Case of the Month July 2010

Illustration of the pain pathway in René Desca...
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A patient, that we will call Ben, reported to my office with low back pain that was traveling down his right leg all the way to the foot.  Upon exam it was pretty clear to me that Ben had a pretty tough case of sciatica, and trust me when I tell this, sciatica is no fun.

Let’s do a quick anatomy review.  The sciatic nerve begins in the low back, right around the top of your hips, or what you will hear as L4 and L5.  This nerve runs through the buttocks and continues down the leg.  When a person has sciatica, pressure is placed on the nerve somewhere along the path and the result is usually pain, although numbness can also be present.

Back to Ben.  When asked to rate the pain on a scale of 1 to 10, with 10 being miserable, Ben was a 9, which indicates it was quite severe.  Upon exam, Ben was showing tight musculature in the low back, decreased movement in the low back and tight musculature in the right buttocks.  Ben’s posture was a mess and several tests revealed the sciatic nerve was aggravated, to say the least.  X-ray was unremarkable.

I suggested to Ben that we try a short trial to make sure that this was the right course of action for him.  He agreed and we began with chiropractic adjustments, exercise, trigger point therapy and traction.  Ice was also applied after each visit.

At first we made some crazy improvements.  Ben’s pain rating dropped from 9 to 5 after 3 visits.  That gave us some information that this was the right course of action and not necessarily a disc herniation as can often be the case with leg pain cases.

The going after that was much slower.  Over the course of 3.5 weeks, we have been able to get Ben’s pain down from a 5 to a 2.  Ben is thrilled with his progress, me I am a little impatient.

In the coming weeks we are looking to improve Ben’s pain to a zero, while helping him with strength and conditioning to increase the chances that this doesn’t happen again.

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