Alden began to experience pain and numbness from the left side of his buttock to his left leg after sneezing forcefully while lying in bed. He immediately felt the pain, which got worse over the next 24 hours. While Alden found it difficult to get into any position without significant discomfort, standing and walking were particularly difficult because putting any weight on the left leg was very painful.
At the time of his first visit to the clinic, the pain had lasted for three days. When asked to rate the level of his pain on a scale from 1 to 10 (with 10 being the most painful), he rated it 10 out of 10. Prior to visiting his chiropractor, Alden had consulted his general physician, who prescribed pain-killers and anti-inflammatory medications: Alden found that they only provided him with temporary relief.
Alden has a history of recurrent low back pain that has responded well with chiropractic treatments. He enjoys playing golf on weekends, but he spends most of his working hours sitting in the office. He is 32 years old, a non-smoker and his general health is good.
Upon examination, the following were noted about Alden’s condition:
- Extreme muscle spasm in the low back region.
- Unable to perform any ranges of motion involving the lumbar spine due to severe pain.
- Straight Leg Response (SLR) test showed that when lying on his back, he could not lift his left leg up beyond 30º without severe pain, compared to 60º in the right leg. The normal range is 80 - 90º.
- X-rays showed mild disc thinning in L4/5 and reduced curvature in the lumbar spine. MRI studies showed moderate posterolateral protrusion of the L4/5 disc and to a lesser extent at L5/S1.
Diagnosis & Analysis
Alden was diagnosed with sciatica, which is pain caused by the compression of one of the nerve roots that give rise to the sciatic nerve. The sciatic nerve is responsible for the muscles and skin of the lower limbs. In Alden's case, the sciatica was caused by a herniated disc in his lower lumbar spine.
Due to his lifestyle, it is possible that Alden may have had a minor disc protrusion before the sneezing incident. There are several lifestyle factors that may have made Alden’s discs vulnerable to protrusion, including the following:
- Sitting increases the pressure on discs, often leading to minor tears. Sitting also reduces blood flow, which would impede the healing of the minor tears.
- Due to the complex mechanics involved in golf, Alden may have increased the wear and tear of his discs.
With the area already vulnerable, the forceful sneeze Alden experienced likely herniated the disc. The injury would have immediately caused swelling and the release of chemicals that would have made the nearby nerves hypersensitive to pain. The surrounding muscles, in turn, would have gone into spasm to limit movement and protect the injured area. The protruded disc would have continued to cause pain as it irritated the nearby nerve in instances where it was stretched (sitting, standing etc.).
Treatment of Sciatica & Prognosis
Alden’s treatment protocol included the following:
- Step 1: Control of Inflammation - Alden received a combination of interferential current therapy, ultrasound and ice to minimize the inflammation.
- Step 2: Restore normal joint mechanics - Flexion-Distraction was performed on the involved segment(s) to reduce disc compression. Spinal manipulation was also performed to correct abnormal spinal mechanics.
- Step 3: Core strengthening - Pelvic stabilization exercises were prescribed to strengthen the Transverse Abdominal muscle to prevent recurrence of symptoms.
Two weeks into treatment, Alden’s pain score was 3/10. He was able to perform most daily activities, except sitting for more than 15 min. He was still feeling some tightness in the left buttock and in the left calf muscle. His SLR test increased to 60º.
Four weeks into treatment, Alden reported a 0/10 pain score, but still had mild numbness in the lower leg area. His SLR increased to 80º, and he was instructed to perform some light exercises at home.
Eight weeks into treatment, Alden had no pain or numbness. He started to incorporate cardio training into his home exercises. He was discharged and recommended to continue regular spinal maintenance treatments once a month.
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