Zusammenfassung der Ressource
TAXI DRIVER
- Mr.singh is 43 years old taxi driver, his job
support his wife and his 3 kids
- he use to be veterinarian in india but since he
came to uae he has worked a taxi dirver
- he has a history of 10 years of nagging pain in his lower
back pain. it first began when he was treating various
animals.
- the pain was aggravated by long period of sitting and heavy
lifting
- one night as he was lifting suitcase he felt pain shooting
down his right leg
- he took tablet of Voltaren but the pain increased after 24 hours as
it radiated to is right foot and become more severe. sitting in taxi
aggravated his pain.
- he could feel his pain in lower back, buttock, back of thigh,
outer side of leg and little toe, and sole of foot (all at right side)
- pain level measured on a visual analogue scale and it was 70mm
(7cm).
- he found that standing and walking relieved the pain while sitting made it
worse.
- he felt numbness in his little toe with tingling sensation (sensory neuron)
- he started limbing (claudication) his posture was abnormal with forward
and lateral tilt (SCOLIOSIS) to right side
- there was hardness of lower back muscles with spasms of erector spinae
msucle. movement os spine in flexion, extension and lateral flexion was
generally painful.
- THE GP told Mr.Singh has sciatica many conditions could be the cause of
this compression
- he started with physiotherapy. five days later there was improvement
- Nonsurgical Treatment for Sciatica
- Heat/ice
- For acute sciatic pain, heat and/or ice packs are readily available and can help alleviate the leg pain,
especially in the initial phase. Usually ice or heat is applied for approximately 20 minutes, and repeated
every two hours. Most people use ice first, but some find more relief with heat. The two may be
alternated. It is best to apply ice with a cloth or towel placed between the ice and skin to avoid an ice
burn.
- Pain medications
- Over-the-counter or prescription medications are often effective in reducing or relieving sciatica pain.
Nonsteroidal anti-inflammatory drugs (such as ibuprofen or naproxen), or oral steroids can reduce the
inflammation that is usually part of the cause of pain. Muscle relaxants or narcotic medications may also
be prescribed for the short term (a few days and up to 2 weeks) to alleviate pain.
- Epidural steroid injections
- If the pain is severe, an epidural steroid injection can reduce inflammation. Unlike oral medications, an
injection goes directly into the painful area around the sciatic nerve to address the inflammation that
may be causing pain.
- Alternative Sciatica Treatment
- Chiropractic/manual manipulation
- Acupuncture
- Massage therapy
- What it is sciatica ??
- The term sciatica describes the symptoms of leg
pain—and possibly tingling, numbness, or
weakness—that originate in the lower back and
travel through the buttock and down the large
sciatic nerve in the back of each leg.
- Sciatic Nerve
- Largest Nerve in the body
- Originates from the lumbosacral
nerves L4 , L5 , S1 , S2 , S3
- Has two major branches :
-Tibular nerve -common
fibular branch
- there is 2 types of pain
- reffered pain
- pain felt in a part of the body other than its actual source.
- radicular pain
- pain the move along the course of nerve
- Abnormal Curvatures
- causes of lordosis
- osteoporosis, obesity, discitis, spondylolisthesis
- causes of kyphosis
- abnormal vertebrae development, poor posture
or slouching, arthritis, spinda bifida, spine
infections or tumors.
- pain at right leg and there is right scoliosis???
- right sciatic nerve will be effected which
will effect right muscle supply, so the
muscles at left will work more and
become more dominant and causing
contraction to left side so spine will tilt to
right side
- History taking
- Visual Analogue Pain VAS
- Measures intensity of pain 0 to 4 mm 0 to 0.4 cm >no pain---- 5 to
44 mm/ 0.5 to 4.4 cm>mild pain ----45 to 74 mm/ 4.5 to 7.4 cm>
moderate pain---- 75 to 100 mm/ 7.5 to 10 cm >severe pain
- after history taking
- look (inspection)
- Posture / deformity ( straight / scoliosis /
ankylosing spondylitis : joint Posture /
deformity
- Skin (scar/abnormal hair/pigmentation)
- Muscle wasting
- after look
- palpation
- Body attitude Antalgic
gait (severe LBP)
- Soft tissues
- swelling and muscle spasm.
- after palpate
- move
- Extension , flexion of the spine
Motor , sensory & reflex
- then finally we do special test
- Straight leg raising test
- causes of lower back pain
- lets mention most common causes of lower
back pain and relate it with out case
- Back Muscle Strain
- Severe or aching pain in the lower back that
starts after activity, sudden movement, or lifting
a heavy object.
- symptoms
- Difficulty moving that can be severe enough to
prevent walking or standing ----sudden localized
pain that does not radiate ----Pain that tends to
be achy and dull---- Muscle spasms, which can
be severe ----Local soreness upon touch
- we will eliminate it because it causes its local
pain and does not radiate
- Degenerative Disc Disease
- symptoms
- Low-level of constant lower back pain punctuated
by episodes of severe pain/muscle spasms lasting
a few days to a few months ----Chronic pain that
can range from nagging to severe ----Back pain
worsened by sitting Walking, even running, may
feel better than sitting/standing ----Changing
positions frequently relieves pain
- it could be the reason. also it could be osteroarthritis, because it happesn at
age 45 and beyond which is close to his age and happens due to overuse of
joints since he was veterinarian
- Isthmic Spondylolisthesis
- Symptoms
- Deep ache in the lower back that worsens
when standing or walking
- we eliminate it because the pain is worsened
when he walk or stand, while in our case the pain
was better in these conditions
- Lumbar Herniated Disc
- symptoms
- Pain typically is ongoing ----Pain may be worse in
the leg and foot than in the lower back----
Typically felt on one side the buttock or leg
only---- Pain that is usually worse after long
periods of standing still or sitting: relieved
somewhat when walking---- More severe
(burning, tingling) vs. dull, aching pain---- May be
accompanied by weakness, numbness or
difficulty moving the leg or foot
- we cant eliminate it because it
could be the cause