Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with left-sided sciatica characterized by radiating pain originating in the lumbar spine/gluteal region and extending down the posterior aspect of the left lower extremity. Symptoms are exacerbated by prolonged sitting, flexion, and Valsalva maneuvers. Patient reports associated paresthesia and numbness in the left dermatomal distribution. No reported bowel or bladder dysfunction.
Clinical Examination Findings
Physical examination reveals tenderness to palpation over the left lumbar paraspinal muscles and the sciatic notch. Straight Leg Raise (SLR) test is positive on the left at [X] degrees, reproducing radicular symptoms. Neurological exam demonstrates 5/5 strength in bilateral lower extremities, intact sensation to light touch in L4-S1 dermatomes, and 2+ patellar/Achilles reflexes. Gait is antalgic favoring the left side.
Treatment Protocol
Initiate conservative management including a short course of NSAIDs and muscle relaxants. Prescribe physical therapy focusing on nerve gliding exercises, core stabilization, and lumbar extension protocols. Advise activity modification to avoid heavy lifting and prolonged static positioning. Follow up in 4-6 weeks; consider lumbar spine MRI if symptoms are refractory to conservative care.