Transcript

Patient: It feels like a muscle pain.
Doctor: Sorry, when did you have back injury?
Patient: My back.
Doctor: How long ago?
Patient: A month ago or something.
Doctor: And what happened with your back injury?
Patient: I couldn't walk for about a week.
Doctor: How did you have the back injury?
Patient: I picked up a box of bananas in the kitchen.
Doctor: And afterward, did you have lower back pain?
Patient: Yeah, I couldn't walk for a little bit. I couldn't move too much.
Doctor: And then?
Patient: And then it just kind of transferred to my leg.
Doctor: So now it's in your leg. Is your back okay?
Patient: I can't... I can't do certain exercises.
Doctor: What do you mean by certain exercises?
Patient: If I go like that, my leg starts hurting.
Doctor: So if you lean back, standing up, then you get pain in your left. And it's the back of the leg? And can you go sideways?
Patient: That's pretty good.
Doctor: How about touching your toes?
Patient: I can't never touch my toes.
Doctor: Alright, can you stand on your toes? And you can stand on your heels. And always just controlling your bladder, your bowels. No fevers, nothing like that.
Patient: I can't possibly. I took the Dufroxin.
Doctor: Yes, and I... They discontinued it. So some nurses bring in...
Patient: The Dufroxin?
Doctor: Yeah, some nurses don't. And the chiropractor would say... Physio? So you saw the physio?
Patient: The physio says... For the naproxen to work, I have to be able to take it consecutively. I can't just take it when I feel pain. I've got to take it in the morning and in the night.
Doctor: So I'm going to write it for 30 days, as needed, twice a day, 500.
Patient: Twice a day?
Doctor: Yeah, for the naproxen.
Patient: So I've got to leave it in the morning, take it, and then...
Doctor: Yeah, so I think it's... Okay.
Patient: And he did say... Something about... Hip.
Doctor: Hip?
Patient: Yeah, to do it... Extra on my hip or something like that? I can do it on Sunday.
Doctor: Yeah, you can move your... Yeah, right now I can't, but... It comes with goals. I don't think you need to. So what stretches are you doing for your lower back?
Patient: I don't think you need a hip exercise. Because sometimes people have hip pain, and then that's actually their hip. But in your case, it's clearly sciatic. You know? You had a back injury, and now you have that nerve. So the sciatic nerve comes out of your spine, comes across your buttock, and goes down the back of the leg. What stretches are you doing for your back?
Patient: I'm doing... I cross my legs, hold my knees to my shoulder. One knee up to my chest. Two knees to my chest.
Doctor: Are you stretching out your hamstring?
Patient: Yeah.
Doctor: Awesome. That's the hamstring back here, right? So you're doing this?
Patient: Yeah.
Doctor: Not bad. You can also put your leg up, straight leg, straight back, and go down. The other exercise you can do is lay on your back. So this is the small of your back. Belly button's here. This is your buttock. And your legs are up like you're going to do a sit-up. Instead of doing a sit-up and raising this part, you kind of tilt your pelvis so that you straighten out your lower back. Because the issue is likely your lower back is what's irritating the nerve, and so you have tension in that muscle, so stretching out. So if you do pelvic tilts at 20 in the morning and 20 at night, that will hopefully stretch out. So you want to take your pelvis and kind of lift it up.
Patient: Yeah, that's the one that I can't do. It's like crazy. That's the one that's like, seriously.
Doctor: So it's irritating it. So you have to start slow and kind of do some not as exaggerated movements, but you have to loosen that up. The physio's going to keep seeing you. The physio asks if you need an x-ray. I don't think you need a hip x-ray. I don't think it's going to buy you any info. So keep working on the sciatica. I'll do a follow-up in a couple weeks. We'll see how you do.
Patient: So continue taking this naproxen twice a day?
Doctor: Twice a day. For a month?
Patient: Yeah, I wrote it for 30 days. Two weeks from now, your pain goes better. You can just stop it.
Doctor: What about ibuprofen? Does ibuprofen get this pain before?
Patient: Ibuprofen and naproxen are similar. Naproxen's better because it's a 12-hour med. Ibuprofen's a 6-hour med.
Patient: When I was outside, I used to take magnesium pills and I wouldn't get this. You have a magnesium deficiency. I was just moving. A lot of household moving. I ate a lot of bananas and took a lot of magnesium pills.
Doctor: It's not a standard treatment for sciatica. They put you on a muscle relaxer before, right? For a week?
Patient: I can restart it again.
Doctor: I'll do a muscle relaxer for you as well. But you gotta really work on the stretches and all that stuff. I'll see you back and we'll go from there. Take care, okay? No red flags of back pain. Normal exam. Counsel. If any new red flags to seek care. Cyclobenzapine 10mg QHS for 7 days and Naproxen 500 BID for 30 days. For treatment, no clear indication for hip x-rays. Can consider x-ray of the spine and or hip after several more weeks if the pain continues without resolution.