Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with acute/chronic low back pain radiating into the left lower extremity in an S1 dermatomal distribution. Pain is described as sharp, electric, and shooting, exacerbated by flexion, coughing, or Valsalva maneuver. Associated with left-sided paresthesia and subjective weakness in the left calf/foot. No bowel or bladder dysfunction reported.
Clinical Examination Findings
Lumbar spine exam reveals restricted range of motion with paraspinal muscle spasm. Neurological exam: Positive straight leg raise (SLR) on the left at 40 degrees, reproducing radicular symptoms. Motor strength: 4/5 left gastrocnemius/soleus (S1). Reflexes: 1+ left Achilles reflex (diminished). Sensory: Hypesthesia noted in the lateral aspect of the left foot and fifth digit. Gait: Antalgic, favoring the left side.
Treatment Protocol
Conservative management initiated: Activity modification (avoid heavy lifting/prolonged sitting), physical therapy for core stabilization and nerve gliding exercises. Pharmacotherapy: NSAIDs, muscle relaxants, and neuropathic pain agents (e.g., Gabapentin). Referral for lumbar epidural steroid injection (LESI) if symptoms persist beyond 6 weeks.