Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with acute/chronic low back pain radiating into the left/right lower extremity in an L5-S1 dermatomal distribution. Pain is described as sharp, electric, and shooting, exacerbated by flexion, prolonged sitting, or Valsalva maneuvers. Associated symptoms include paresthesia, numbness in the lateral foot/sole, and subjective weakness in plantar flexion or great toe extension. No bowel/bladder dysfunction or saddle anesthesia reported.
Clinical Examination Findings
Lumbar spine examination reveals restricted range of motion with localized paraspinal muscle spasm. Neurological exam: Positive straight leg raise (SLR) at [X] degrees on the affected side. Motor strength: [X]/5 in EHL (L5) and gastrocnemius (S1). Reflexes: Diminished or absent Achilles reflex (S1). Sensory: Hypoesthesia noted in the lateral aspect of the foot and fifth digit. Gait: Antalgic, favoring the affected limb.
Treatment Protocol
Conservative management initiated: Activity modification, avoidance of heavy lifting, and physical therapy focusing on core stabilization and McKenzie exercises. Pharmacotherapy: NSAIDs (e.g., Naproxen), muscle relaxants, and neuropathic agents (e.g., Gabapentin). Consider epidural steroid injection (ESI) if symptoms persist beyond 6 weeks. Surgical consultation for microdiscectomy if progressive neurological deficit or cauda equina syndrome develops.