male 60 complain of pain in back and both lower limb since two years. diagnose n management plz



before getting an MRI, kindly do detailed neurological examination to ascertain if the pain is true radiation or just mechanical. look for dermatomal sensations, reflexes, motor power. if its not nerve root pain, put on analgesics, muscle relaxant, pregabalin, back strengthening physio

thanks very proper treatment line

1st go for MRI to rule out lumbar spine degeneration and lumbar clodication or any nerve impingement...if degeneration is mild to moderate then kindly go for physiotherapy treatment.. its take at least one month to recover.. in physiotherapy 1 st week go fermentation..10-15 mints with low intensity tens 10-15 mints...,ultrasonic therapy 1mhz with 1.2 to1.6 w/cm2 intensity 5 to 8 mints . if pain is more then also used laser therapy...n do Hoffa's massage in the direction of muscle fibre..specily in l4,l5 n s1 facet joint. if pain is subsided in one week then work on core stability n core strengthen exercise ,mobilization,McKenzie exercises n also do lower limb strengthing exercise n stretching for tight str...also give him ergonomics advice's n educate him about proper posture n gait ..prescribe him lumbar corset..

MRI is not indicated presently. needs detailed clinical examination to ascertain radiculopathy. physio+ conservative management. if no response in 3-4 weeks, MRI can be done then

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thanks for replying dr I could understand there is straight ing of lumbar lordosis. gross degenerative changes.stenosis can b there as osteophytes encroaching in the spinal canal.seen all over the lumbar spine.its PID grade 1.continue with physiotherapy in the form of spinal extension exercise or posterior pelvic tilt. abdominal exercise spinal mobility and IFT.

why we cannot do Spinl.flexion ex's? mam ,and why could use pelvic post.tilting ex's pls.

dr suryam , the patient complains of pain in walking and standing and weakness that means there must b some neural structures involve ment, that can lead to compression of the spinal posterior pelvic tikt exercises as this opens up the canal space biomechanically. also I have adviced for abdominal exercise which is also spinal flexion exercise. as its just mild pid, abdominal exercise can b given but a modified one.

dr suryam I have mentioned that patient can do spibal mobility exercises. lower limb pain is indicative of some neural compression,moreover there is straight ening of lumbar spine.and you must b aware that posterior pelvic tilt exercise opens up the spinal canal thus reducing any compression.

xrays shows compression .. so first use heat modality then use 5 min static traction then next 5 min intermitant traction .. then spinal extension exercise & use precautions like don't do spinal flexion use hard bed maintain sitting ,walking & lying positions

use NDS treatment for nerve compression

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what is the history of the patient? any trauma? any tingling and numbness.

fall before 9 years not much significant. yup there is but pain while walking n standing up, weakness

these days this is a common issue... kindly go for basic treatment protocol... but ergonomic advise is must ...posture correction is needed for long term betterment... taught home exercise at the end to be followed by patient to remain fit nd healthy:)

lumbar lysthesis in four and five,lig.weakness has been noticed, TREATMENT : static lumbar traction followed by intermittent and gives I.F.T With lumbar flexion Ex's are encouraged, latter on stability and strengthening ex's are given.Trac.for week without any ex's later on ex's monitoring for four weeks.

To me it appears as degenerated Lx spine with multiple level osteophytes (bridging osteophytes), loss of Lx lordosis. H/o claudication can give further clue for clinical examination and later effectiveness of treatment. As Dr. Hardik as said in 1 of his comments that pt has more pain in sit to stand and walking, it 'MAY' be LCS. I would start with physiotherapy, pain relieving modality like IFT, gentle manual traction with belt, moist heat and core muscle training (phase 1) and gradual progression with ex. Change in claudication distance (if present) can give an idea about effectiveness of treatment

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