Management of a female with chronic sciatica and low back pain: a case report

This case report describes therapeutic exercise management for a female with a chief complaint of right sciatica and secondary low back pain (LBP). The patient was a 61-year old female with chronic right sciatica and LBP. At initial examination she reported pain at 9 on a scale of 10, with 10 being the most severe, demonstrated a straight leg raise (SLR) limited to 45 degrees , and a positive Ober's test. The Oswestry Disability Index (ODI) was 40%. The first six weeks (five visits) the patient was instructed in stabilization and spinal flexion exercises. After noting limited improvement, the intervention plan was revised for 13 additional weeks (10 visits) to include the following exercises to reposition and stabilize the pelvis: muscle activation of the left hamstrings, adductors, gluteus medius, abdominals, and right gluteus maximus; stretching the left posterior hip capsule; and muscle inhibition for the paraspinals. After five visits (six weeks), the patient reported 6/10 pain and leg pain. At discharge, patient reported 0/10 pain, SLR was 70 degrees , the Ober's test was negative, and the Oswestry Disability Index was 0%. Stabilization and flexion exercises resulted in limited outcomes and did not eliminate the right sciatica symptoms. The addition of muscle activation, muscle inhibition, and a left hip capsule flexibility exercises resulted in remarkable outcomes and appears to be beneficial for eliminating pain and improving function for this woman with chronic right sciatica/LBP.