#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 Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at [email protected]. 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