Transient Neuropathic Pain Following Mechanically Assisted Manipulation of the Spine: A Clinical Case Study

We describe the case of a patient developing acute neuropathic pain in the sciatic nerve distribution following spinal manipulation. Manipulative treatment with an Activator Adjusting Instrument (AAI) was recommended and performed. Within 24 hours, the patient developed severe 10/10 pain originating from the left gluteal area at the site of one of the activator deployments with radiation all the way down his left leg to the foot. He was able to maintain distal left leg strength and sensation. Relief was achieved with subsequent physical therapy techniques to relax his deep gluteal muscles, raising the hypothesis of temporary injury to the deep gluteal muscles, with painful contractions resulting in gluteal region pain as well as sciatic nerve inflammation as the nerve passed through that region. This clinical case illustrates some of the perils and risks of spinal manipulation, particularly in the elderly, and the need for careful patient selection.