# The Effect of Soft Tissue Release at the Thoracolumbar Junction in a Patient with Bilateral Leg Symptoms: A Case Report

## TL;DR

A 39-year-old woman with long-term bilateral leg symptoms improved after treatment targeting the thoracolumbar junction and sympathetic nervous system.

## Contribution

This case report explores the potential of soft tissue release at the thoracolumbar junction for treating bilateral leg symptoms.

## Key findings

- The patient showed significant improvement in pain, disability, and anxiety after 10 sessions of treatment.
- Soft tissue release and related techniques at the thoracolumbar junction may benefit patients with non-dermatomal leg symptoms.
- The thoracolumbar junction and sympathetic nervous system should be evaluated in similar cases.

## Abstract

Background: Manual therapists mostly see patients with bilateral leg symptoms.
Pain, pins and needles, fatigue, heaviness, lower limb coldness, and loss of
neurological conduction are the patients’ symptoms. It is hypothesized to be
caused by the sympathetic nervous system. Few publications cover its
pathophysiology, diagnosis, and treatment. Limited research has examined the
consequences of soft tissue release (STR) at the thoracolumbar junction. This
case describes STR in a patient with bilateral leg symptoms.Case Report: A
39-year-old female presented with bilateral leg symptoms, especially the left
leg, with more intensity at night. The symptoms started without a clear cause
almost two years ago. She had clear low back pain 2 years ago. The sacroiliac
joint and neurologic tests were normal. The examiner found some stiffness in the
hip joint range of motion and SLR, especially on the left side. The patient
reported some stiffness during active lumbar ROM, especially in rotation to the
right and flexion. Palpation revealed tenderness in the piriformis, biceps
femoris, and gastrocnemius muscles and L5, especially on the left side, and
hypomobility in the thoracolumbar junction. The patient has been treated for 10
sessions with a 6-week multimodal approach consisting of STR, the Garston
technique, and electrical stimulation in the thoracolumbar junction. The patient
was assessed four times. She had a significant decrement in the Numerical Pain
Rating Scale (NPRS), the Oswestry Disability Index (ODI), the Global Rating of
Change Scales (GRC), and the Beck Anxiety Index following the interventions. She
could do her personal activities and would sleep without the
sedative.Conclusion: T10 to L2 supply lower extremity sympathetic nerve fibers.
This case study demonstrates that these treatments could help these clinical
presentations. Interventions with STR need more research. Therapists should
evaluate the thoracolumbar junction and SNS in individuals with bilateral leg
symptoms without a dermatomal pattern.