An Osteopathic Approach to Low Back Pain and Short Leg Syndrome in a Patient with Traumatic Brain Injury Following Motor Vehicle Crash: A Case Report

A 16-year-old boy suffered a traumatic brain injury in a motor vehicle collision with resulting subdural hematoma, post-traumatic seizures, headaches, and cognitive dysfunction. In addition, he experienced severe acute low back, neck, and hip pain. The patient’s pediatrician identified him as likely to benefit from osteopathic manipulative medicine (OMM), and he was subsequently referred to the Des Moines University (DMU) specialty care clinic for further evaluation and management. The patient’s outpatient rehabilitation was impacted by multiple somatic dysfunctions and by onset of short leg syndrome. An OMM approach with direct techniques (muscle energy; low-velocity, moderate-amplitude; soft tissue), indirect techniques (counterstrain, Still, myofascial release), and cranial techniques were utilized to minimize his pain, maximize the neuromusculoskeletal recovery, and to assist in returning him to his prior level of functioning. The acute nature of the injury and apparent new-onset leg length discrepancy allowed for a rapid correction with a heel lift and an ongoing OMM approach to address somatic dysfunction associated with the condition. After 5 treatments with OMM and use of the heel lift, the patient’s low back pain substantially improved, and his headaches completely resolved.