Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with acute/chronic low back pain radiating into the right/left lower extremity in an L5 dermatomal distribution. Symptoms exacerbated by flexion, sitting, and Valsalva maneuver. Reports associated paresthesia and subjective weakness in the great toe extensor (EHL). Denies bowel/bladder incontinence or saddle anesthesia.
Clinical Examination Findings
Lumbar spine exam reveals restricted range of motion with paraspinal muscle spasm. Neurological exam: Positive straight leg raise (SLR) at [X] degrees on the affected side. Motor strength: [X]/5 EHL weakness. Reflexes: Patellar and Achilles reflexes symmetric/asymmetric. Sensory: Diminished light touch in the L5 dermatome. Gait: Antalgic, favoring the affected limb.
Treatment Protocol
Initiate conservative management: Activity modification, physical therapy (McKenzie protocol), and non-steroidal anti-inflammatory drugs (NSAIDs). Consider short-course oral corticosteroids or muscle relaxants. If refractory to 6 weeks of conservative care, obtain MRI lumbar spine and consider epidural steroid injection (ESI) or surgical consultation for microdiscectomy.