By Dr. Yoon Jeon. MChiro, MB, BSc, Dip.TCM, PGCert.
Case Presentation
A 44-year-old office worker presented to the clinic with a history of chronic low back pain for over 10 years.
The pain had been intermittent in the past, typically described as a mild, dull ache. However, in the month prior to presentation, the pain had become persistent and progressively worse.
There were no reported bladder or bowel changes.
The pain intensified as the day progressed, and by the afternoon, the patient found walking, standing, and even lying down increasingly difficult due to the severity of the pain.
No associated symptoms such as leg pain, numbness, or weakness were reported.
Clinical Examination
On physical examination:
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Tenderness was noted over the lumbar paraspinal muscles
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Segmental restriction and pain were identified at L4/L5 on motion palpation and spring testing
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Lumbar active range of motion (AROM) was generally full and pain-free, except for lumbar extension, which reproduced bilateral pain at the L4 level
Orthopaedic testing revealed:
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Adam’s test and supported Adam’s test produced mild bilateral discomfort at L3/L4
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Yeoman’s test elicited bilateral aching pain at L4/L5, suggesting lumbar facet involvement or soft tissue strain
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FABER (Patrick’s), Gaenslen’s, and hip stress tests were negative, ruling out hip joint pathology
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Straight Leg Raise was negative for radicular symptoms (mild discomfort only at 80° on the right side)
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Neurological examination (sensory, motor, reflexes) was within normal limits
Findings were consistent with a lumbar origin of pain, rather than sacroiliac or neurogenic pathology.
Clinical Impression
The presentation was most consistent with:
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Lumbar myofascial pain syndrome
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Lumbar facet joint dysfunction
The quadratus lumborum (QL) muscle is recognised as a common source of low back pain and may account for a significant proportion of musculoskeletal complaints (Travell & Simons, 1992).
Lumbar facet joint dysfunction is also a well-established contributor to chronic low back pain (Souza, 2001).
Treatment
A structured treatment plan was implemented, including:
Chiropractic Spinal Adjustment / Manipulation
Targeted spinal adjustments were applied to improve joint mobility and reduce facet joint irritation.
Lumbar Mobilisation
Segmental mobilisation techniques were used to restore normal movement and reduce stiffness.
Dry Needling (Medical Acupuncture)
Dry needling was applied to hypertonic muscles, particularly the quadratus lumborum, to reduce muscle spasm and pain.
Rehabilitation & Exercise
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Early-stage: gentle mobility and pain-reduction strategies
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Progression to strengthening exercises (isometric → isotonic)
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Focus on improving lumbar stability and muscular control
Postural Advice & Home Care
A personalised home exercise programme was provided to support long-term recovery and prevent recurrence.
Clinical Rationale
Spinal manipulation has been shown to be effective in managing lumbar facet syndrome (Cook, 2004).
Dry needling has demonstrated effectiveness in reducing muscle spasm and promoting relaxation through neuromuscular mechanisms (Cummings & White, 2001).
Exercise rehabilitation plays a critical role in restoring function, improving muscular endurance, and reducing recurrence risk in chronic low back pain (Von Korff & Moore, 2001).
Outcome
The patient returned after 3 days and reported significant improvement in both pain and mobility.
By the third visit, further improvement was noted, with increased ability to perform daily activities.
Following subsequent treatments, the patient reported that the low back pain had almost completely resolved.
He was reviewed twice more over the following month, reporting only occasional mild discomfort.
At a 3-month follow-up, the patient remained asymptomatic.
Summary
This case demonstrates the effectiveness of a combined approach using chiropractic care, acupuncture, and rehabilitation in the management of chronic low back pain associated with lumbar facet dysfunction.
References
Cook, J. (2004). Orthopaedic Lecture Notes
Cummings, M., & White, A. (2001)
Travell, J., & Simons, D. (1992)
Souza, T. (2001)
Von Korff, M., & Moore, J. C. (2001)
