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    Week 8 Category 2

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    This document discusses the management of a patient presenting with bilateral leg pain that is likely due to a central spinal issue rather than a peripheral one given the bilateral presentation. Potential causes include spinal cord neoplasms or stenosis. Common lumbar stenosis findings include chronic low back pain, paraesthesia, and pain relieved by flexion. Differential diagnosis should consider involvement of the L5, S1, and S2 nerve roots and discs. Management includes conservative care with PRICE, avoidance of extension, massage, mobilization, medications, and rehabilitation focusing on core strengthening. Surgery may be an option if conservative care is ineffective.

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    Week 8 Category 2

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    api-468093714
    87 views4 pages
    This document discusses the management of a patient presenting with bilateral leg pain that is likely due to a central spinal issue rather than a peripheral one given the bilateral presentation. Potential causes include spinal cord neoplasms or stenosis. Common lumbar stenosis findings include chronic low back pain, paraesthesia, and pain relieved by flexion. Differential diagnosis should consider involvement of the L5, S1, and S2 nerve roots and discs. Management includes conservative care with PRICE, avoidance of extension, massage, mobilization, medications, and rehabilitation focusing on core strengthening. Surgery may be an option if conservative care is ineffective.

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    This document discusses the management of a patient presenting with bilateral leg pain that is likely due to a central spinal issue rather than a peripheral one given the bilateral presentation. Potential causes include spinal cord neoplasms or stenosis. Common lumbar stenosis findings include chronic low back pain, paraesthesia, and pain relieved by flexion. Differential diagnosis should consider involvement of the L5, S1, and S2 nerve roots and discs. Management includes conservative care with PRICE, avoidance of extension, massage, mobilization, medications, and rehabilitation focusing on core strengthening. Surgery may be an option if conservative care is ineffective.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    87 views4 pages

    Week 8 Category 2

    Uploaded by

    api-468093714
    This document discusses the management of a patient presenting with bilateral leg pain that is likely due to a central spinal issue rather than a peripheral one given the bilateral presentation. Potential causes include spinal cord neoplasms or stenosis. Common lumbar stenosis findings include chronic low back pain, paraesthesia, and pain relieved by flexion. Differential diagnosis should consider involvement of the L5, S1, and S2 nerve roots and discs. Management includes conservative care with PRICE, avoidance of extension, massage, mobilization, medications, and rehabilitation focusing on core strengthening. Surgery may be an option if conservative care is ineffective.

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    Week 8 Category 2

    • With an insidious onset, bilateral presentation such as this, what is the likelihood that this
    would be a peripheral issue?
    It is very uncommon for peripheral issues to present bilaterally, typically they occur
    unilaterally. Generally, if the issue presents bilaterally the issue will be more central

    • What neoplasms/malignancies would we consider in a patient of this age?


    • Spinal cord neoplasms (astrocytoma's; glioma's, etc)
    • Other visceral organs that refer pain (kidney; prostate; etc)

    • List common findings, history for stenotic lumbar complaints


    • Chronic LBP
    • Paraesthesia
    • Relieved with flexion or sitting
    • Pain worse with extension

    • What nerve roots and peripheral branches do you need to eliminate in this of potential of
    buttock referral? Be specific about disc and IVF levels that could be involved.
    • L5; S1; S2

    Posterior osteophytes off vertebral


    body & facet arthropy causing
    spinal stenosis (narrowing of spinal
    canal)
    Central spinal canal stenosis

    • How could you differentiate vascular claudication from neuro-claudication?


    Neuro-claudication Vascular-claudication

    Age Over 50 - long history of back ache Over 50

    Type of pain Weakness, burning, numbing or tingling Cramping, aching, squeezing

    Leg pain Proximal Distal

    Back pain Yes Not usually

    Onset Walking (uphill & downhill). Prolonged Walking a set distance each
    standing time, especially uphill

    Relief Lying down, flexing spine Standing still

    Associations Bowel & bladder symptoms Impotence

    Pulses Present Present (usually), reduced or


    absent in some

    Lumbar Aggravates No change


    extension

    Neurological Saddle distribution. Ankle reflex may be No change


    changes reduced after some exercise
    • What would be your management strategy for this case?
    • PRICE when acute
    • Avoiding lumbar extension
    • Massage therapy - relaxation to spinal musculature
    • Mobilisation/manipulations - flexion based adjustments
    • Medication
    o NSAID's
    o Analgesics for acute flare up's
    • Rehabilitation
    o Stretch & strength training - improve core body strength

    • What is your likelihood of success?


    According to Johnsson et.al (1991), approx. 30% of patients improved with conservative
    treatment

    • How quickly would you expect to see improvement in this case?


    The pain associated with spinal stenosis can improve with medication and conservative
    treatment and rehabilitation. The time taken varies on the individual.

    • What surgical options are available for these cases?


    If surgery were required, a laminotomy or laminectomy would be performed. The goal of
    surgery is to decompress the affected nerve roots.

    1. Outline a management plan including a rehabilitation protocol for one of your serious MSK
    differentials.
    Conservative treatment
    • PRICE when acute
    • Avoiding lumbar extension
    • Massage therapy - relaxation to spinal musculature
    • Mobilisation/manipulations
    o Flexion based adjustments
    o Side-lying lumbar rotation thrust
    o P-A mobilisations

    • Medication
    o NSAID's
    o Analgesics for acute flare up's

    • Rehabilitation during conservative treatment


    o Lumbar isometric & stretching exercises
    o Static & dynamic postural exercises
    o Muscle strengthen - lumbar spine & core
    o Flexion based exercises

    • Single & double knee to chest in supine position

    Surgery
    May be necessary is conservative treatment is not effective. Aim is to decompress the affected
    roots.

    2. Demonstrate / Describe 3 exercises you could use for this patient to improve his leg
    symptoms and strength the lumbopelvic area.

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