Clinical Scenario 1:
Dave S. is a 62-year-old accountant who loves golf. He has a history of occasional back pain that never interfered with daily activities until 3 months ago. Recently, prolonged walking and standing became increasingly painful. Massage therapy and chiropractic treatment helped initially, but were no longer effective. He was worried about pain and numbness in the back of his left leg and calf. Dave saw his Internist who determined that his symptoms were not due to an arterial or circulatory problem. He was referred for a Spine Physiatry consultation with Dr. Lin.
A Physiatric evaluation, along with review of Dave's x-rays and MRI, confirmed the diagnoses of sciatica and spinal stenosis. Dr. Lin recommended an epidural steroid injection under fluoroscopic (x-ray guided) imaging. This procedure reduced the swelling and pain.
Dave was able to return to his daily routine of walking for exercise. At this point, Dr. Lin prescribed specific exercises with a Physical Therapist for core stabilization and strengthening. Later that year, Dave was still exercising on a regular basis and his golf game improved.
Clinical Scenario 2:
Mary L., a 33-year-old realtor and jogger, decided to fulfill one of her life goals of running a marathon. She underwent an aggressive 6-month training program with some friends. 2 months before the race, she experienced low back pain, knee pain and occasional numbness in the right foot. This worsened with prolonged periods of sitting, particularly in traffic or during long meetings. She continued training and exercising but this only made symptoms worse.
Massage therapy no longer provided any relief. Mary went to her primary care physician. He prescribed ibuprofen and Tylenol. The low back pain improved and the numbness in the right foot resolved.
She was referred to Dr. Lin for persistent soreness in the right knee. Her history and physical revealed that the persistent pain was unrelated to her spine. Rather, Mary had iliotibial band syndrome. A simple injection alleviated the pain immediately. She was then able to learn preventive exercises and new stretching techniques. She went on to successfully complete her marathon.
Clinical Scenario 3:
Phil K. is a 48-year-old construction site manager. 8 months ago, he bent down to pull some papers out of filing cabinet, when he experienced severe back pain. 3 days later, he felt numbness and tingling in the left calf and foot. The pain worsened with bending or sitting for extended periods of time.
He went to the Urgent Care clinic near his job site. His physician prescribed a muscle relaxant and a nonsteroidal anti-inflammatory agent. Despite these medications, the pain worsened. Phil was frustrated that the pain was causing him to miss work; his wife was concerned about him avoiding activities with his family and friends. His physician ordered an MRI which revealed 2 herniated disks. Phil was referred to a Surgeon, but he wanted to know about non-operative treatment options.
Phil was referred for a Spine Physiatry consultation with Dr. Dwight Lin, who recommended a fluoroscopic (x-ray image guided) epidural steroid injection. He was pleased to learn about medical treatments other than surgery. After the injection, the swelling and pain improved significantly. Dr. Lin then prescribed specific exercises with a physical therapist to alleviate the pain and prevent future symptoms. Phil was able to return to work and enjoy family activities again.