01.04.19 Clinical Hours

22-year-old male student came in to the Marjon sports injury clinic with complaints of sharp pain radiating down the left leg. Before this session my aim was to try and go through the SOARxP process as efficiently as possible to practice for my clinic induction in May. I conducted a full lumbar spine assessment including observation (static/dynamic), palpation of the lumbar vertebrae, active and passive range of movements and then went through a neurological assessment. Dermatomes and myotomes were all fine, but the unilateral leg raise was +ve in the 35-70° range, which indicates sciatica (Konin, Lebsack, Valier & Isear, 2016). I also conducted a piriformis tightness test to see whether sciatic type pain was due to a tight compressing piriformis. This test was however -ve. I also assessed general lower limb function by asking the patient to perform a squat. Diagnosis was Sciatica which originates from a nerve compression in the lumbar spine. Treatment was mobilisations of the lumbar spine (unilateral PA, on right transverse processes of lumbar spine) and soft tissue massage.

This session was difficult as I have not had a lot of experience in assessing the lumbar spine. I found it difficult to remember the myotomes and dermatomes for the lumbar spine. As such I will revise these using the help of lecture notes. Furthermore, I was not confident in my treatment of sciatica as there can be multiple causes of sciatic pain such as herniated disks, facet joint dysfunction, swelling and more.  (Peul et al., 2007) stated that the most common cause of sciatica is nerve compression by a herniated vertebral disk. If this was the case, I could have used the McKenzie protocol exercises (repeated movements) with the goal of centralising the radiating pain back to the pain origin (lumbar spine). For future reference I will do some more reading on the McKenzie protocol in treating lumbar nerve compression due to herniated disks.

References:

Konin, J., Lebsack, D., Valier, A., & Isear, J. (2016). Special tests for orthopedic examination (4th ed., pp. 364-390). SLACK incorparated.

Peul, W., van Houwelingen, H., van den Hout, W., Brand, R., Eekhof, J., & Tans, J. et al. (2007). Surgery versus Prolonged Conservative Treatment for Sciatica. New England Journal Of Medicine356(22), 2245-2256. doi: 10.1056/nejmoa064039

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