Chiropractic management of acute low back pain in a U.S. veteran with unilateral transtibial amputation: A case report

Objective: The purpose of this case report is to describe chiropractic management of acute low back pain for a patient with a unilateral transtibial amputation. Clinical features: A 39-year-old male veteran presented to the VA Puget Sound chiropractic clinic with acute low back pain. The patient had a history of a left transtibial amputation secondary to a blast injury sustained during combat. He presented wearing a prosthesis, walking with a left trunk antalgia, and utilizing a cane for ambulation assistance due to low back pain severity. The PEG patient-reported outcome was scored 7.3/10. Lumbar range of motion produced severe pain with flexion and mild pain with extension and right lateral flexion. Repetitive lumbar extension reduced the low back pain intensity without peripheralization of symptoms. Orthopedic testing was provocative for low back pain, but not radicular symptoms. Intervention and outcome: A trial of care was completed with six visits over six weeks and included high-velocity, low-amplitude spinal manipulative therapy spinal manipulative therapy, spinal end-range loading, and exercise prescription. Following the first visit, there was an immediate reduction in pain, and the patient was able to ambulate without the use of his cane. A resolution of the complaint was achieved by the sixth visit, with a final PEG mean score of 1/10, and he was released from care to self-management. Conclusion: This is only the third case report to describe the chiropractic management of a patient with comorbid transtibial amputation. Our case highlights the necessary modification of the examination and a positive outcome following a trial of care. There is currently limited guidance available for clinicians to aid the management of individuals with spinal complaints and lower limb amputations, suggesting a gap in the literature.