovery of function. Objectives: To perform a manual therapy treatment of a patient with low back pain with lumbar disc herniation in a period of one month. Methods: it was performed a study in a 40 years old male patient who presented a case of low back pain with lumbar disc herniation. For the assessment tests were used palpatory motion (Mitchell lumbar test, Gillet test Sacroiliac) observation of postural asymmetries; active mobility test standing; VAS for pain assessment; lumbar compression tests in a sitting position; neurological conducting tests, neurodynamic tests. The tests were applied at the beginning and end of the first 4 sessions of manual therapy treatment with an interval of one week. The follow-up was conducted one week after the 4th session. Results: After treatment there was a lack of antalgic posture. The pain decreased from 5 / 10 to 0 / 10 (VAS) in flexion, extension, left rotation and tilt left of the lumbar segment, standing, with normal amplitude of mobility. Pain decreased 3 / 10 to 0 / 10 (VAS) in the sitting compression test and 6 / 10 to 0 / 10 (VAS) for the sitting compression test + tilt left. The initial test of Mitchell lumbar (L5 FRS; NSR lumbar) was negative as well as the sacroiliac Gillet test, test of SLR; SLR + neck flection; conduction tests of L5 found positive with hypoesthesia in the dermatome of L5 and grade 3 + of strength at the dorsiflexores on the left turned negative for hypoesthesia and grade 5 of strength at the dorsiflexores on the left. Conclusion: In this case the set of manual therapy techniques used in conjunction with therapeutic exercise, postural advices and lifestyles helped the patient to a functional complete recover and abolished the pain.
Introduction: in this study was evaluated a case of low back pain with lumbar disc herniation by clinical examination confirmed by MRI. Was performed with a manual therapy treatment for 4 weeks before the elimination of symptoms and full recovery of function. Objectives: To perform a manual therapy treatment of a patient with low back pain with lumbar disc herniation in a period of one month. Methods: it was performed a study in a 40 years old male patient who presented a case of low back pain with lumbar disc herniation. For the assessment tests were used palpatory motion (Mitchell lumbar test, Gillet test Sacroiliac) observation of postural asymmetries; active mobility test standing; VAS for pain assessment; lumbar compression tests in a sitting position; neurological conducting tests, neurodynamic tests. The tests were applied at the beginning and end of the first 4 sessions of manual therapy treatment with an interval of one week. The follow-up was conducted one week after the 4th session. Results: After treatment there was a lack of antalgic posture. The pain decreased from 5 / 10 to 0 / 10 (VAS) in flexion, extension, left rotation and tilt left of the lumbar segment, standing, with normal amplitude of mobility. Pain decreased 3 / 10 to 0 / 10 (VAS) in the sitting compression test and 6 / 10 to 0 / 10 (VAS) for the sitting compression test + tilt left. The initial test of Mitchell lumbar (L5 FRS; NSR lumbar) was negative as well as the sacroiliac Gillet test, test of SLR; SLR + neck flection; conduction tests of L5 found positive with hypoesthesia in the dermatome of L5 and grade 3 + of strength at the dorsiflexores on the left turned negative for hypoesthesia and grade 5 of strength at the dorsiflexores on the left. Conclusion: In this case the set of manual therapy techniques used in conjunction with therapeutic exercise, postural advices and lifestyles helped the patient to a functional complete recover and abolished the pain.
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Keywords
Lombociatalgia Terapia manual ortopédica Diagnóstico diferencial Hérnia discal lombar Reabilitação Low back-related leg pain Orthopedic manual therapy Differential diagnosis Lumbar disc hernia Rehabilitation
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Publisher
Instituto Politécnico do Porto. Escola Superior de Tecnologia da Saúde do Porto