Ben,
Would agree with advice from John; however, the increase in symptoms with
walking bothers me. Could he also have a significant facet joint irritation
as well. Considering his activities, and how the symptoms began this could
be a possibility. Thus creating a "lateral recess stenosis" presentation.
Let the inflammation subside and then re-establish movement. Would be
interesting to see if his reflex returns as the pain subsides. good luck!!
Rege
At 02:28 PM 1/23/2003 +0000, you wrote:
>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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