#59: Back pain and Sciatica: Straighten out your practice
Solidify your approach to back pain and sciatica with Dr. Chris Miles, Assistant Professor, Family & Community Medicine and Associate Director, Sports Medicine program, Wake Forest Baptist Medical Center. He schools us on red/yellow flags, physical exam maneuvers, when to order imaging, and practical tools and tips for evidence-based management! Correspondent Dr. Shreya Trivedi cohosts!
Full show notes available at http://thecurbsiders.com/podcast
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Case from Kashlak Memorial: 53 yo M construction worker with a BMI of 29 and PMhx of DM2, HTN, depression presenting with right low back pain. He can't remember any trauma or injury. Denies radiation, no bowel or bladder dysfunction, saddle anesthesia, weakness
Case from Kashlak Memorial: 48 yo F nurse who has had intermittent back pain for years presented with acute flare after helping lift a patient. The pain similar to previous episodes but more severe and also radiates to her left foot. She has tried naproxen and exercises/mindful stress reduction for months without improvement. It is unbearable for her to work.
Time Stamps
00:00 Intro
02:14 Listener feedback
03:44 Announcements
05:14 Picks of the week
08:20 Millenial learners
10:40 Topic intro and guest bio
12:06 Getting to know our guest
17:30 Clinical case of back pain
20:18 How to hand sensory deficits
21:51 Red and yellow flag symptoms
25:44 How to approach patient with yellow flag symptoms
28:00 Physical exam for back pain
30:00 Special testing: Trendelenburg, Slump test, and Straight leg raise
35:48 Classifying types of back pain and a quick recap of teaching points so far
39:28 How to manage patient expectations
40:42 Treatment of non-radicular back pain
46:33 Home exercises and YouTube training
49:31 When to follow up after initial treatment trial
51:35 The patient with severe acute pain
53:33 Some pearls on muscle relaxants
55:22 Clinical case and how to treat radicular pain
59:40 Invasive treatment of back pain
65:04 Back pain treatments that don’t work