David, a 35 year old dad with back pain and sciatica

David's Journey: Overcoming Lower Back Pain and Sciatica at Tangram Health

Meet David, a 35-year-old new dad who came to Tangram Health with severe lower back pain and shooting pain down his left leg. David's pain started when he was lifting his newborn baby out of the crib. Let's follow David's journey from pain to recovery with our skilled Physiotherapist, Andre.

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First Visit: Understanding David's Condition

When David arrived at Tangram Health, Andre began with a thorough assessment.

Questions Andre Asked

Andre started by asking David some important questions:

1. How did the pain start?
2. Where exactly do you feel the pain?
3. Does the pain travel down your leg? If so, how far?
4. What makes the pain better or worse?
5. Have you had similar pain before?
6. How is the pain affecting your daily activities and sleep?
7. Have you tried any treatments at home?

David explained that the pain started suddenly when lifting his baby. He felt a sharp pain in his lower back, which then spread down his left leg to his foot. Bending forward and sitting for long periods made the pain worse, while lying down helped a bit. He was having trouble sleeping and found it difficult to care for his baby.

[Suggested Image: A diagram of the lower back and leg, highlighting the path of sciatic pain]

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Physical Examination

Next, Andre performed a careful physical examination:

1. Observation: David was leaning slightly to his right side when standing.
2. Range of Motion (ROM) Tests:
     Andre checked how David's spine moved in different directions:
     - Bending forward was limited and increased leg pain
     - Bending backward slightly reduced leg pain
     - Bending to the right increased pain, while bending left was more comfortable
3. Neurological Examination:
     - Muscle strength: Slight weakness when lifting the left foot up
     - Reflexes: Reduced ankle reflex on the left side
     - Sensation: Numbness along the outer side of the left foot
4. Special Tests:
     - Straight Leg Raise (SLR) test: Positive on the left side at 40 degrees
     - Slump test: Positive, reproducing David's leg pain
5. Palpation: Andre gently felt David's lower back muscles, which were tight and tender, especially on the left side.

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Diagnostic Imaging: Confirming the Diagnosis

Based on the initial assessment, Andre suspected a disc herniation causing nerve root irritation. To confirm this and rule out other conditions, he referred David for some imaging tests.

X-rays

David had X-rays taken of his lower back from his GP already. Andre reviewed these and it showed:

• Normal alignment of the spine
• No fractures or bone abnormalities
• Slight narrowing of the L5-S1 disc space

MRI Scan

Andre ordered an MRI scan for David's back,which gives the most detailed views of the lumbar spine. The MRI showed:

• Moderate left-sided disc herniation at L5-S1 level
• Compression of the left S1 nerve root
• Mild degenerative changes in the L5-S1 disc

These imaging results confirmed Andre's initial diagnosis of a disc herniation causing nerve root compression and sciatica.

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Treatment Plan: Road to Recovery

With a clear diagnosis, Andre developed a comprehensive treatment plan for David.

Initial Treatment (Days 1-7)

1. Pain Management:
     - Andre used gentle manual therapy techniques to help reduce pain and improve spinal mobility.
     - David was advised on appropriate over-the-counter pain medication and the use of ice packs.
2. Postural Education:
     - Andre taught David how to maintain a good spine position when lifting his baby and doing daily activities.
     - He provided tips for safe lifting techniques to protect David's back.
3. Gentle Mobilisation:
     - Andre performed gentle spinal mobilisations to improve joint mobility and reduce muscle tension.
4. McKenzie Method Exercises:
     - Based on David's directional preference, Andre taught him extension-based exercises to help centralise his pain.
5. Soft Tissue Therapy:
     - Gentle massage to the lower back muscles to reduce tension and pain.

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Follow-up Session (Day 4)

David returned for a follow-up session. His back pain had reduced slightly, but the leg pain was still significant.

1. ‍Progress Assessment:
     - ROM was re-measured, showing slight improvements in forward bending.
     - Neurological examination remained similar to the initial assessment.‍
2. Treatment Progression:
     - Andre performed gentle spinal manipulation to improve joint mobility.
     - He introduced neural mobilisation exercises to help reduce nerve irritation.
3. Exercise Progression:
     - Core activation exercises were introduced, focusing on gentle, pain-free movements.
     - David was taught how to perform self-mobilisation exercises at home.

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Intermediate Phase (Weeks 2-4)

As David's acute pain began to settle, Andre progressed his treatment:

1. Manual Therapy
     - Continued spinal mobilisations and soft tissue therapy, gradually increasing intensity as tolerated.
2. Exercise Progression
     - Andre designed a progressive strengthening program.
     - Exercises included:
       - Gentle bridges
       - Bird-dog exercises
       - Wall squats
       - Walking program to improve cardiovascular fitness
3. Pain Education:
     - Andre provided education on pain science to help David understand his condition and reduce fear of movement.
4. Functional Retraining:
     - David worked with Andre to improve his lifting technique when picking up his baby and practice daily activities with proper body mechanics.

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Advanced Rehabilitation (Weeks 5-8)

As David's pain continued to improve, Andre focused on building strength and preparing him for daily parenting tasks:

1. Progressive Strengthening:
     - Andre progressed David's exercises to include:
       - Deadlifts with light weights
       - Lunges
       - Planks
       - Rotational exercises
2. Flexibility Training:
     - Andre introduced a comprehensive stretching routine for the lower back, hamstrings, and hip muscles.
3. Daily Activity Simulation:
     - Gradual introduction of movements specific to parenting tasks like lifting his baby from different positions safely.
4. Cardiovascular Training:
     - Andre designed a program to improve David's overall fitness, including stationary cycling and swimming.

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Monitoring Progress

Throughout David's treatment, Andre regularly assessed his progress:

• Pain Levels:
    - David's back pain reduced from 8/10 to 2/10 over 8 weeks.
    - Leg pain completely resolved by week 6.
• Functional Measures:
    - Oswestry Disability Index (ODI) scores improved from 60% (severe disability) to 15% (minimal disability).
• ROM and Strength:
    - By week 8, David had full, pain-free ROM in all directions.
    - Core and leg strength had significantly improved.
• Neurological Signs:
    - Foot strength returned to normal.
    - Sensation in the left foot fully recovered.

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Return to Daily Life as a New Dad

After 8 weeks of dedicated rehabilitation, David was ready to return fully to parenting duties:

• Daily Activity Integration:
    - David practiced lifting techniques regularly when carrying his baby.
    - He learned how to manage diaper changes and playtime without straining his back.
• Final Assessment:
    - Andre performed a comprehensive assessment that included strength testing and movement patterns relevant to parenting tasks.
    - David demonstrated excellent spine control and confidence in all tasks related to caring for his baby.
• Ongoing Management:
    - Andre provided David with a maintenance exercise program focusing on core strength and flexibility that he could continue at home.
    - Regular check-ups were scheduled to monitor his progress and address any concerns as he adjusted to being a new dad.

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Long-term Management and Prevention

To help prevent future episodes of back pain as he continues in his role as a new dad, Andre provided David with strategies for long-term management:

• Regular Exercise:
    - Andre designed a home exercise program focusing on core strength, flexibility, and overall fitness.
    - David was encouraged to maintain a regular exercise routine that included both strength training and cardiovascular activities whenever possible.
• Ergonomic Awareness:
    - Andre provided ongoing advice on maintaining good posture while caring for his baby.
    - Tips were given on how to set up safe environments around the house for lifting or carrying tasks.
• Stress Management:
    - Andre discussed how stress can contribute to physical discomfort.
    - Simple relaxation techniques were introduced that could be done even while caring for an infant.
• Healthy Lifestyle Choices:
    - Andre emphasised maintaining healthy habits such as staying active during walks with the baby in a stroller or carrier.
• Regular Check-ups:
     – Andre advised periodic assessments even when feeling well so that any minor issues could be addressed before they became significant problems again.

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Take home message: A Successful Recovery

David's case demonstrates the effectiveness of a comprehensive physiotherapy approach to treating acute lower back pain with sciatica from a disc herniation. Through Andre's expert care at Tangram Health, David progressed from severe pain and limited function back into full parenting duties with confidence.

Key factors in David's successful recovery included:

• Accurate initial assessment and diagnosis
• Appropriate use of diagnostic imaging
• A tailored rehabilitation program focused on practical daily activities
• Regular monitoring and adjustment of treatment plans
• Active involvement in recovery through education about movement patterns

David's commitment combined with Andre's expertise led him through recovery while reducing future risks associated with parenting tasks involving heavy lifting or awkward positions related to caring for an infant.

If you're experiencing back pain or any other musculoskeletal problem—especially as you navigate parenthood—don't hesitate to reach out to our team at Tangram Health! We're here to help you get back into your daily life without discomfort!

Remember, every person's journey with back pain is unique, and treatment plans are always tailored to individual needs. Our experienced physiotherapists at Tangram Health are ready to guide you through your own path to recovery, just as Andre did for David.