Thanks for the information. Hope the following is helpful.
"Jill H. Kison" wrote:
> Here are a few answers to some questions posed yesterday about my
> patient with LBP & radiculopathy.
>
> The patient did have some functional LLD on top of true LLD. The
> functional LLD has resolved & the Pt has a heel lift to minimize the
> true LLD. Soft tissue pathology is a problem as pain & tingling Sxs
> appear & seem to increase with increased radiculopathy. During times
> of minimal Sxs (between flare-ups), the Pt has only minimal
> piriformis tightness- no other muscles or tissues involved.
>From what you are telling me above I would think most of her sxs are soft
tissue in nature and not from a disc.
> The
> sacral & ilial problems seem to be resolved & holding well between Tx
> sessions.
A pelvis stabilization program including exercises, posture training and
avoidance of excessive torque on the pelvis should help to minimizes her
sxs and increase the interval btwn flare ups.
> I've been told that a discogram with a laser
> disc-shrinking surgery may be indicated (according to a PT)
My opinion is that this would have a low probability of significantly
helping the situation and a rather significant possibility of making
things worse.
> & again,
> an epidural is suggested by the MD- a physiatrist.
An epidural would have minimal risk and often does give a good benefit
from sxs in these cases. Probably due to its effect on the numerous
structures in the area in addition to the disc.
> The Pt has been
> deemed a non-surgical patient because the disc is assumed to still be
> contained. Obviously- the Pt wants the most conservative,
> cost-effective, & least time-consuming methods for Sx resolution-
> especially with the increased functional limitations at home and
> work.
>
> Jill Kison, SPT, ATC
Good luck
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