ClinicalPatterns.com: Lumbar disc herniation with associated radiculopathy

Symptom description

-Lumbar region and buttock pain (ache, stiffness, sharp, unilateral or bilateral) -Radiating and/or shooting pain into leg along dermatome or non-specific pattern -Numbness and/or tingling in associated dermatome or non-specific pattern

Behavior (Aggravating factors)

-Sitting, bending (putting on shoes), in AM, coughing and sneezing, driving

Behavior (Easing factors)

-Walking, may have positional relief, may have relief with NSAIDs

Special questions & Red flags

-Clarify numbness and tingling symptoms if present (unilateral vs. bilateral) -Inquire about and clarify muscle weakness or heaviness in legs -Inquire about bowel and bladder changes (Cauda Equina syn.)

History

-May be traumatic onset i.e. lifting heavy object while bending at waist, moving boxes/furniture -May have gradual onset without injury i.e. cumulative micro-trauma to disc from poor sitting habits of office worker

Objective signs & Special tests

-Lateral shift may be present -Lumbar AROM: Increased pain and/or restriction with forward bending and side-bending -(+) Neuro signs: sensation, DTR, myotome changes -(+) Lumbar joint signs at level of injury -(+) slump, SLR

Treatment options

-May show directional preference and/or centralization i.e. extension, lateral shift correction, or opening vs. closing position. If present, BEGIN TREATMENT HERE -Manual treatment: soft tissue techniques, joint mobilization (central and unilateral PA’s, manipulation (if centralization present), traction -Progressive nerve tensioning exercise i.e. knee pumps then progress to seated tensioning -General trunk stabilization. This may follow directional preference in early stages. -Low-impact cardiovascular exercise: walking (usually best)