• Any age, usually middle-aged History of injury:
• Yes, lifting or twisting
• Can be spontaneous
Site and radiation:
• Unilateral low back, distal radiation along dermatome, tends to have a 'distal' emphasis
Type of pain:
• Deep aching or stabbing pain (episodic) develops soon after rising in morning
• Activity, lifting, intercourse, sitting, bending, car travel, coughing, sneezing, straining Relief:
• Rest, lying, standing Associations:
• Distal paraesthesia ± numbness, stiffness Physical examination (significant):
• Guarded and restricted movement
• Loss of lumbar lordosis
• Lateral deviation (scoliosis)
• Restricted flexion, extension, lateral flexion
• SLR and slump test positive
± specific muscle/myotomal weakness (typically unilateral) ± reduced distal sensation (typically unilateral) ± reduced ankle jerk (S1) (typically unilateral)
Diagnostic confirmation (for special reasons):
• CT scan, discogram, radiculogram, MRI or myelogram
The two nerve roots that account for most of these problems are L5 and S1. Most settle with time (6 to 12 weeks). The management is outlined at the end of this chapter and under 'Sciatica' (Chapter 60).
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