This is a question submitted via the blog on acute lumbar pain. Is it too early to move? Click below to find out!
Hi Dr. E,
I'm an acute care PT, former orthopedic PT, who still follows your blog. I've been seeing patients intermittently in the emergency department, mostly for mobility reasons. I just encountered a PT order for an acute disc herniation. At this point he is <48 hrs from initial injury. MRI showed annular fissures at L4-5 and L5-S1 with moderate canal stenosis, indenting the thecal sac. He is in severe pain, doesn't want to move at all. Is it too early to start working into extension? I'm thinking about trying to get him prone on his hospital bed, is this a good idea? I've never had the luxury of seeing such an acute musculoskeletal injury. I have not yet seen him, but would like to today or tomorrow. Looking forward to a response.
Also, I forgot to mention in my last email, he has no signs or symptoms of neurological compromise and no pain distal to buttocks. Only c/o LBP and flank pain. Neurosurgeons have given him a Medrol dose pack and are not planning to do surgery. I've gotten all this info from a chart review. I realize I probably won't get a response until after I get a chance to see him, but this is good stuff to know.
Thanks in advance.
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Matt, you're in luck! What good fortune for both the patient and the clinician to be seen so close to onset!
Don't worry about the MRI findings, sounds about right for some wrinkles on the inside.
In other words, do not be discouraged by severe pain and less than 48 hours, be ENcouraged! What a great opportunity to help a patient in severe pain! Good luck, post on the forum on how he does and if you need any help and we'll try to get back to you ASAP!
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