Often in our practice we see patients with back pain, chronic tight hamstrings and/or glut pain. In many instances the patient will constantly stretch their legs only to have short term relief. Usually in this type of cases we will find that in fact the patient will have one or two things:
1. a disc bulge/herniation - often a broad posterior herniation
2. a pars defect/fracture - whether congenital or acquired
3. or both 1 and 2
Management of this patients is often difficult because conservative care often offers only temporary relief, and the pain or discomfort level may not be indicative of a surgical intervention. Diagnostic imaging is usually necessary to fully identify the potential cause of the problem which will include x-rays, MRI's, CT's and NCVs.
Treatment protocol will consist initially of conservative care including spinal chiropractic alignment, core strengthening and passive modalities such as ultrasound and electrical muscle stimulation. Another helpful technique may be spinal decompression.
If conservative care fails, one can try a variety of minimally invasive procedures such as epidurals, nerve blocks and prolotherapy.
A team approach is helpful to the patient which should include a chiropractor, neurosurgeon and a physical therapist.