Quoting Ben Fisher <[log in to unmask]>:
> 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).
> 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.
>
Ben:
My opinion is to avoid any activity that aggravates (i.e.increases) definite
neuro signs/symptoms (S/S). There are several studies that have shown that
radicular S/S only occur when the nerve root is inflammed (e.g. compessing or
tractioning a normal, healthy nerve root does not produce radicular pain)
therefore activities that increase radicular S/S are likely causing increased
inflammation around the nerve root. I would avoid as many aggravating activites
as possible until the inflammation settles down (so unless he has to play in the
World Cup - back off)
If the distal symptoms were non-radicular in nature - i.e. non-dermatomal
pattern with no other S/S - then I would say keep being active as long as they
are transient. But in your patient's case - it seems like nerve root involvement
(which is likely after the amount of repetitive lumabr movement in a squash match).
His symptoms should settle if he backs off:
1) it's only been a week
2) he can relieve his symptoms with rest
3) doesn't seem like disc herniation (full flexion, no problems coughing, etc)
I'd tell your patient that it's like an ankle sprain - he has to back off for a
while until it settles - or he will delay healing.
john jefferson
USA PT Dept
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