Sciatica? Herniated Disk? Part 2

EVALUATION AND TREATMENT

Physical therapy evaluation, after taking a thorough history of the injury, starts with the observation of the patient’s gait and transition from one position to another. It continues with the assessment of the lumbar range of motion and the effects of the repeated movements on the location of radicular (going down the leg) symptoms.

The assessment of the pelvic alignment is necessary and the differentiation is made between a shift which is usually a sign of a herniated disk (the patient’s upper body is shifted away from the injured side, thus producing a pelvic shift towards the side of the herniated disk) and pelvic misalignment which is usually a sign of a sacroiliac joint problem. I have treated many patients who experience a dramatic improvement of symptoms after the pelvis was re-aligned.

Major lower extremities joints’ range of motion is assessed and followed by the strength testing of the lower extremities and abdominals, including deep abdominal muscles that stabilize the spine. 

A thorough physical therapy evaluation identifies the cause of the patient’s symptoms and sets up an appropriate treatment plan.

If the symptoms were created by a herniated disc the treatment is focused on the centralization of the pain. This means that the primary goal of the treatment is to get rid of the pain in the leg and centralize it in the lower back. After this is achieved, next goal is to abolish the pain completely.

If the symptoms are caused by mechanical low back problem (such as a sprain or an abnormal movement in one or more spinal joints) or the sacroiliac joint problem, the treatment focuses on manual therapy for restoration of normal joint mechanics, strength, and position sense of lumbar-pelvic area. Core stabilization program is always included in the treatment, regardless of the cause.

Contrary to some opinions, therapy should not be painful but should lessen the pain with every treatment. Effective physical therapy should be based on manual therapy with a hands-on approach to exercises performed by licensed therapists.

If unresolved fast, low back problems become chronic and can be very frustrating for the patients and health care providers. Patients with chronic low back pain or sciatica may become very dependent on narcotic pain medications. However, if rehabilitated timely and properly, low back pain patients recover fast and, with correct postural and body mechanics education, become much more aware of potential problems and learn to avoid new injuries.

Take a quiz and get a chance to win a tube of Biofreeze for fast, drug-free pain relief!

1. True or False: Sciatica is more prevalent in women 30 years and older.

2. True or False: Sitting is great for treatment of most herniated disks.

3. True or False: Primary goal of the treatment is to get rid of the pain in the leg and centralize it in the lower back.

4. True or False: Physical Therapy should be painful.

You can post your answers as comments or you can email them to me at michaelpt.freemotion@gmail.com. First 20 people to respond will be entered to win (3 tubes of Biofreeze will be given away!)

Stay healthy and take care of your back!

Michael Sheynin, PT, Co-owner of Free Motion Rehab Center