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!

Prevent Injuries with Neuromuscular Training

In our PT clinic, we see so many young athletes who have been injured for no apparent reason.  They describe the typical scenario: running along playing soccer, stopped quickly and turned, and BAM!  Knee pain and swelling.

These non-contact injuries can be devastating.  If another athlete jumps up and lands on your knee from the side, you may get injured, but at least you'll understand why you got injured.  But if you're just running along and go to turn and twist your knee, that injury can be confusing. What did you do wrong?

Recently the American Academy of Pediatrics published a paper about ACL injuries in young athletes.  In it, they cite that one of the most modifiable variables for the prevention of non-contact ACL injuries is proper training with a neuromuscular component.

The physical therapists at Capital Region Physical Therapy are all trained to assess your form when running, jumping, and landing and can prescribe the correct neuromuscular training program to help you prevent non-contact injuries while participating in sports.  Call your PT and ask about working on proper neuromuscular training for your specific sport.

Physical Therapy Month and the Myths Surrounding PT

October is National Physical Therapy Month, and this year the theme is "Common Myths About Physical Therapy."  The American Physical Therapy Association (APTA) has released information about PT and the myths associated with the profession.

A couple years ago, I wrote an article on my About.com page called Physical Therapy Mythbusters.  It was a tongue in cheek look at some common PT myths (like PTs and chiropractors don't get along).

The APTA list is a little different from mine, and I'm glad.  It would be a little uncomfortable if my professional organization was stealing my content and using it for their national campaign.

Here's both links so you can see for yourself:

• 7 Myths About PT (from the APTA)
• Physical Therapy Mythbusters

Stories from Behind the Curtain in PT

This afternoon I was working with a patient who had a partial knee replacement surgery.  He is an active person, but his knee pain would prevent him from running and playing tennis, so he opted for the surgery to help get back on track.

Overall he is doing well.  This morning we shared a little chuckle.  He was working on quadriceps strengthening on the Cybex leg extension machine.  The first repetition he tried was difficult and he winced.

I asked if he was ok, and he stated he was.  I told him the first rep of any exercise is difficult, and the last 3 were also tough.

He asked if we were only doing 4 reps.

Funny guy.

What's with All the Kinesiology Tape?

You've heard about kinesiology tape, haven't you?  If you have watched just about any sporting event in the past few years, you've probably noticed your favorite athletes plastered in colorful tape on their shoulders, knees, wrists, or calves.

So what is the stuff?  Kinesiology tape is a special type of athletic tape that is non-latex and elastic.  It's special properties can be used for many different functions including:

• Muscle facilitation
• Muscle inhibition and pain control
• Swelling management

Kinesiology tape involves using different types of tape strips to serve a specific purpose.  Suppose your physical therapist assesses your painful shoulder and decides that rotator cuff weakness may be causing your problem.  He or she will likely prescribe rotator cuff strengthening exercises, and kinesiology tape may be used on your shoulder to facilitate rotator cuff contractions and improve your body's ability to use your rotator cuff muscles to support your shoulder.

Kinesiology tape isn't for everyone, and some folks with certain medical conditions should avoid it.  A visit with your PT can help decide if kinesiology tape is right for you and your specific condition.

At Capital Region Physical Therapy, we sometimes use kinesiology tape to help augment your physical therapy program.  It's not for everyone, but it may be something your PT may consider to help improve your overall rehab outcome.