#59: Back pain and Sciatica: Straighten out your practice

The Curbsiders Internal Medicine Podcast

Health & Fitness, Medicine, Science, Higher Education, Education

4.8 • 3.1K Ratings

🗓️ 25 September 2017

⏱️ 70 minutes

🔗️ Recording | iTunes | RSS

🧾️ Download transcript

Summary

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

Transcript

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0:00.0	Hey, this is Matt and just before we get to the show today on Backpane, I wanted to make
0:07.7	a quick announcement.
0:09.4	This Sunday, October 1st, Dr. Stewart can break them and myself.
0:14.2	We'll be jumping on Facebook Live to do a recap episode, talking about some of our recent
0:20.5	episodes and also answering listener questions live.
0:25.0	So if you want to jump on Facebook, please follow our Facebook page.
0:29.0	You can ask us questions live and we'll do our best to answer them during that recap
0:33.3	episode.
0:34.5	And then we will be later posting that to YouTube and also to our normal podcast feed
0:40.7	on iTunes and everywhere else you can get your podcasts.
0:44.2	So that's something new that we're going to be trying out.
0:46.5	We definitely want your feedback and we want your questions.
0:50.2	So please watch us this Sunday, October 1st at 8.30 pm.
0:55.4	And now for your regularly scheduled program.
1:16.3	Welcome back to the Curbsiders, the internal medicine podcast that uses expert interviews
1:22.7	to bring you clinical pearls and practice changing knowledge.
1:25.9	Wonderful.
1:26.9	I'm Dr. Matthew Frank Wato here with several co-hosts.
1:31.0	You want to introduce yourselves, Stewart, Paul, Shreya.
1:33.6	Hello.
1:34.6	I mean, technically you just introduced us, Matt.
1:36.4	I don't.
	...

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