Case Study: Low Back Disc Complaint
A 39 year old female presented to our clinic complaining of severe low back pain with left leg referral down into the toes. The problem had started ten days previously for no apparent reason; however, it may have been related to a lifting incident. The patient had presented to the hospital for assessment. She was given pain killers and sent her home. She presented two days later to her GP who once again gave her a prescription for pain killers and sent her home.
On presentation at our clinic she was unable to stand on the toes on the left leg. Presentations of leg referral with weakness or loss of ability to stand on the toes or standing on the heels are always a concern to practitioners. “ Hard neuro signs” can indicate significant compression on nerve roots that can create long standing complications if not addressed readily. Further examination revealed a loss of heel reflex and a straight leg raise of 25 degrees on the left hand side. Additionally there was loss of sensation in parts of the foot and lower leg on the left hand side.
The patient was referred for an MRI which showed a significant disc bulge at L5/S1 on the left hand side, compressing the S1 nerve root. Due to the loss of reflexes and muscle weakness, treatment was initiated with the requirement that significant progress needed to be made within a week or otherwise urgent referral for a neurosurgical consultation was required.
Due to lack of progress she was referred to a neurosurgeon who performed a micro discectomy. The patient presented to our clinic 1 week post-operatively for rehabilitation.
We progressed through a range of decompression exercises, re-strengthening and postural re-training exercises to help her return to normal and fortify the system to protect against future injury.
For these types of cases, patients return to work within 4-6 weeks for office work or 6-12 weeks for manual workers. Full resolution is reached within 12 months.
In this instance the patient had a very good outcome and returned to normal work and activities with no long standing disabilities or ramifications.
This type of case highlights the importance of doing affective neurological and orthopaedic testing to identify correctly what is happening. This appropriate imaging and management to ensure that serious problems are not missed and they are cared for in the most appropriate manner.
We have unfortunately seen other cases similar to this that have not been managed well that have ended up with permanent disability as a result of miss-management.
If you have a significant low back and leg referral complaint, it is always advisable to have this analysed affectively by your trusted health care practitioner.