What are you doing to improve lumbar extension and hip extension? After a
dose of this treatment how is his ROM and comp. signs?
Patrick Zerr
www.apluspt.com
The easiest way to prepare for the National PT Exam!
www.summitpt.com
Summit Physical Therapy; Tempe, Arizona
----- Original Message -----
From: "Ben Fisher" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Thursday, January 23, 2003 7:28 AM
Subject: LBP & neuro signs dilemma
> 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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