Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with acute/chronic right-sided low back pain radiating into the right posterior thigh and calf, consistent with L5-S1 radiculopathy. Symptoms exacerbated by flexion, prolonged sitting, and Valsalva maneuver. Reports associated paresthesia in the S1 dermatome (lateral foot). Denies bowel/bladder incontinence or saddle anesthesia.
Clinical Examination Findings
Physical exam reveals positive straight leg raise (SLR) on the right at 40 degrees, reproducing radicular symptoms. Motor strength 4/5 in right gastrocnemius/soleus (S1). Diminished right Achilles reflex (S1). Sensory deficit noted in the lateral aspect of the right foot. Gait is antalgic favoring the right lower extremity.
Treatment Protocol
Initiate conservative management including physical therapy, NSAIDs, and activity modification. Consider short-term course of oral corticosteroids or muscle relaxants. If refractory to conservative care, proceed with lumbar epidural steroid injection (LESI) and repeat MRI imaging. Monitor for red flags requiring urgent surgical consultation.