Case Report
Treatment of a Case of Subacute Lumbar Compartment Syndrome Using the Graston Technique

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Objective

To discuss subacute lumbar compartment syndrome and its treatment using a soft tissue mobilization technique.

Clinical Features

A patient presented with low back pain related to exercise combined with prolonged flexion posture. The symptoms were relieved with rest and lumbar extension. The patient had restrictive lumbar fascia in flexion and rotation and no neurological deficits.

Intervention and Outcome

The restrictive lumbar posterior fascial layers and adjoining restrictive fascia (thoracic, gluteal, hamstring) were treated with a form of instrument-assisted soft tissue mobilization called the Graston technique. Restoration of fascial extensibility and resolution of the complaint occurred after 6 treatment visits.

Conclusions

The posterior spinal fascial compartments may be responsible for intermittent lower back pain. Functional clinical tests can be employed to determine whether the involved fascia is abnormally restrictive. Treatment directed at the restrictive fascia using this soft tissue technique may result in improved fascial functional testing and reduction of symptoms.

Section snippets

Case Report

A 59-year-old man complained of intermittent lumbar pain of 2 weeks' duration. He worked as a shoe salesman and became aware of his pain especially in the flexed lumbar position. His pain became severe every 2 to 3 months for the ensuing year, causing him to miss work 2 to 3 days at a time. Usually, bed rest and analgesics provided relief. This time his pain continued and although bed rest still relieved him, the pain persisted especially when he flexed forward. Bending backward relieved his

Discussion

It is not uncommon to see patients with low back pain whose symptoms are increased by exercises or activities involving repetitive forward flexion and are relieved by rest and backward extension. Often, these patients do not have neurologic deficits in their lower extremities. Styf and Lysell20 mention these symptoms in a diagnosis of “chronic compartment syndrome” in the erector spinae muscle. The treatment described was fasciotomy of the erector spinae muscles which normalized the

Conclusion

This case describes the treatment of a patient with subacute lumbar compartment syndrome using the GT. Previous descriptions of treatment for this syndrome involve surgical intervention to normalize intramuscular pressures. In this case study, it is hypothesized that intramuscular pressures were normalized after instrument-assisted soft tissue mobilization and stretching. Future prospective research is needed to quantify lumbar compartmental pressures before and after intervention.

Acknowledgments

The authors thank Sarah B. Kucera for her assistance with this project.

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