Posts tagged leg pain
Non Steroidal Anti Inflammatory Drugs for Sciatica
NSAIDs-anti inflammatory drugs-Sciatica-treatment

Our previous posts have documented the success of Physical Therapy treatments on sciatica, radiating pain down the back of leg, compared to other conservative treatments and surgery.  Specifically, no differences have been noted between surgery and PT at long term follow up.  Another medical intervention for sciatica includes non steroidal anti inflammatory drugs (NSAIDs).  These are one the most common medications prescribed for sciatica and a recent study sheds light on their lack of effectiveness of this condition.

Authors in the Spine Journal updated a review article including all research papers documenting the effectiveness of NSAIDs on patients with sciatica (Rasmussen-Barr et al. 2017).  The authors included 10 papers including 1651 patients with sciatica who were prescribed NSAIDs for their symptoms.  The authors found minimal support for the use of NSAIDs for symptoms of sciatica and some evidence showing the effects on NSAIDs were equal to the placebo pill condition.  The authors also described the higher rates of adverse effects in patients taking NSAIDs over a placebo pill.  

These minimal benefits and higher risks must be considered when utilizing NSAIDs for sciatica symptoms.  Patients are encouraged to meet with their local PT for the effective treatment of sciatica symptoms.  

Lumbar Spinal Stenosis Physical Therapy vs. Surgical Interventions
lumbar spinal stenosis, physical therapy interventions, surgery

Lumbar Spinal Stenosis is a spinal diagnosis found in older adults and involves a narrowing of the canals in which the nerves exit the spine.  It can be found in either the central canal of the spine or in the foramen where nerves exit on each side of the spine.  Often these patients reports symptoms of back and leg pain, pins and needles, numbness, or leg weakness.  Lumbar spinal stenosis is the leading cause of lumbar surgery in the U.S. but non surgical Physical Therapy interventions including manual therapy, exercise and body weight supported treadmill have been shown to have a positive impact on pain and disability in this population (Whitman et al. 2006). 

A recent study in the Annals of Internal Medicine (2015) by Delitto et al. compared the impact of surgery to non surgical treatments for patients with lumbar stenosis.  169 patients were randomly assigned to either a surgical or Physical Therapy group and were followed for 2 years.  Authors reported surgical decompression had similar effects to a Physical Therapy treatment program for patients with lumbar stenosis.  Try a manual physical therapy approach to reduce your pain, improve your function, and avoid the unnecessary cost and risks of spine surgery. 

Lumbar stenosis, surgery, physical therapy interventions

Lumbar Injections for Back and Leg Pain
lumbar epidural injections, back and leg pain

The use of lumbar corticosteroid injections is often utilized for patients with back and leg pain (radicular pain) and/or leg numbness, pins and needles, or nerve root weakness (radiculopathy).  In an older adult these symptoms may be due to a narrowing of the canals in which the lumbar nerve roots exit (lumbar stenosis).  These injections are costly and not without risk including a number of cases of infection in 2013-2014.  A recent review of the available literature published this month in the Annals of Internal Medicine found limited effectiveness of these treatments compared to placebo trials for both lumbar radiculopathy and stenosis.  Chou et al. and colleagues reported injections for radiculopathy may offer a small, short-term effect but long term effectiveness is limited.  In patients with lumbar stenosis the evidence reported little to no effectiveness on pain or function.  Physical Therapy is the first line intervention for patients with these conditions. 

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