In: Nursing
linda is a 45 year old female with mild to moderate
lumbar pain and knee pain that has persisted for more than six
months. she has mild relief with rest and non- steroidal
anti-inflammatory drugs. her pain worsens with exercise
what are the advantages/ disadvantages of the option
should she try one therapy or treatment option at a time or
consider a combination approach why?
would she benefit from beginning her treatment with less invasive
options? Are there downsides to this approach?
Linda have mild to moderate lumbar pain and knee pain that has persisted for more than six weeks . She has mild relief with rest and NSAIDs use.
Pain is aggravated by exercise.
Lower back pain or lumbar pain can have causes that are not due to underlying disease. Examples include overuse such as working out or lifting too much, prolonged sitting and laying down, sleeping in an uncomfortable position, wearing a poorly fitting backpack.
The causes of lumbar pain and knee pain is may be due to many reasons. It includes laboratory tests like X-ray, MRI, CT scan, etc.
The diagnosis may be -
Sciatica, herniated disc or slipped disc, muscle strain, arthritis, etc .
but as per case, pain is increasing by exercise, so , it might be herniated disc or sciatica.
Most people assume if they have knee pain, it is due to a problem with the knee joint. This is not always the case. While the discomfort can be due to a knee condition, it can also be the result of a disc protrusion or a pinched nerve in your lower back
** Herniated disc -
The vertebrae that form the spine in the back are cushioned by discs. These discs are round, like small pillows, with a tough, outer layer (annulus) that surrounds the nucleus. Located between each of the vertebra in the spinal column, discs act as shock absorbers for the spinal bones.
A herniated disc is a fragment of disc nucleus that is pushed out of the annulus (outer layer) into spinal canal through tear or rupture in the outer layer. Due to this displacement, the disc presses on spinal nerves, often producing pain.
A single excessive strain or injury may cause a herniated disc. However, disc material degenerates naturally as one ages, and the ligaments that hold it in place begin to weaken. As this degeneration progresses, a relatively minor strain or twisting movement can cause a disc to rupture.
Herniated disc cause knee pain also because the nerve roots act as telegraph lines to other parts of the body, a common complication of disc hernia took is that it can cause pain that is felt in other parts of the body.
A lumbar herniated disc or lumbar spinal stenosis that causes compression of the L3 nerve root in mid-back region may cause knee pain and weakness. One may also experience pain in the front of your thigh, side of hip, and the groin region.
** Sciatica
Knee pain that cannot be traced back to a physical injury may be caused by a problem in lower back. The muscles around knees are powered by nerves that originate in lower spine. Irritation or compression of these nerves at their spinal origin causes symptoms, commonly known as sciatica, which may include knee pain and/or weakness.
Knee pain and back pain are may be the symptoms of sciatica. Because of the compression of the L4 spinal nerve root, it could be the reason behind the knee pain.
Common causes of compression are spinal stenosis or herniated disc.
# Initial treatment includes conservative and non surgical treatment.
- Patient is advised to maintain a low, painless activity level for few weeks, as it may help in decreasing inflammation of spinal nerve. Bed rest is not recommended.
- Herniated disc is normally treated with NSAIDs if the pain is mild or moderate like paracetamol, strong pain killers like codeine or muscle relaxant like diazepam.
- An epidural steroid injection may be performed utilizing a spinal needle under X-ray guidance to direct the medication to the exact level of the disc herniation.
- Physical therapy is recommended. Therapy may include pelvic traction, gentle massage, ice and heat therapy, ultrasound, electrical muscle stimulation and stretching exercises.
- Pain medication and muscle relaxants may also be beneficial in conjunction with physical therapy.
- SURGERY - Lumbar spine surgery.
Lumbar laminotomy is a procedure often utilized to relieve leg pain and sciatica caused by a herniated disc.
* It is performed through a small incision down the center of the back over the area of the herniated disc. During this procedure, a portion of the lamina may be removed. Once the incision is made through the skin, the muscles are moved to the side so that the surgeon can see the back of the vertebrae. A small opening is made between the two vertebrae to gain access to the herniated disc. After the disc is removed through a discectomy, the spine may need to be stabilized. Spinal fusion often is performed in conjunction with a laminotomy. In more involved cases, a laminectomy may be performed.
- Follow up -
* Specific instructions are given after surgery and pain killers
are given. Some patients may benefit from supervised rehabilitation
or physical therapy after surgery.
## She may get benefit from non invasive treatment but if she would
not be if it from non invasive treatment then surgical treatment is
required.