| Multi-Specialty
Case Reviews: Sciatica |
Sciatica: chiropractor viewpoint
The gentleman appears to be experiencing pain from nerve
root compression at L5-S1. A MRI performed in August
of 2000 confirms a disc herniation at the L5-S1and at
L4-L5. Specific information is not given regarding nerve
root compression/central or lateral recess stenosis.
A comprehensive conservative treatment history is needed before any chiropractic
treatment, one that provides insight into the types of physical therapy procedures,
osteopathic manipulative techniques, home exercises and ergonomic recommendations.There
are objective findings consistent with sacroiliac joint dysfunction and degenerative
joint (facet) disease. The SI and facet joints produce various patterns of
pain and may be contributing to the gentleman symptoms.
The lateral calf pain seems consistent with nerve root compression at L5-S1.
Based on the objective findings I would recommend the following chiropractic
treatment program. This is a 2-3 week chiropractic program only. The cardiac
rehabilitation is of utmost importance and if the conservative chiropractic program
fails I recommend surgery. The patient would then be able to return to cardiac
rehab with out limitations.
Chiropractic treatment program
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The treatment program designed by the chiropractor
will begin with right SI and or facet injections
followed immediately by chiropractic treatment.
-
High velocity chiropractic manipulation to improve
facet generated pain and restore vertebral motion.
Specific SI manipulations to improve SI dysfunction
and eliminate this as a pain generator.
-
Chiropractic flexion distraction manipulation to
improve disc elasticity, facet mobility, erector
spinae and nerve root flexibility.
-
A comprehensive home rehabilitation program will
supplement the chiropractic care, including ergonomic
recommendations will be provided to enhance healing
and eliminate external exacerbating factors.
-
In house
physical therapy utilizing flexion and or extension
based protocols along with a lumbar stability program
will be utilized immediately following each chiropractic
treatment.
A 2-3 week trial of this conservative chiropractic
program is recommended. If there is no improvement
in the patient’s symptoms I would recommend a
surgical approach.
By:
Rodney K. Lefler, DC, CSCS
May 1, 2001
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