case 2 - radiculopathy

Question 1

S1 Radiculopathy assessment

Answer 1

1. Neurological

Question 2

1. Neurological

Answer 2

Need to know extent of neurological deficits - check which dermatome/s, use for baseline assessment and can see if improving or getting worse, red flags, confirms diagnostic

Question 3

Neurodynamic

Answer 3

2. c – checks mechanosenstivity which can be a starting treatment and how much mechanosensitivity is contributing to symptoms.
   - Distinguish’s if pain is nerve or muscle/tissue pain

Question 4

3. Palpation & PAIVMs (clear SIJ)

Answer 4

• Paivm to know the ‘reactivity’ or pain associated with movement of the vertebral segment and to know The mobility of the segment
• To confirm segment
• Check for sensitivity (central/peripheral) hyperalgesia, potential referred pain too
• Patient satisfaction etc
  e. g. add DF for hamstrings in hip flexion, for calf - go out of hip flx and add DF (if calf pain would get pain on both but if nerve then only pain in hip flx)

Question 5

management priorities

Answer 5

1. Advice and education
   Neurodynamics → sliders
2. self correction technique of lateral shift
   or 4. Manual therapy

Question 6

radicul

management: 1. Advice and education

Answer 6

• Reassurance re: radiculopathy
  Radiculopathy is caused by irritation of a nerve as it is leaving the spine and that is what is causing your symptoms.
  • Good outcomes are expected with physiotherapy management.
  • It can take some time for the condition to settle and it isn’t something to be concerned about, but if you do experience a drastic increase in your symptoms, consult me or a doctor immediately.
• Favorable prognosis:
  • Symptoms should start to settle within 1-2 weeks, and most people make a complete recovery in 4-6 weeks.
  • For some people the symptoms can stay around longer as nerves are very sensitive structures.
• Plan for RTW
  • get patient to help identify potential modifcations (hours, change of position, task modifications, regular breaks and movement)
  • whether it half days, some is better than none. trying to stay at work but reducing hours or modifying tasks, regular breaks and movements, changes of positions.
  • importance for RTW as better prognosis and better long term outcomes

• Other modifications they can do =
- Sitting/sleeping positions
- identify what activities are causing the irritation and temporarily limit these activities in order to help your symptoms settle
- short walks and slowly increasing distance and time
Might be helpful to consult GP for appropriate pain medication to assist with short term symptom management

Question 7

management

2. Neurodynamics → sliders

Answer 7

• Be cautious as don’t want to worsen neurological
• Reduce mechanosensitivity – reduce sensitivity of nerve by improving physiological movement of nerve. Tensioners if v low irritability (can become progression but not natural progression - most people treated with sliders just into more range)
• Can explain to patient like this: These are to reduce pain and sensitivity of the nerve. Explain to the patient that you found there was sensitivity with moving the nerve (from your tests) and the exercise is to help reduce the sensitivity of the nerve and to allow it to move more easily.

Question 8

management

4. Manual therapy

Answer 8

→ rotation or reverse lateral flexion

Question 9

other management

Answer 9

1. Gentle exercises → knees to chest, cat/cow, knees side to side
   Reduces pain and increases comfort/decrease fear

Question 10

Summary 8 week plan;

Answer 10

• Advice and education → latent increase in symptoms (tell them to monitor symptoms after 10 min after and if it gets worse then discontinue or modify
• If neuro symptoms spread then need to stop and refer
• Her understanding of it
• Graduated return to activity
• Plan to return to work (breaks, half days, talking to boss)
• Talk more long term about prognosis
• Manual therapy – progress as tolerated if this has been helpful
• Higher grades or MWM - (SNAG) sit to heels and (when the patient can achieve some flexion in standing without lateral shift). Consider MWM/SNAG in standing to flexion.
• Lateral shift – in clinic and as HEP
• Supine Sliders (start with head and foot movement – or holding leg and doing knee flex/ext with DF/PF)
• Increase walking and consider a gradual return to gym activities – starting with exercises that are up in standing as tolerated – adding load gradually. Trial these exercises in the clinic to see how patient is tolerating.
• Practicing keeping a neutral spine in sitting – see if this helps with symptoms.
Consider ways of managing tasks at home such as making bed and vacuuming