David, a 35 year old dad with back pain and sciatica

Meet David: A Case Study of Acute Lower Back Pain with Sciatica

David, a 35-year-old new dad, came to Blacktown Health with severe lower back pain and shooting pain down his left leg. The pain started three days ago when he was lifting his newborn baby out of the crib. Let's follow David's journey from pain to recovery with our team of Physiotherapists, Chiropractors, and Exercise Physiologists.

Initial Assessment: Understanding David's Condition

When David arrived at our Blacktown clinic, our experienced Physiotherapist, Emma, began with a thorough assessment.

Questions We Asked

Emma started by asking David some important questions:

1. How did the pain start?
2. Where exactly do you feel the pain?
3. Does the pain travel down your leg? If so, how far?
4. What makes the pain better or worse?
5. Have you had similar pain before?
6. How is the pain affecting your daily activities and sleep?
7. Have you tried any treatments at home?

David explained that the pain started suddenly when lifting his baby from the crib. He felt a sharp pain in his lower back, which then spread down his left leg to his foot. Sitting for long periods and bending forward made the pain worse, while lying down provided some relief. He had trouble sleeping and found it difficult to care for his baby.[Suggested Image: A diagram of the lower back and leg, highlighting the path of sciatic pain]

Physical Examination

Next, Emma performed a careful physical examination:

1. Observation: David had a slightly bent-forward posture and favoured his right side when standing.
2. Range of Motion (ROM) Tests:
   Emma assessed David's spine movement in different directions to detect a directional preference:
   • Forward bending was limited and increased leg pain
   • Backward bending slightly reduced leg pain
   • Side bending to the right increased pain, while left side bending was more comfortable
3. Neurological Examination:
   • Muscle strength: Slight weakness in left foot dorsiflexion (lifting the foot up)
   • Reflexes: Reduced ankle reflex on the left side
   • Sensation: Numbness along the outer side of the left foot
4. Special Tests:
   • Straight Leg Raise (SLR) test: Positive on the left side at 40 degrees
   • Slump test: Positive, reproducing David's leg pain
5. Palpation: Emma gently felt David's lower back muscles, which were tight and tender, especially on the left side.

[Suggested Video: Short clip demonstrating the Straight Leg Raise and Slump tests]

Diagnostic Imaging: Confirming the Diagnosis

Based on the initial assessment, Emma suspected a disc bulge causing nerve root irritation. To confirm this and rule out other conditions, she referred David for some imaging tests.

X-rays

David had X-rays taken of his lower back. These showed:

• Normal alignment of the spine
• No fractures or bone abnormalities
• Slight narrowing of the L4-L5 disc space

CT Scan

A CT scan provided more detailed images of David's spine:

• Mild disc bulge at L4-L5 level
• No significant spinal canal stenosis

MRI Scan

An MRI scan gave the most detailed view of David's soft tissues:

• Moderate left-sided disc bulge at L4-L5 level
• Compression of the left L5 nerve root
• Mild degenerative changes in the L4-L5 disc

These imaging results confirmed Emma's initial diagnosis of a disc bulge causing nerve root compression and sciatica.[Suggested Image: Side-by-side comparison of normal lumbar MRI and David's MRI showing the disc bulge]

Treatment Plan: Road to Recovery

With a clear diagnosis, Emma developed a comprehensive treatment plan for David, involving our Physiotherapy, Chiropractic, and Exercise Physiology teams.

Initial Treatment (Days 1-7)

1. Pain Management:
   • Our Chiropractor, Mark, used gentle manual therapy techniques to help reduce pain and improve spinal mobility.
   • David was advised on appropriate over-the-counter pain medication and the use of ice packs.
2. Postural Education:
   • Emma taught David how to maintain a neutral spine position when lifting his baby and performing daily activities.
   • She provided tips for safe lifting techniques to protect his back.
3. Gentle Mobilisation:
   • Emma performed gentle spinal mobilisations to improve joint mobility and reduce muscle tension.
4. McKenzie Method Exercises:
   • Based on David's directional preference, Emma taught him extension-based exercises to help centralise his pain.
5. Soft Tissue Therapy:
   • Gentle massage to the lower back muscles to reduce tension and pain.

[Suggested Video: Demonstration of McKenzie method extension exercises]

Follow-up Session (Day 4)

David returned for a follow-up session. His back pain had reduced slightly, but the leg pain was still significant.

1. Progress Assessment:
   • ROM was re-measured, showing slight improvements in forward bending.
   • Neurological examination remained similar to the initial assessment.
2. Treatment Progression:
   • Mark performed gentle spinal manipulation to improve joint mobility.
   • Emma introduced neural mobilisation exercises to help reduce nerve irritation.
3. Exercise Progression:
   • Core activation exercises were introduced, focusing on gentle, pain-free movements.
   • David was taught how to perform self-mobilisation exercises at home.

[Suggested Image: David performing neural mobilisation exercises]

Intermediate Phase (Weeks 2-4)

As David's acute pain began to settle, we progressed his treatment:

1. Manual Therapy:
   • Continued spinal mobilisations and soft tissue therapy, gradually increasing intensity as tolerated.
2. Exercise Physiology Sessions:
   • Our Exercise Physiologist, Lisa, designed a progressive strengthening program.
   • Exercises included:
     • Gentle bridges
     • Bird-dog exercises
     • Wall squats
     • Walking program to improve cardiovascular fitness
3. Pain Education:
   • Emma provided education on pain science to help David understand his condition and reduce fear of movement.
4. Functional Retraining:
   • David worked with our team to improve his lifting technique when picking up his baby and practice daily activities with proper body mechanics.

[Suggested Video: David performing bird-dog exercises with proper form]

Advanced Rehabilitation (Weeks 5-8)

As David's pain continued to improve, we focused on building strength and preparing him for daily parenting tasks:

1. Progressive Strengthening:
   • Lisa progressed David's exercises to include:
     • Deadlifts with light weights
     • Lunges
     • Planks
     • Rotational exercises
2. Flexibility Training:
   • Emma introduced a comprehensive stretching routine for the lower back, hamstrings, and hip muscles.
3. Daily Activity Simulation:
   • Gradual introduction of movements specific to parenting tasks like lifting his baby from different positions safely.
4. Cardiovascular Training:
   • Lisa designed a program to improve David's overall fitness, including stationary cycling and swimming.

[Suggested Image: David performing a deadlift with proper technique]

Monitoring Progress

Throughout David's treatment, we regularly assessed his progress:

1. Pain Levels:
   • David's back pain reduced from 8/10 to 2/10 over 8 weeks.
   • Leg pain completely resolved by week 6.
2. Functional Measures:
   • Oswestry Disability Index (ODI) scores improved from 60% (severe disability) to 15% (minimal disability).
3. ROM and Strength:
   • By week 8, David had full, pain-free ROM in all directions.
   • Core and leg strength had significantly improved.
4. Neurological Signs:
   • Foot dorsiflexion strength returned to normal.
   • Sensation in the left foot fully recovered.

Return to Daily Life as a New Dad

After 8 weeks of dedicated rehabilitation, David was ready to return fully to parenting duties:

1. Daily Activity Integration:
   • David practiced lifting techniques regularly when carrying his baby.
   • He learned how to manage diaper changes and playtime without straining his back.
2. Final Assessment:
   • Our team performed a comprehensive assessment that included strength testing and movement patterns relevant to parenting tasks.
   • David demonstrated excellent spine control and confidence in all tasks related to caring for his baby.
3. Ongoing Management:
   • We provided David with a maintenance exercise program focusing on core strength and flexibility that he could continue at home.
   • Regular check-ups were scheduled to monitor his progress and address any concerns as he adjusted to being a new dad.

[Suggested Video: David successfully lifting his baby using proper technique]

Long-term Management and Prevention

To help prevent future episodes of back pain as he continues in his role as a new dad, our team at Blacktown Health provided David with strategies for long-term management:

1. Regular Exercise:
   • Lisa designed a home exercise program focusing on core strength, flexibility, and overall fitness.
   • David was encouraged to maintain a regular exercise routine that included both strength training and cardiovascular activities whenever possible.
2. Ergonomic Awareness:
   • Emma provided ongoing advice on maintaining good posture while caring for his baby.
   • Tips were given on how to set up safe environments around the house for lifting or carrying tasks.
3. Stress Management:
   • Our team discussed how stress can contribute to physical discomfort.
   • Simple relaxation techniques were introduced that could be done even while caring for an infant.
4. Healthy Lifestyle Choices:
   • We emphasised maintaining healthy habits such as staying active during walks with the baby in a stroller or carrier.
5. Regular Check-ups:
   – We advised periodic assessments even when feeling well so that any minor issues could be addressed before they became significant problems again.

[Suggested Image: Infographic showing tips for long-term back health]

Conclusion: A Successful Recovery

David's case demonstrates the effectiveness of a comprehensive, multidisciplinary approach to treating acute lower back pain with sciatica from a disc bulge. Through combined efforts from our Physiotherapy, Chiropractic, and Exercise Physiology teams at Blacktown Health, David progressed from severe pain and limited function back into full parenting duties with confidence.Key factors in David's successful recovery included:

• Accurate initial assessment and diagnosis
• Appropriate use of diagnostic imaging
• A tailored rehabilitation program focused on practical daily activities
• Regular monitoring and adjustment of treatment plans
• Active involvement in recovery through education about movement patterns

David’s commitment combined with our Blacktown Health team's expertise led him through recovery while reducing future risks associated with parenting tasks involving heavy lifting or awkward positions related to caring for an infant.If you're experiencing back pain or any other musculoskeletal problem—especially as you navigate parenthood—don’t hesitate to reach out to our team at Blacktown Health! We’re here to help you get back into your daily life without discomfort!