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Long term leg pain

Recently a patient consulted me in regard to a right leg pain that had persisted for 12 months and thought to be a symptom of a golf ball versus a sand wedge. She had received excellent care from a range of professionals including many x-rays in search for relief.

On assessment of her, the sciatic involvement displayed left trunk antalgia, a negative SLR, no pain to sit or lie, but acute pain to weight bear on the right leg. When the L5/S1 disk is herniated, it usually causes pressure on the S1 nerve root. This was the finding, together with unilateral weakness of the plantar flexors, achilles reflex, with sensory deficits in the posterior calf and lateral foot. I found several apparent issues that would logically point to valid reasons for such pain, and these were corrected.

Following treatment however..…no change. Naturally, one might suggest I haven’t given this sufficient time. Some years ago I would have concurred with such a suggestion. Over time I have learnt that the speed of correction is virtually immediate in terms of initiating change. In my experience a reasonable expectation would be a 40 % immediate reduction in pain following treatment of this type of complaint. It is always a concern when there is no evidence of any change following a treatment.

After trusting the brain for so many years, I have respect as to what it is endeavouring to convey when the siren of pain is loud and persistent. I explained to the patient, that an MRI scan is warranted for 2 reasons:

Even after one treatment the ‘intelligence’ is totally aware as to the fundamental reason/s for the problem yet is unable to change the symptom pattern. To ensure that the reasons for pain were not coupled with more sinister issues. The answer was a desiccated disk where fragments were implicating the thecal sac.

An hour’s surgery and a pain free outcome translated into very a thankful 60 yr old who along with myself has come to appreciate when enough is enough.

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