Matthew Donovan, a taxi driver in his 40s presents with pain at the base of his lower spine.

Personal life:

He is married and has a son. He mentions that he sometimes has to lift heavy weights like suitcases.

Presenting complain:

Right side back pain, sharp pain in the lower back through his leg when he lifted a suitcase on Thursday.

History of presenting complain:

  • Onset: started about 10 years ago
  • Characteristics: continuous pain with prickling and burning sensations
  • Radiation: feels pain in his buttocks, right thigh, and numbness on the little toe
  • Exacerbating/Relieving factors: pain gets worse during work while lifting weights
    and while sitting. he also feels intense pain while coughing or sneezing. Pain
    relieves when lying on a firm surface or when standing.
  • Pain Severity: 7.5 on a VAS scale
  • No relevant past medical or surgical history.
  • No relevant drug history.

Family history:

Father experienced back pain, brothers are healthy.

Physical Examination:

  • All vitals within normal limits.
  • Walking test: claudication
  • Posture: bent forward with a lateral right tilt.
  • Spine palpation: hardness of lower back muscles.
  • Reduced and painful flexion, extension and lateral flexion.
  • Reduced sensation in the little toe.
  • Foot movements: weak eversion, cannot walk on tiptoes.
  • Lasague sign positive (40 ̊)
  • Wassrmann negative, Babinsky positive.

Diagnosis:

Sciatica

Treatment and management:

  • Avoid overloading back
  • 2 weeks medical leave
  • Physiotherapy
  • NSAIDs - if the pain is unbearable and no more than 3 tabs

Visit 2:

The patient says he feels better, however, is still experiencing some pain in the lower back and right leg when sitting.


Pain Severity: 3 -3.5 on the VAS.

Physical exam:


  • All vital signs within normal limits.
  • Walking: Claudication
  • Posture: bent forward with a lateral right tilt.
  • Improved spine movement.
  • Recovered right ankle reflex.
  • Improved Lasague sign (80 ̊)
  • Babinski and Wassermann negative.

Management:

  • Continue NSAID therapy.
  • Follow an exercise program.