A 39 years old female had a history of slipped disc took physiotherapy for 10 days but then after that pain didint improve and went for surgery . after surgery came for rehabilitation program and did well for 1.5 months . suddenly she started having same pain again. on examination SLR is ok. There is tightness of hamstring and quads muscle. but pain is radiating down to the leg . Attached is the MRI report . what should be the treatment line ? @Dr_anuraag Jaiswal



Kindly post MRI images lat n transverse both. Pre n post laminectomy. Also enquire how the pain started n what relieves it. Till then go for contrast bath, neural stretch, core muscles isometric and back strengthening. Posture modification may help. IFT or Tens for at least 45 minutes twice a day till pain subsides.

Hi @Kirti Yadav Firstly an Ortho or Spine specialist opinion is needed in terms of FBS or post laminectomy failure and also taking into consideration about spinal stenosis pre surgery. Or else work in co ordination with the surgeon or respective doc... In terms of physio... conservative management is the best. Initially start with isometrics and gravity assisted movements.. of legs and back depending on the muscle sustainability. Also start with general upper body training.. including active movements of shoulder, neck, isometric shrugs and retraction exercises. Stretching of muscles is also a key component. Important - please do check if there is anterior pelvic tilt noted ... as hams may be already stretched due to postural fault. So do not overstretch the hams... Proper postural and ergonomical guidance is must. A proper double reinforced lumbar belt is must . Weight reduction is also recommended if the patient is overweight or obese. Thank you.

@Nikhil S. Shah thanks for the valuable reply.

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MRI images will be helpful here. pre-op MRI will tell the status of L3-4 pre-operatively and will help in understanding the problem.

Go for MRI and LS spine xray (AP&LAT) And for pain relief you can give analgesic like tramadol or Neuropathic pain blocker like prgabalin or gabapentin with mecobalamin LS spine brace can be advised

Lumbar belt first.. pain relief and numness used for electrotherapy.. release tightness gently.isometric abs,quads and hamstring.. lumbar kinesiology tapping under advice of surgeon if belt is not help. Contact with surgeon first .his/her suggesion prior.

McKenzie protocol Core stability exercises Stretching of the hamstrings and rectus femoris Ergonomic correction - avoid forward stooping activities

Respected Dr Kriti The case appears to be a case of FAILED BACK SYNDROME. Its worth noting here that a LAMINECTOMY done but no spinal fixation made , this fact becomes vital in the knowledge of lost lordosis and sacralization.The same has become a causes of revision of symptoms I WOULD suggest u conservative physical therapy managment along special stress of multifudus strenghthini and Brace is vital. Thank you

@Dr_anuraag Jaiswal anuraathanks for the valuable reply

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MRI images and stress x-rays in lumbar flexion and extension views will be helpful in assessing the listhesis, based on that we can plan further treatment.

Firstly you should check trigger points of piriformis muscles because the other causes of radiating pain are trigger points

There should be few precautions 1)avoid pillow, neck bending habbits.2)avoid long standing & weight lifting.3)avoid prolong use of mobile phone.4)avoid stress. Remember slip disc cases do not solve in10 data in physiotherapy .it should be given for around 30-45 days .at least 70%problems solves.

@Balmukund Mishra thanx sir. U r rite
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