We all know of at least one person who suffers from pain into their lower back. This week I will focus on a case involving sharp lower back disc pain with referral shooting pain down the leg. The Patient involved has a history of lower back pain however his symptoms have greatly worsened over the past 6 months with shooting pain down the leg.
Signs & Symptoms that he experiences:
Sharp pain into the lower back with pain radiating down into the knee
Occasional pain into both hips
Muscle spasm of lower back
Pain is aggravated by forward bending movements
Tingling pain into outside area of ankle coupled with numbness into the big toe
Difficulty in moving from a forward bending position to a tall upright position
A feeling of weakness into his left leg
So what is causing the sharp lower back & leg pain?
On clinical examination the Patient has excessive mobility in his lower lumbar spine from L4-S1 vertebrae. This means that the lower vertebrae blocks of the lower back are moving incorrectly causing the disc bulging in this region with the disc bulge being biased towards the left side of the lower back. The disc bulge is subsequently pressing on the nerve roots that originate from the lower back and in this case the Sciatic nerve root is being impinged thus causing lower leg pain. MRI scanning in this case is very useful in that it helps to pinpoint the exact position of the disc bulge. Many years of Poor posture and constant forward bending of the lower back have led to this dysfunction to occur in the lower back.
Treatment & Management
The treatment plan consists of gradual graded mobilization techniques to the lower spine in order to correct a positional fault of the L4 and L5 vertebrae which is causing the disc to bulge to the left side. Nerve gliding techniques to the sciatic nerve can be helpful also. A phased special homecare exercise program is devised for the patient with emphasis on stabilizing the spine and moving the spine into pain free lumbar extension positions. Graded soft tissue treatment should be applied to the heavily tightened muscles of the lower back & pelvic and hip region in order to improve the malfunctioning lower spine and pelvis.
Next week I will discuss problems of the hip region.
Tomás Ryan is a Registered Physical Therapist with The Irish Association of Physical Therapy and is based in Thurles.
Contact Number: 0504 26672
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Injury Solutions Clinic
Physiotherapy & Injury Rehabilitation Clinic in Tipperary