First AD

Second AD

A 62-year-old man presents to your office with moderate to severe leg pain after playing 36 holes of golf over the weekend. After an extensive physical examination, you note the pain originates from the lumbar spine and radiates into his lower extremities. His back-related leg pain appears to be caused by nerve root involvement from disc herniation.

D. Spinal manipulation plus a home exercise program

Answer: D Spinal manipulation plus a home exercise program

Back-related leg pain can be a constellation of symptoms characterized by radiating pain originating from the lumbar spine and traveling into the proximal or distal lower extremity, with or without neurologic signs. Many conditions can lead to back-related leg pain, including disc herniation, progressive neurologic deficits, cauda equina syndrome, spinal fracture, spinal stenosis, surgical lumbar spine fusion, lumbar spine surgery, and chronic pain syndrome, as well as compression fractures, severe osteoporosis, and inflammatory or destructive tissue changes of the spine.

Most patients with back-related leg pain are treated with prescription medications and injections, but there is little to no evidence to support their use. Surgery is another common approach, although there is only some evidence for short-term effectiveness of surgery compared with less invasive treatments.

In a new study of nearly 200 patients with back-related leg pain, spinal manipulative therapy plus home exercise and advice provided more short-term improvement in pain and function than home exercise alone. Patients who received spinal manipulative therapy plus home exercise and advice had less leg pain, lower back pain, and disability after 12 weeks than those who received home exercise and advice alone.

Those differences were no longer significant at 1 year, but those who received the conservative combination therapy experienced more global improvement, higher satisfaction, and lower medication use.

Bronfort G, Hondras MA, Schulz CA, et al. 

Spinal manipulation and home exercise with advice for subacute and chronic back-related leg pain: a trial with adaptive allocation. 

  2014;161:381-391. doi:10.7326/M14-0006

Pain

A 62-year-old man has moderate to severe leg pain after playing 36 holes of golf. The pain originates from the lumbar spine and radiates into his lower extremities. What is the best course of treatment?

What Course to Take for Back-Related Leg Pain