Spinal Manipulation, Osteopathic Manipulative Treatment, and Spasticity

A 31-year-old male was referred to your office for spinal manipulation with a diagnosis of myofascial pain syndrome. He states that he has chronic low back pain and is asking for spinal manipulative treatment for symptomatic relief of his low back pain. On examination you notice that he has left-sided muscle spasm and somatic dysfunction of the lumbar spine at L5-S1 (rotated left side bent right). He also has mild spasticity, confined to the lower extremities, which upon further questioning you find out is from a benign but compressive meningioma that was neurosurgically removed from his thoracic spine when he was younger. His gait is altered due to lower extremity spasticity, and he has chronic low back pain that is worse when he ambulates or stands for a prolonged period of time. MRI shows chronic postsurgical changes, and mild facet hypertrophy, but is otherwise unremarkable.