LOW back pain radiating to left lower limb

A patient come with low back pain radiating to left lower limb, tingling and numbness over the left leg, having history of hypothyroidism taking thyronorm 100 mcg tablet complaint of pain during standing and worst during walking not able to sit for long time. 3 years before MRI finding he has disc bulge at L4L5. SLR test is positive I had used IFT over back and collateral hot pack over back. After following these in 3 days his pain 10per decreased, then I apply technique to activate diaphragm after using electrotherapy and diaphragm activation now his pain decreased to 50 per and he is able to walk without pain he is able to sit upto 45 min without pain and tingling and numbness is stopped.

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Hi Shweta , you seem to have managed the patient well. Few additional points When patients complain of tingling and numbness, make sure you assess myotomes fro strength and dermatome for sensation. Only a resolution of pain is not adequate to confirm healing in patients presenting with these symptoms. SLR is positive in anyone with disc bulge, but it can also be positive in a lot more cases. As such the specificity of an SLR is low . Slump test should also be done, Also your patient had pain the most in walking, typically disc bulges get relieved on walking while listhesis can aggravate on walking.. so it's really important to check for step , instability etc especially since it is accompanied by tingling numbness . Do not be misled by MRI, a detailed physical examination is paramount. Diaphragm activation is a good strategy to work with patients, a lot of us miss it, but it is also important to work on pelvic floor and core strength. I am not a big believer in electrotherapy due to poor scientific evidence in long run but I feel you could have started mild Exercises also day 1. Would be interested in knowing your future plan with the client... Thank you for sharing

Ma'am I had mild exercise after day 3 only ankle toe movt n heel dragging , I didn't do slump test because pt is in too much pain so I believe to use electrotherapy for pain relief then only pt can got confidence to do anything .. And I believe to manage the pt by functional activities.. Thank u for your precious information..I will definitely go for core strength and pelvic floor strengthening exercises
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You have got wonderful results Your results can improve further if you were to add following thing 1) advise to avoid lifting heavy weight 2) advise to avoid jerky movement - such as travel by auto, scooter with bumpy ride 3) advise to avoid soft mattresses and instead use hard surface to sleep 4) Back muscle strengthening exercises is most important advise that you can give, Certain yoga postures such as Dhanurasan, Mayurasan can be helpful

Thank you doctor
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Good result Some disc bulge with radiculopathy gets better with conservative treatment

I agree
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The case is PIVD, start core strengthening exercise and streching of hip muscles

Thank you @Melitta Menezes
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Once repeat MRI spine for current position.

Yoga exercises have given excellent results

Thanks Nihar Ranjan mohanty,Dr. Dinesh Gupta ,Shweta Giri
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