Question
Hi Dr. Park,
In June 2007, I had a massage where the Therapist hyper-extended my L4/5/S1 area in an aggressive stretch (lying prone he lifted my R) leg in extension whilst holding my lumbar region steady). The next day..Stiff lower back and neuralgia R) leg extending from Gluteal region down thru lateral aspect of R) ankle. It lasted about 3/52 then spontaneously resolved. Fast-forward to November '07 and it reappeared, the same stiffness and mild LBP plus really bad sciatica after a bad nights sleep.

Tried Physical Therapist for a months tx, dx..bulging disc causing nerve entrapment, but,  no improvement post-tx (mobilizations, stretches, Ultra-sound).

Now seeing an Osteopath and after 2 treatments mildly improved (Pyriformis stretches, mobilizations, various adjustments Lumbar to Cervical areas. Still neuralgia and paraesthesia R) limb.Pain scale was 8/9 out of 10, now probably 7/8 out of 10. The D.O says probably not a herniated disc, but still a nerve entrapment. He suggests 5-6 Treatments (adjustments).

The "Sphinx" stretch, lying flat, taking NSAID's are the only things that mildly releive my symptoms. the longer I'm on my feet the worse the symptoms become.

My profession is a Podiatrist (age <40), so lots of sitting!

Questions:

1. What would be your (approximate) diagnosis?
2. Are manual adjustments sufficient?
3. If so, what approximate duration of Tx (?weeks) would you envisage to resolve the sciatica/neuralgia?

Thanks a million for your opinion.


Answer
Sounds like you definitely have a lumbar disc problem (bulge or herniation). I would suggest you have an MRI to rule out any other pathology. Since you seem to be responding to the "Sphinx" stretch, I would explore McKenzie physical therapy protocols for managing disc issues.

Manual therapy is necessary, but probably not enough. Since you do a lot of sitting your lumbar spine is in a predominantly flexed position (hypolordotic) which compresses the disc anteriorly and can push the disc (nucleus pulposis) posteriorly causing nerve root compression. Extension exercises for your lower back would probably benefit you the most along with a stretching program if you have tight hip flexors and hamstrings. Once you do the appropriate exercises and stretches, work in better ergonomic positions and limit the amount of sitting, you should probably see some improvement within 6-8 weeks.

Sounds like you're doing all the right things though. Get the MRI first and go from there. Good luck!