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.
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.
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.
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.
Thanks a lot
physio
The right back and leg pain is because of L5 sacralisation and nerve root conpression. So here in form of physiotherapy lumbar traction and IFT can be given. And back care and core stability exercises can be given. Patient would get better in 10 -15 days.
Physiotherapy treatment is going to immmense help in this case. McKenzie technique,electrotherapy,dry needling,back care exercises amd advicew are very helpful treatment for her. U ll get good result
Cases that would interest you
- Login to View the image
A 52/M Patient came for Back pain treatment.. - Tenderness at Lt Sacroiliac joint and Lt gluteal region.. - Radiating pain in Lt LL, while walking he complains. - Piriformis shortness + - Plz feel free to diagnose the radiograph and express ur views on Physiotherapy management... ...Thank u
Dhana Krishna Damara1 Like22 Answers - Login to View the image
Respected Vaidyas, An interesting case was on my Yesterday OPD. A male of 35 yrs having only the Chief complaint - Pain and Stiffness in Sacral region and having radiculopathy to B/L buttocks Since 5 yrs. He is an Athlete and a regular football player, henceforth H/O fall is obvious. Occupational History - Insurance Agent Personal History - Appetite - Good Bowel Habit - Regular and Clear Urinary Habit - Normal Sleep Habit - Normal Mental Status - Having Familiar stress related to Land matters. Pulse - Regular B.P.- Normotensive Ht. - 5'7" Wt. - 85 kg Advised for X-ray of Limbo Sacral Spine ( A.P. view and Lateral View ) showing no obvious change only Mild Osteophytic changes in L1, L4, L5 Vertebrals , I.V. disc spaces normal , no Spondylosis or Listhiasis. X - ray of Pelvis (A.P. view ) - Normal 25( OH ) Vit D3 and HLA B27 reports are pending. Respected Curofians Kindly Suggest the possible Pathologies and approximate diagnosis and Ayurveda line of management.
Dr. Niranjan Ram5 Likes26 Answers - Login to View the image
A 32 years Female patient who is hypothyroid. complaints of neck pain radiating to arm. tingling and numbness seen. she had vitD3 and B12 deficiencies. please diagnose and suggest treatment...
Srivalli Jandyala4 Likes25 Answers - Login to View the image
45yrs male driver by profession Presented with c/o backache which increases during work x 2months...No h/o any radiation or no diurnal variation...x ray done...management???
Dr. William Mattu4 Likes12 Answers - Login to View the image
48 yrs male pt. having constant pain over Back and Rt. lower limb since last 1 month...pain comes suddenly then disappear then comes again.what is the plan of Rx.?? No any c/o Hypertension Or DM
Dr. Janakba Jadeja1 Like12 Answers
2 Likes