Scribe Review

Good morning, Michael. How are you doing? I've been better, Doc. My lower back is killing me. I hurt my back at work three days ago. What happened? I was unloading a truck Monday afternoon. I twisted while lifting a 50-pound box and felt a sharp pain immediately. It was much worse the next morning. Where does it hurt? Across my lower back and down my left leg to about the knee. It's a 7 out of 10 today. Sitting and bending forward are the worst. Standing and walking feel better, but rolling over keeps waking me up at night. Any numbness, weakness, or trouble controlling your bladder or bowels? No. Just the pain. Have you injured your back before? I had a similar problem two years ago, but it went away with care. How's the family doing otherwise? Pretty good. My son just started football practice, so he thinks he's going to be the next NFL superstar. Let him enjoy that confidence while he still has it. Is he a Steelers fan? Unfortunately, yes. That sounds like responsible parenting to me. What are you taking right now? Ibuprofen, 800 mg twice a day. I also take lisinopril, 10 mg daily, for my blood pressure, and a multivitamin. Alright, stand up for me. You're shifting your weight away from the left side. Bend forward as far as you comfortably can. That's about it. Your lumbar range of motion is decreased. Forward flexion is roughly half of normal. Now lean backward. That hurts too. Extension is limited to about 10 degrees. Bend to the left. That sends the pain down my leg. Okay, left side bending reproduces the leg pain. Lie on your back. I'm going to raise each leg while keeping the knee straight. The right side is negative. Tell me when you feel your usual pain on the left. Right there. That starts at about 45 degrees, so the left straight leg raise is positive. Your leg strength and reflexes are still normal. Roll onto your stomach for me. You are tender at L4 and L5 on both sides, there is motion restriction at both levels, and the surrounding muscles are tight and in spasm. That matches what I'm feeling. I figured carrying groceries for my wife would prepare me for lifting boxes. Apparently, the groceries won this round. This looks like an acute lumbar strain with radiculopathy from the lifting injury. The radiating pain suggests nerve irritation, but there is no current loss of strength or reflexes. Because you still have joint restrictions, muscle spasms, and leg symptoms, continued care is appropriate. Today I'll do a chiropractic adjustment using the diversified technique at L4 and L5 on both sides, and perform soft tissue therapy for the muscle spasm. Afterward, use ice for 15 minutes three or four times a day with a towel between the ice and your skin. Put a pillow under your knees when sleeping on your back. Avoid heavy lifting for one week and keep anything you lift under 20 pounds. When driving, stop and stretch at least once an hour. So I'm officially off box duty? For one week, yes. I can write that down if your coworkers need proof. Please do. They'll think I'm trying to get out of work. We'll follow up in one week and repeat the straight leg raise. If you develop weakness, groin numbness, or bladder or bowel problems, seek immediate medical care. Otherwise, take it easy and let your son handle the football drills for now.