Casuistry by spinal stenosis and multiple discs herniations in the lumbar spine

Do you feel strong pain in the lumbar spine which shoots to the surrounding areas or even to the toes on your feet? Does your leg drop and you can’t stand on it? Doctors offer you only surgical solution, but you would rather try to find some other option? Check out how we solved similar case at FYZIOklinika. In most cases it is possible to treat without operation!


Client - a man in age of 58 years came to FYZIOklinika with strong pain in the area of lumbar spine, in the middle of the last year. The pain was extending into the left leg, especially into the hip joint, groin, and the side of the calf. Generally he was very limited in daily activities (sitting, walking, standing but also sleeping). He started to feel problems half year ago and since then it was gradually getting worse and worse. His condition was getting worse to the extent when he could not walk into stairs or slight hill, because his leg was dropping down from time to time and he felt weakened and pain in the left hip joint. The patient was able to walk without walking stick. He felt a permanent pain, during night it would wake him up from sleep. He also had problems stepping out of the car.

After medical examination, he was advised to undergo the only possible treatment - neurosurgical operation. But the man wanted to avoid the surgical treatment therefore he searched out our physiotherapeutic clinic. In june 2016, when he came to FYZIOklinika, on his own request and our recommendation he went to MRI (magnetic resonance imaging). The results from MRI examination showed disc protrusion and herniation of the discs L2-3 to L5/S1 on the left, and L4/L5 on the right, with narrowed dural sac and moved vertebra L4 backwards.


The man arrived to our clinic half year after the problems first appeared (june 2016), he didn’t absolve any kind of therapy, he just absolved complexive kinesiological examination by a physiotherapist. He wasn’t sure with his standing position, and standing on the left leg was not possible at all. Pelvis was tilted to the left and up. The left SI joint was moved. Weakened function of the abdominal wall because of slight android type obesity. Bending down was painful already from the start of the movement, and the range of movement was significantly restricted, he had to straighten back with a help of hand. The patient had limited range of movement in the lumbar spine area to all directions, more to the left, and positive neurological tests on the segments L3/4 and L4/L5 on the left. Painful muscle spasm of the buttocks muscles and muscles in the left lower thoracic and lumbar spine area (m. quadratus lumborum, mm.erectores spinae, mm.gluteus medius, m.piriformis).


We choosed physiotherapy with combination of focused and radial shockwave therapy and kinesio taping.
Shockwave therapy lowered the tension in the muscles and pain immediately after first therapy, and client left with sensation that he can stand again on his left leg. The relief remained and the painful condition didn’t return anymore. Thanks to soft techniques which relieve soft tissues (skin, subcutaneous tissues, fasciitis and muscles) and soft mobilization and traction techniques we optimized the muscle tension and gradually restored the mobility between each vertebrae. We used especially exercises with neurophysiological basis, with which we activated the deep stabilizing muscles, that help to keep the spine in a straight position and prevent that way future herniation, worsened problems, and returning the vertebrae and discs into the original position.
The client exercised regularly every day at home a set of exercises, and his condition gradually got better. He was instructed to keep preventive measures - correct ergonomy while sitting, working, carrying, lifting objects. After 10 therapies 2 times a week his condition significantly improved. Sometimes there was a temporary worsening, as a result of incorrect movement behavior at home, or at work etc… Now he visits our facility just once a week, and we continue in exercising. We’re using a shockwave therapy according to the current situation and need after incorrect body movement. During the therapy we always used stabilization techniques and kinesio taping in the lumbar spine area and sacrum. The client is this way able to go to work and perform daily activities, but he has to keep preventive measurements and restrict to carry heavy objects and doing undesirable houseworks. The man continues in daily exercising at home 1-2 a dayin order to keep the optimal strength of the stabilizing muscles of the spine, trunk and pelvis. Without activate and complexive approach we can’t reach the expected results.

Visit us, and we will help you too!



Author: FYZIOklinika physiotherapy Ltd., Prague, Czech Republic

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