(zaid hijab) 4th stage
Rehabilitation of sciatica
Sciatica is a common pain syndrome, considering that ∼10% of low back pain
episodes, which have a lifetime cumulative incidence of 80%, will be accompanied
by sciatica. Nerve root compression by disc herniation is regarded as the most
frequent cause of sciatica.
College of
Health and medical technology
Baghdad
Department of
Physiotherapy & Rehabilitation
This is the presentation which was delivered to third year Bachelor of Physiotherapy students at Kathmandu University School of Medical Sciences (KUSMS), Dhulikhel, Nepal. Different schools of thoughts in manual therapy are the part of curriculum for the undergraduate students at KUSMS.
Brian Mulligan described novel concept of the simultaneous application of therapist applied accessory mobilizations and patient generated active movements
This is the presentation which was delivered to third year Bachelor of Physiotherapy students at Kathmandu University School of Medical Sciences (KUSMS), Dhulikhel, Nepal. Different schools of thoughts in manual therapy are the part of curriculum for the undergraduate students at KUSMS.
Brian Mulligan described novel concept of the simultaneous application of therapist applied accessory mobilizations and patient generated active movements
Myofascial release refers to the manual
technique for stretching the fascia and
releasing bonds between fascia and
Lintegument, musles,and bones, with the goal of
eliminating pain, increasing range of motion
and balancing the body.
Neurodynamics, mobilization of nervous system, neural mobilizationSaurab Sharma
This is the presentation which was delivered to third year Bachelor of Physiotherapy students at Kathmandu University School of Medical Sciences (KUSMS), Dhulikhel, Nepal. Different schools of thoughts in manual therapy are the part of curriculum for the undergraduate students at KUSMS.
At the end of the lecture, the students should be able to:
Discuss the theoretical basis of the neurodevelopmental approaches
Discuss the concepts and principles underlying the Bobath approach
Discuss the concepts and principles underlying the Brunnstrom approach
Bicipital tendonitis is inflammation of long head of the biceps tendon under the bicipital groove.
In early stage, tendon becomes red and swollen, as tendonitis develops the tendon sheath can thicken.
In late stage, often become dark red in color due to inflammation.
Principles of Manipulation or manipulative therapySaurab Sharma
This is the presentation which was delivered to third year Bachelor of Physiotherapy students at Kathmandu University School of Medical Sciences (KUSMS), Dhulikhel, Nepal. principles of manipulative therapy is the part of curriculum for the undergraduate students at KUSMS. This presentation highlights the need of meticulous assessment before delivering manipulative therapies to patients. Part of the slides were extracted from the teaching materials provided by Professor Joshua Cleland who conducted a workshop in Manipulation of Lumbar Spine in Nepal in 2014 in Nepal Physiotherapy Conference. I would like to thank Dr. Cleland for his contribution.
There are evidence in History of treatment by Passive stretching techniques.
Over past 30-40 years many therapists have worked to identify and learn the techniques which are are more suitable and effective for the patient’s problem.
Joint mobilisations and manipulations techniques are used to safely stretch or snap structures to restore normal joint mechanics with less trauma.
NDT, BOBATH TECHNIQUE, BASIC IDEA OF BOBATH, CONCEPT OF BOBATH, NEUROPHYSIOLOGY OF NDT, ICF MODEL, PRINCIPLES OF TREATMENT OF NDT IN STROKE AND CP, AUTOMATIC AND EQUILIBRIUM REACTIONS, KEY POINTS OF CONTROL, FACILITATION, INHIBITION AND HANDLING IN NDT
How chiropractor in los angeles provides superior healthDr.Joeseph Hakimi
How Chiropractor In Los Angeles Provides Superior Health?
https://bit.ly/3kULg6b
A professional Chiropractor does chiropractic adjustment, in order to reduce pain.
Chiropractic manipulation is done using various hands-on techniques and instruments.
One of the biggest advantages of chiropractic is that it releases stress and anxiety.
Along with this, chiropractic adjustment also results in speedy recovery.
Chiropractic manipulation prevents disorders. Other advantages of a chiropractic adjustment are It improves joint and muscle mobility function.
If you have a weak immune system, a chiropractic adjustment will improve that.
Chiropractic manipulation also has the advantage of the improvement of muscle mobility.
Chiropractic adjustments are also known as chiropractic manipulations as it consists use controlled force deemed manipulation.
There is a chiropractic method called the Activator technique. This chiropractic method is done using a device.
Another Chiropractic Method is the Flexion-Distraction Therapy. In this, a specially designed table is used to perform Chiropractic manipulation.
Flexion-Distraction Therapy is a chiropractic method where chiropractors find trigger points and release them.
A skilled and professional chiropractor does all these chiropractic manipulations in order to solve the issues you are facing.
Are you looking for the best chiropractor in Los Angeles? - https://bit.ly/3c4cVgn
Like, Share and Subscribe: https://bit.ly/3buuwxG
#chiropracticadjustment #chiropracticmanipulation #losangeles
Sports and Physical Therapy Associates share a informational slideshow documenting prevention of back pain, causes, and treatment.
Most adults will experience back pain, find out how to prevent it and how to treat it.
Myofascial release refers to the manual
technique for stretching the fascia and
releasing bonds between fascia and
Lintegument, musles,and bones, with the goal of
eliminating pain, increasing range of motion
and balancing the body.
Neurodynamics, mobilization of nervous system, neural mobilizationSaurab Sharma
This is the presentation which was delivered to third year Bachelor of Physiotherapy students at Kathmandu University School of Medical Sciences (KUSMS), Dhulikhel, Nepal. Different schools of thoughts in manual therapy are the part of curriculum for the undergraduate students at KUSMS.
At the end of the lecture, the students should be able to:
Discuss the theoretical basis of the neurodevelopmental approaches
Discuss the concepts and principles underlying the Bobath approach
Discuss the concepts and principles underlying the Brunnstrom approach
Bicipital tendonitis is inflammation of long head of the biceps tendon under the bicipital groove.
In early stage, tendon becomes red and swollen, as tendonitis develops the tendon sheath can thicken.
In late stage, often become dark red in color due to inflammation.
Principles of Manipulation or manipulative therapySaurab Sharma
This is the presentation which was delivered to third year Bachelor of Physiotherapy students at Kathmandu University School of Medical Sciences (KUSMS), Dhulikhel, Nepal. principles of manipulative therapy is the part of curriculum for the undergraduate students at KUSMS. This presentation highlights the need of meticulous assessment before delivering manipulative therapies to patients. Part of the slides were extracted from the teaching materials provided by Professor Joshua Cleland who conducted a workshop in Manipulation of Lumbar Spine in Nepal in 2014 in Nepal Physiotherapy Conference. I would like to thank Dr. Cleland for his contribution.
There are evidence in History of treatment by Passive stretching techniques.
Over past 30-40 years many therapists have worked to identify and learn the techniques which are are more suitable and effective for the patient’s problem.
Joint mobilisations and manipulations techniques are used to safely stretch or snap structures to restore normal joint mechanics with less trauma.
NDT, BOBATH TECHNIQUE, BASIC IDEA OF BOBATH, CONCEPT OF BOBATH, NEUROPHYSIOLOGY OF NDT, ICF MODEL, PRINCIPLES OF TREATMENT OF NDT IN STROKE AND CP, AUTOMATIC AND EQUILIBRIUM REACTIONS, KEY POINTS OF CONTROL, FACILITATION, INHIBITION AND HANDLING IN NDT
How chiropractor in los angeles provides superior healthDr.Joeseph Hakimi
How Chiropractor In Los Angeles Provides Superior Health?
https://bit.ly/3kULg6b
A professional Chiropractor does chiropractic adjustment, in order to reduce pain.
Chiropractic manipulation is done using various hands-on techniques and instruments.
One of the biggest advantages of chiropractic is that it releases stress and anxiety.
Along with this, chiropractic adjustment also results in speedy recovery.
Chiropractic manipulation prevents disorders. Other advantages of a chiropractic adjustment are It improves joint and muscle mobility function.
If you have a weak immune system, a chiropractic adjustment will improve that.
Chiropractic manipulation also has the advantage of the improvement of muscle mobility.
Chiropractic adjustments are also known as chiropractic manipulations as it consists use controlled force deemed manipulation.
There is a chiropractic method called the Activator technique. This chiropractic method is done using a device.
Another Chiropractic Method is the Flexion-Distraction Therapy. In this, a specially designed table is used to perform Chiropractic manipulation.
Flexion-Distraction Therapy is a chiropractic method where chiropractors find trigger points and release them.
A skilled and professional chiropractor does all these chiropractic manipulations in order to solve the issues you are facing.
Are you looking for the best chiropractor in Los Angeles? - https://bit.ly/3c4cVgn
Like, Share and Subscribe: https://bit.ly/3buuwxG
#chiropracticadjustment #chiropracticmanipulation #losangeles
Sports and Physical Therapy Associates share a informational slideshow documenting prevention of back pain, causes, and treatment.
Most adults will experience back pain, find out how to prevent it and how to treat it.
Back pain, whether it lasts a day, a month, or a year, has most of us looking for a way out of it. While back pain is a common concern, the good news is that most back pain is self-limited and will resolve with conservative care.
Physical therapy exercises for low back painHealthQuest
Physical therapy exercises are highly acclaimed solutions for low back pain. Under proper guidance, you can undertake various physical therapy exercises to reduce pain and bring back muscle strength.
Lower back pain is a common health issue. Besides medication, chiropractic, physical therapy and advanced interventional therapy are important modes of back pain management.
While individually prescribed exercise programs are often the bread and butter of a physical therapy plan of care, there is no denying that technological advances in physical therapy tools have a place in the clinic also.
How physiotherapy help in your life by treating painshealthheal
Physiotherapy is a healthcare profession that assesses, diagnoses, treats, and works to prevent disease and disability through physical means. Physiotherapists are experts in movement and function who work in partnership with their patients, assisting them to overcome movement disorders, which may have been present from birth, acquired through accident or injury, or are the result of ageing or life-changing events.
Things about massage that you should knowDianne Myo
Having a massage is not only good for relaxation. But having a massage gives you more than that. There are many research conducted about some of the benefits of it either health, or emotional.
How los angeles chiropractor provides chiropractic care for back painDr.Joeseph Hakimi
How Los Angeles Chiropractor Provides Chiropractic Care For Back Pain
https://bit.ly/3AzOTTO
Back pain affects everyone, from youth to the elderly. This problem may affect anybody, from professional athletes to working professionals.
With spinal manipulation, this back pain can be reduced.
If you are looking for a lower back adjustment Chiropractor in Los Angeles, we have the perfect chiropractic care for back pain for you!
Back pain might make it difficult to go about your daily activities, and pain relievers don't last very long. Spinal manipulation is the answer to this problem.
Chiropractic care for back pain is extremely successful and uses a variety of approaches. A chiropractor employs manual procedures such as lower back adjustment chiropractor to help people heal from back pain.
Each patient's level of back pain is different. The chiropractor in Los Angeles country examines and locates the specific source of discomfort before performing chiropractic care for back pain.
The chiropractor of Los Angeles Healthcare studies the x-ray and MRI and accordingly, a chiropractic plan of spinal manipulation is made.
Chiropractic care for back pain helps to reduce inflammation and tightness in muscles. This is turn, reduces back pain.
There are various methods is used in Los Angeles healthcare to perform spinal manipulation chiropractic adjustment in order to reduce back pain.
After the recovery, the lower back adjustment chiropractor designs and gives exercises to the patient suffering from back pain. This is done to have a long-lasting effect on spinal manipulation treatment.
Chiropractic care for back pain usually lasts for 15-20 days. But it all depends on the severity of back pain and the pace of recovery of the patient.
Chiropractic care for back pain in Los Angeles healthcare has been proven very effective.
Get spinal manipulation for your back pain done today!
Are you looking for the best chiropractor in Los Angeles? - https://bit.ly/3c4cVgn
Like, Share and Subscribe: https://bit.ly/3buuwxG
#chiropracticadjustment #backpain #losangeles
زيد حجاب توفيق الكلية التقنية الطبية بغداد قسم العلاج الطبيعي
Zaid Hijab Tawfeeq
College of
Health and medical technology – Baghdad
Physiotherapy and Rehabilitation
Osteomalacia is softening of the bones. This ineffective bone mineralization in children
is referred to as Rickets. It is caused by impaired bone metabolism which in turn causes
inadequate bone mineralization. Bone metabolism is impaired due to insufficient
calcium, vitamin D or phosphate or calcium resorption.
-Affect any age group.
-Most of them inversion injury (incomplete tear of lateral ligaments.
-Complete rupture mean:
1-Fail to heal.
2-Instability of ankle.
-Signs and symptoms:
1-Pain.
2-Instability to weight bear in some cases.
3-Swelling.
4-Ecchymosis & bruising.
5-Palpation of ligaments especially ATFL is tender.
-Ottowa ankle rule: Institutions to determine on which patients ankle radiographs should be ordered.
1-No weight bearing X4 staps at time of injury.
2-Bony tendernes around medial and lateral malleolus.
3-Positive squeeze test.
4-stress test.
-Squeeze test: fibula and tibia pushed together by exminer at about the shin creating pain at ankle.
-Stress test: grasp the heel and forcibly put gently invert the foot, feeling for opening up thenlateral side of the ankle between tibia and talus.
Treatment:
-PRICE
-Pain control.
-Rest.
-Ice.
-Compression.
-Elevation.
--Fractures may require surgical fixation.
Orthopaedic examination made easy
-Javad parvizi
by:Zaid Hjab
زيد حجاب
Types of joint :
Fibrous joint - skull sutures
cartilaginous joint - intervertebral discs between the bodies of vertebrae
-the pubic symphysis between the front ends of the two hip bones.
synovial joint
=ball and socket -hip - shoulder
=hinge elbow -interphalangeal
=condylar - knee -jaw
=ellipsoid - wrist
=saddle -the base of the thumb
=plane between some wrist and foot bones
Fibrous bones united by fibrous tissue (no movement)
Cartilageinous bones united by plates of cartilage (limited movement)
Synovial bones ends covered by cartilage and sur-roundedby fibrous capsule and have synovial fluid.
by Zaid hjab
in English
with figures
زيد حجاب
The concise Handbook of Human Anatomy-
R. M. H. McMinn
R. T. Hutchings
B. M. Logan
Therapeutic Exercises divided in to R.O.M exercises and Resisted exercises ROM = range of motion. r.o.m exercises divided into passive and active .
by Zaid Hjab
زيد حجاب الكلية التقنية لطبية قسم العلاج الطبيعي
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
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New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
1. Rehabilitation of sciatica
Report about
College of
Health and medical technology
Baghdad
Department of
Physiotherapy & Rehabilitation
Done by
Zaid Hjab Tawfeeq
4th
stage student
Supervised by
Zainab Ali Hussein
M.Sc. Physiotherapy, B.M. Tech.
2. 1
Introduction:
Sciatica is a common pain syndrome, considering that ∼10% of low back pain
episodes, which have a lifetime cumulative incidence of 80%, will be accompanied
by sciatica. Nerve root compression by disc herniation is regarded as the most
frequent cause of sciatica.
Sciatica is mainly diagnosed by history taking and physical examination. In
general, the clinical course of acute sciatica is considered to be favorable. In the
first 6–8 weeks, there is consensus that treatment of sciatica should be
conservative. We review and comment on the levels of evidence of the efficacy of
patient information, advice to stay active, physical therapy analgesics, non-
steroidal anti-inflammatory drugs (NSAIDs), epidural corticosteroid injections and
transformational peri-radicular injections of corticosteroid. There is good evidence
that discectomy is effective in the short term. But, in the long term, it is not more
effective than prolonged conservative care. Shared decision making with regard to
surgery is necessary in the absence of severe progressive neurological symptoms.
Sciatica is a symptom rather than a specific diagnosis. The most important
symptom is leg pain radiating below the knee and into the foot and toes. Clinical
findings of neurological deficit, such as muscle weakness and reflex changes, may
also be present. Inw90% of cases, sciatica is caused by a herniated disc with nerve-
root compression, but lumbar canal or foramina stenosis and (less often) tumors or
cysts are other possible causes.
3. 2
Rehabilitation of sciatica:
Once your acute pain improves, your doctor or a physical therapist can design a
rehabilitation program to help you prevent future injuries. This typically includes
exercises to correct your posture, strengthen the muscles supporting your back
and improve your flexibility.
Goals of Physical Therapy and Exercise in Treating Sciatica:
Restore pain-free functional movement patterns.
Relieve lower back, buttock, thigh, and leg pain.
Reduce muscle spasm.
Restore function of the lumbar spine and the sacroiliac joint.
Improve mobility of the lower body.
Foster a better healing environment in the lower back.
Promote neurologic adaptations to reduce the perception of pain.
Prevent future pain flare-ups and reduce fear associated with movement.
Common techniques:
Extension and flexion back exercises: help relieve pain by promoting movement
of the spine. Often, individuals with lower back pain and sciatica feel relief with
specific directional movement of the spine. A physical therapist typically evaluates
an individual’s directional preference before prescribing specific directional
exercises, as these are tailored to the individual patient and symptoms. These
exercises include backward (extension) and forward (flexion) bending. This
directional movement is an important component of the McKenzie Method, also
known as mechanical diagnosis and therapy (MDT).
4. 3
The McKenzie Method (mechanical diagnosis and therapy):
Is a technique that involves a series of active directional movements to identify
and treat a pain source in the spine, muscles, and/or joints? The technique
focusses on moving the radiating pain closer to the center of the body through
exercise, for example, moving leg pain closer to the spine. The theory of this
approach is that centralizing the pain indicates improvements in symptoms. The
goal is to reduce radiating symptoms originating from the spine. A therapist who
practices this technique usually has special training in the McKenzie Method.
Exercise 1 – Lying Face
Down
Exercise 3 – Lying Face
Down in Extension
Exercise 4 – Extension in Lying
Exercise 5 – extension in standing Exercise 6 – extension in lying supine
Exercise 2 – Flexion
in Standing
5. 4
Strengthening exercises: include bodyweight and resistance exercises to
strengthen the muscles of the abdomen, low back, hips, and legs.
Isometric exercises involve contracting muscles without moving the joints.
Examples of isometric exercises include a plank or a bridge hold. These
exercises can help strengthen muscles when symptoms are more acute.
Isotonic exercises include the contraction of a muscle to resist a constant
load, such as resistance bands and weight training, to help increase muscle
strength through constant resistance to specific motions.
Functional retraining includes reintroducing movements, such as lifting, carrying,
and bending or squatting. The use of proper technique and healthy movement
patterns are incorporated to reduce pain and prevent re-injury.
Nerve glides (nerve mobilization) involves active or passive techniques on a
symptomatic nerve when it is placed into and out of tension to facilitate
movement and reduce symptoms.
Joint mobilization is a manual therapy technique in which the therapist applies
pressure to a joint to mobilize it and produce a therapeutic effect.
Joint manipulation is a manual technique in which the therapist applies a quick,
thrust force at the end range of motion of a joint to promote pain relief and
restore normal movement.
Dry needling is a technique in which a certified healthcare provider uses a small
needle to target a trigger point in a muscle. This technique is performed to
release hyper-irritable and/or hyper-contracted muscle tissue to reduce pain.
Muscle energy technique is a form of manual therapy that involves the patient
performing gentle muscle contractions in conjunction with the therapist moving
the painful joints through a specific range of motion. This technique may help
reduce pain and restore function.
Myofascial release and soft tissue mobilization include the therapist using their
hands or an instrument to mobilize the tissues in the lower back, hips, or legs to
treat fascial (underlying soft tissue) restrictions and decrease muscle tension or
spasm.
6. 5
Posture and Lifestyle Modifications for Sciatica:
In addition to physical therapy and exercise, committing to correct and
ergonomically supported posture while sitting, standing, and walking is essential
in treating and preventing sciatica. Daily routines, such as following ergonomically
safe lifting techniques and using good sleep postures are also important to follow.
Activity is more effective than bed rest:
When sciatica is severe, patients may find the pain hard to bear and may need to
rest a day or two. However, resting for more than a couple of days is generally not
advised, as prolonged rest or inactivity can increase pain and lead to
deconditioning. Regular movement is important to allow the flow of healing
nutrients to the injured structures that cause pain.
While physical therapy is usually elective, meaning that it is the individual’s
decision to participate or not, it is typically an essential component of resolving
the signs and symptoms and aiding in the long-term prevention of sciatica.
Physical Therapy Aids and Passive Techniques for Treating Sciatica:
Heat and Cold Packs
Heat packs may relieve pain by reducing muscle stiffness. The heat from these
packs helps dilate blood vessels, improve blood flow, and reduce muscle tension.
Using a heat pack may help promote relaxation and prepare for a physical therapy
appointment.
Cold packs may relieve pain by causing a numbing effect. These packs typically
constrict the blood vessels beneath the skin, helping to reduce pain and swelling.
Cold packs also slow down the chemical reactions that cause inflammation and
pain.
Transcutaneous Electric Nerve Stimulation (TENS)
A TENS unit applies electric current directly to sensory nerves, creating a tingling
sensation that may reduce the feeling of pain. When used in conjunction with
physical therapy, a TENS unit may help reduce acute lower back pain. This
reduction in pain may help improve a patient’s tolerance for active movements
that facilitate healing.
7. 6
Neuromuscular Electric Muscle Stimulation
Neuromuscular electrical stimulation using different wavelengths and amplitudes
is a therapeutic method of inducing muscle contraction. In certain cases, when
nerve involvement is severe and a patient is unable to voluntarily contract
muscles in their hip or leg, or muscle contraction is weak, electrical
stimulation can help facilitate these contractions to improve function.
Electric muscle stimulators are available in different forms, including machines
with electrodes that are taped to the body, or smaller devices that are placed
directly on the body. A computer or hand-held remote helps to adjust the
frequency and intensity of electric current that is passed.
Traction
Mechanical traction gently pulls the vertebrae apart to relieve the compression of
spinal tissues. In treating sciatica, traction of the lumbar spine can help:
Temporarily widen spaces in the intervertebral foramina to relieve
compression of the spinal nerves
Provide muscle stretch to relieve spasm
Relieve pressure on injured discs, reducing nerve symptoms
A therapist may apply traction manually or use mechanical traction, where the
patient lies on a table and is secured using a harness or straps. The therapist
usually determines the type and amount of force to be used. The tension may be
increased gradually and is usually followed by a period of relaxation.
M. traction
8. 7
References
1- Patrick C. A. J. Vroomen, Marc C. T. F. M. de Krom, Patty D. Slofstra, and J. Andre
Knottnerus. Conservative Treatment of Sciatica: A Systematic Review. Journal of Spinal
Disorders. December 2000. Vol. 13, No. 6, pp. 463–469.
2- Jean-Pierre Valat, Ste´phane Genevay, Marc Marty, Sylvie Rozenberg, Bart Koes.
Sciatica. Elsevier. Best Practice & Research Clinical Rheumatology 24 (2010) 241–252.
3- Margareta C Nordin, Federico Balagué. Exercise may be beneficial for patients with
chronic severe sciatica who would normally qualify for surgery. Evidence-Based
Medicine. 2012; 37:531–42.
4- Kim EJ, Choi YD, Lim CY, Kim KH, and Lee SD. Effect of heating and cooling combination
therapy on patients with chronic low back pain: study protocol for a randomized
controlled trial. Trials. 2015; 16:285.