I had an interesting case recently that worthy of blogging. I was treating an 18 year old female for a ACL repair (yes, I also do sports medicine) who came into her appointment complaining of severe low back pain.
She woke up a few days prior with some back pain and went to her family chiropractor. She had pain “20 times worse” after manipulation to her back. She stated after her manipulation she began to have some redness on the R side of her spine. Clinical exam showed normal and pain-free lumbar range of motion, positive SIJ pain provocation tests, and a positive straight leg raise test.
To be on the safe side, I referred her to her PCP for follow up as I was concerned about the redness of her skin, and a diagnosis of shingles was confirmed.
Shingles in a 14 year old is rare condition. This was the first time I have referred someone in my career for a suspected case of shingles with low back pain. Shingles is basically the reactivation of the herpes zoster virus that usually remains dormant after a case of chicken pox. The mechanism to why the virus becomes reactivated remains unknown, however, it is usually attributed to stress or compromised immune system.
Being the curious guy that I am, I was wondered if the spine manipulation could have caused the reactivation of the herpes zoster virus, causing shingles. Especially since the patient states was pretty stress free and taking most of the summer off before she went to college and is generally healthy. Although it is possible that she was developing shingles prior to her lumbar manipulation, but I wonder if it was possible that a nerve traction injury from a vigorous manipulation was enough to reactivate the virus.
The only reference I could find that had a similar mechanism was a 2009 study in which a patient got shingles from a trigeminal nerve surgical manipulation. You can find the article here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2827157/
If any of my physical therapy colleagues have any thoughts, please post in the comments section. I’m curious if anyone else have had this experience. I do know of one case of a physical therapist who claims that aggressive dry needling actually caused her to have a case of shingles.