45 yrs old lady with h/o whole left leg and back pain got mri done. what will be best line of treatment for her.is surgery is the only answer@
Respected Dr In my strong opinion Sir a surgery should not be warranted until physical therapeutics fails.Here as we see three pathological issues are visible each one of which is to be adressed.As far as discogenic condition is in concern SACRAL SHIFT rectification followed by back extension can be very helpful.Inflammation associated to muscles ligaments and facet joints can be dealt with UST whereas symptomatic Radiculopathy managment can be done with TENS ( Burst preferred) and a much newer technique of NEURO MUSCULAR DRY NEEDLING as per pattern of symptoms can be of great help. Sacralization if observed an HLAB27 should be checked however Sacaral mobilization techniques can help in attaining some level of mobility if at all possible bringing down the pain levels. I However have more concern towards the osteophytic growth been talked about particularly if it is present inside the spinal cannal, because if this will be cause of pain less can be done in physical therapeutics to eliminate it apart from symptomatic managment.I also suggest ASH Brace or Lumbr corset along with core muscle strenghtining and Back Global strenghtining.Pelvic floor muscles are to be worked upon too with adequate postural advice. Thank you.
No. Start with conservative treatment as surgery should be the last option. Physical therapy along with medical Treatment should be carried out initially. We can manage conservatively with contrast bath, stretching of the hams,hip flexors, piriformis n lower back muscles. Strengthening of spine extensers, core muscles (isometric). IFT, US n ILT for pain relief with mobilisations of SI and L5 - SI joint. Also posture and lifestyle modification is essential and may require LS belt initially.
Start conservatively. TENS US HOT PACK × 15 DAYS. LOOK FOR TENDER POINTS. DRY NEEDLING OF MULTIFIDUS LUMBAR , GL. MAX.AND CAN CHECK FOR PIRIFIRMIS TOO. IF IMPROVES THEN CAN GO FOR STRENGTHENING EXERCISE OF BACK.
physio
Need to see MRI films to give final opinion....will probably be managed with conservative manangemant on Pregabalin, methylcobalamin and best rest for few days alongwith hot fomentation
Its a very simple case fr physiotherapy ..plz go with dry nedling of erector spinae q lumborum g.meduius maximus and minimus thoracolumbsr fascia and lattidmus dorsi ..and bilateral piriformis..
Primarily Physiotherapy treatment alongwith required medicine and strong posture control... Surgery is secondary but also depends upon pts age and severity.
surgery
Hi in this particular case surgery is not suggested because ! 1) age factor Pt is 45 yr is old female . 2) claudication is present or not if present than it will u/L or B/L. 3)first line of treatment is physiotherapy . In that both electrotherapy and manual mobilisation is helpfull. 4) until and unless physiotherapy does not respond than go for next option. Note: If PT is undergoing physiotherapy which is first line of treatment than do it regularly and minimum for 20 to 25 days . For getting good results.
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