Dear Physio List
I am aware of allowing patients more management of their condition in back
pain, and encouraging graduated activity and exercise. However, I can find
no real guidance for the management of patients with back pain and
transient neuro signs (eg. pins & needles, numbness).
For example, in a patient with low back pain who gets pins and needles &
numbness (but no other red flags) in a dermatomal distribution with
activity, is it better to advise activity that avoids bringing on these
signs?
If not, could this repeated exercise cause further trauma, maybe even
neuropathy, if the patient were to continue exercising through these signs?
The reason for asking is the following case:
CASE
27 yr old male, plays many sports. Acute onset (1 week) of (R) sided LBP
with pins and needles in (Right) S1 distribution following squash match.
Pain and pins and needles with standing, walking and other extension (eg.
prone).
O/E Restricted and +ve SLR on the (Right). Absent (R) T-A reflex. All
other neuro OK.
Has full range flexion with minimal pain EOR. Pain with extension
(immediate) and graduating to pins and needles after about 1 minute.
Palpation of (R) L5 facet was initially provocative, but not now. No
increase in pain with cough, sneezing etc
He is still able to go to the gym and cycle, though has some increase in
pain later. My dilemma is that he can only go a very short distance walking
before he has to stop because of pain and numbness. And his leg gets
increasingly painful & numb if he is active, though this seems to resolve
after a few hours rest back to normal.
Condition has been ISQ for 1 week.
THE KEY POINT
If I were to advise him to avoid activities that bought on numbness and
pins and needles, he would be restricted to sitting and cycling, and would
be unable to work. Therefore my original question. Does anyone have any
opinion on this? I have scoured the textbooks and the internet and found no
answer.
Thank you very much for your help.
Ben Fisher
Junior Physiotherapist
London, UK
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