Sciatica Case Studies

1) Acute Sciatica – sciatic nerve pain occurs due to pressure placed on the sciatic nerve. Sciatica is characterized by pain that starts in the lower back and radiates through the buttock and to one or both lower extremities (LE). Sciatica is also known to cause a feeling of numbness or weakness to the one or both LE (Casazza, 2012).
Why? - The patient presented with a c/o right lower dull back pain rated 7/10 with radiation to buttocks and below the knee x 5 days. Red flags indicating sciatica are c/o numbness along outside of right LE and a positive SLR in the RLE. Patent also states that pain is worse with sitting and walking and improved with rest.
Diagnostics – Sciatica is primarily diagnosed by history and physical exam. As stated
Research shows that the recommended first line of treatment should be an anti-inflammatory drug or acetaminophen (Casazza, 2012). Since the patient reports that Ibuprofen has not been effective, a different anti- inflammatory medication should be recommended. An opioid such as Percocet is not recommended and the use of opioids for management back pain is discouraged (Casazza, 2012).
(2) Refer Patient to Physical Therapy (PT) - To avoid the use of opioids, I would refer the patient to physical therapy. Physical therapy can assist with strengthening the muscles supporting the spine as well as assist in preventing further injury.
Adjunct therapy and
- Pt C/O lower back and radiates through the buttock and to one or both lower extremities. The patient reports that he is a construction foreman who assist with lifting machinery. A herniated disc is characterized by leg pain greater than back pain that radiates below the knee that worsens with sitting (Casazza, 2012). In addition to this a herniated disc may be the underlying cause for the patient current sciatic nerve pain. As stated by Rothaus (2015), the most common cause of sciatica is herniation of the disc in the lumbar region. Rothaus (2015), also states that a positive SLR is also indicative of disc herniation.
Why not? - Although the patient may very well have a herniated disc, it is believed that the patient primary problem to be addressed is acute sciatica. An MRI can be done to confirm a diagnosis of lumbar disc herniation, but the results most likely will not alter the plan to care.
3) Lumbar Spinal Stenosis- a progressive narrowing of the spinal canal causing bulging of the hardened disc into the spinal canal.
Why?- The is diagnosis is characterized by leg pain greater than back pain which worsen with standing and walking and improves with rest or when the spine is flexed. The patient has a c/o right lower dull back pain, rated 7/10 with radiation to buttocks and below the