Patient with Sciatica and Dorsiflexion Weakness: Treat or Refer Back?

I have recently been treating a patient with a few week history of sciatica with anterior tibialis weakness.   She reports her pain gradually came on for no apparent reason, and it worsened to the point where sitting, rising from sitting, and sleeping were difficult.

She reported to her doctor and was referred to an orthopedist.  The ortho doc referred her to PT.

Upon evaluation, it was noted she had a positive slump and SLR test and weakness through dorsiflexion, with her strength graded as 4/5.  My patient wasn't too concerned about it, and we proceeded with the eval, set up a treatment plan, and sent her on home with her home exercise program.

After the evaluation, I casually mentioned to a coworker about my patient with her sciatica and ankle weakness.  My coworker was astonished that I didn't refer my patient back to the doctor.  Sciatica with dorsiflexion weakness means that the sciatic nerve is pinched and the nerve needs to be decompressed right away, right?

I was confident that my patient would be ok.  Why?  Because her ankle weakness was mild during the initial eval, and over the course of 2 or 3 PT sessions, it wasn't getting worse.  It wasn't progressive weakness.

If my patient returned to me after the evaluation and her dorsiflexion strength was worsening, I would consider referring her back to her doctor.  But it wasn't getting worse.  The key is, progressive weakness needs swift attention.  Stable weakness needs monitoring, and I monitored my patient's condition at every PT session.

I recently saw this patient for her 5th PT session, and her symptoms are almost abolished.  And guess what?  Her dorsiflexion strength is almost back to normal.

So, what would you do?  When you encounter weakness from sciatica (or cervical radiculopathy), do you quickly refer back to the doctor?

If the weakness isn't progressive, it requires monitoring.  If it's progressively getting worse, it needs attention.  

How Long to Ice?

How long do I keep the ice on when I'm icing?

This question is asked a lot in the PT clinic.  Most physical therapists will keep ice on about 10 to 15 minutes.  But why?  Is there a way that you can tell when your body is ready to shed the ice?

There is.

In PT, we love to use acronyms to remember stuff.  R.I.C.E.  P.O.L.I.C.E.  F.O.S.

And to remember when to take the ice off when your cooling down your injury, just remember C.B.A.N.  This stands for cold, burning, aching, and numb, and it's the symptoms that you should feel  when icing an injury.

Check it out:  How Long Should Ice Be Applied?

First you'll feel cold, then a burning sensation.  Then the area you are icing will ache, and finally, you'll feel numb.

When you get to the numb part, take the ice off.  Easy peasy.

(Remember to check in with your doctor or PT before using ice for any injury.)

New Articles I've Written in the Past Month

I write a lot each month.  I try to post to social media as much as possible whenever I write a new article, but a lot of folks mention that they miss a few articles from time to time.

So, here is a list of the past few articles I written.  That way, you can keep up to date on what's going on in the physical therapy world.  Easy peasy!

• Exercises You Can Do with Therapy Putty
• The Pes Anserine Insertion
• Have a Catch for Better Balance
• Isometric Gluteus Medius Strengthening Exercise
• Advanced Balance Exercises
• 7 Things You Didn't Know About Your Physical Therapist

So, take your pick, click away to learn about physical therapy, that great profession that helps you move better and feel better.

Cheers!