Dr Abdelrahman Taha

Had an interesting lecture yesterday in our Neurology Department about therapeutic positioning. Among the research presented, I came across some studies discussing cervical and lumbar radicular syndrome that really caught my attention. While I haven't gone through the entire research to fully evaluate it, it seems promising and valuable to share. In addition to the research by Aly M M. and his colleagues (https://www.researchgate.net/profile/Mahmoud-Elrazzy), we also have significant studies conducted by Dr. Badr M. et al. (https://www.researchgate.net/profile/Mohamed-Badr-17), as well as Dr. Sabbahi M. A. et al. (https://www.researchgate.net/profile/Mohamed-Sabbahi?_tp=eyJjb250ZXh0Ijp7ImZpcnN0UGFnZSI6InB1YmxpY2F0aW9uIiwicGFnZSI6InByb2ZpbGUiLCJwcmV2aW91c1BhZ2UiOiJwdWJsaWNhdGlvbiJ9fQ)

I’m proud to highlight this work coming from the Faculty of Physical Therapy at Cairo University. It’s great to see how our research can contribute to improving the understanding and treatment of radicular syndromes.

I’m excited to introduce my latest webinar: "Understanding Spinal Radicular Syndromes".

🚨 Less than 24 hours left to register! This webinar is specifically designed for physiotherapists, as well as any medical professionals who deal with or see patients with spine-related radicular syndromes.

💡 Wishing you an enjoyable and informative webinar. See you tomorrow, and best of luck to everyone!

Here are some snapshots from my presentation

📅 Date: 11/10/2024
🕒 Time: 9:00 pm
💻 Platform: Google Meet

What you’ll learn:
1. Clarify the terminology: Understand radicular syndrome and how it differs from other spinal conditions.
2. Most common causes: Explore the primary causes, including disc herniation and spinal stenosis.
3. Clinical diagnosis: Learn how to diagnose radicular syndrome through patient history and physical exams.
4. Treatment options: Review conservative and surgical interventions to manage this syndrome effectively.

This session is ideal for medical professionals looking to deepen their knowledge of spinal conditions and improve their diagnostic and treatment skills.

Register now and enhance your understanding of spinal radicular syndrome!

Up to 60% of patients with low back pain (LBP) also suffer from leg pain, which can lead to worse health outcomes. In some cases, this leg pain is caused by nerve root involvement, commonly known as 'sciatica.' While some patients with sciatica experience nociceptive pain, others may develop neuropathic pain, which is often described as burning, tingling, or electric shock-like sensations. Neuropathic pain tends to worsen both the discomfort and disability associated with sciatica.

According to the NICE guidelines, non-invasive treatments, such as medication and physiotherapy, should be tried before considering invasive options like surgery. The role of natural recovery, corticosteroid treatments (usually via epidural injection), and surgical decompression are well-accepted in spinal surgery. However, opinions differ widely regarding the timing and effectiveness of physiotherapy interventions, as well as post-surgical rehabilitation, with considerable variability among surgeons. Unfortunately, the initial treatment for sciatica is often ineffective, and about one-third of patients develop chronic pain and disability lasting over a year.

A widely recommended protocol developed by Hans van Helvoirt and colleagues suggests the following:

1. van Helvoirt H, Apeldoorn AT, Knol DL, et al. Transforaminal epidural steroid injections influence Mechanical Diagnosis and Therapy (MDT) pain response classification in candidates for lumbar herniated disc surgery. J Back Musculoskelet Rehabil 2016.

2. van Helvoirt H, Apeldoorn AT, Ostelo RW, et al. Transforaminal Epidural Steroid Injections Followed by Mechanical Diagnosis and Therapy to Prevent Surgery for Lumbar Disc Herniation. Pain Med 2014.

For patients with severe radicular symptoms who do not improve after an epidural steroid injection, a discectomy is often the next beneficial step. Using epidural injections as part of the decision-making process for referral to surgical evaluation can be highly effective.

If you’d like to learn more, join my free online session: Understanding Spinal Radicular Syndrome

🗓 Date: 11/10/2024
🕒 Time: 9:00 pm
💻 Platform: Google meet.

🔗 for reservation and more information Send massages on Whatsapp: 01061910491

Up to 60% of patients with low back pain (LBP) also suffer from leg pain, which can lead to worse health outcomes. In some cases, this leg pain is caused by nerve root involvement, commonly known as 'sciatica.' While some patients with sciatica experience nociceptive pain, others may develop neuropathic pain, which is often described as burning, tingling, or electric shock-like sensations. Neuropathic pain tends to worsen both the discomfort and disability associated with sciatica.

According to the NICE guidelines, non-invasive treatments, such as medication and physiotherapy, should be tried before considering invasive options like surgery. The role of natural recovery, corticosteroid treatments (usually via epidural injection), and surgical decompression are well-accepted in spinal surgery. However, opinions differ widely regarding the timing and effectiveness of physiotherapy interventions, as well as post-surgical rehabilitation, with considerable variability among surgeons. Unfortunately, the initial treatment for sciatica is often ineffective, and about one-third of patients develop chronic pain and disability lasting over a year.

A widely recommended protocol developed by Hans van Helvoirt and colleagues suggests the following:

1. van Helvoirt H, Apeldoorn AT, Knol DL, et al. Transforaminal epidural steroid injections influence Mechanical Diagnosis and Therapy (MDT) pain response classification in candidates for lumbar herniated disc surgery. J Back Musculoskelet Rehabil 2016.

2. van Helvoirt H, Apeldoorn AT, Ostelo RW, et al. Transforaminal Epidural Steroid Injections Followed by Mechanical Diagnosis and Therapy to Prevent Surgery for Lumbar Disc Herniation. Pain Med 2014.

For patients with severe radicular symptoms who do not improve after an epidural steroid injection, a discectomy is often the next beneficial step. Using epidural injections as part of the decision-making process for referral to surgical evaluation can be highly effective.

If you’d like to learn more, join my free online session at Physio speaker on October 11th at 9:00 PM.

A 21-year-old male with a history of right hip labral repair (endoscopic) presented with stabbing low back pain (LBP) and intermittent posterior thigh pain (above the knee) for the past seven months. His condition had worsened without any apparent cause. The patient reported the following pain levels on the Visual Analog Scale (VAS): best "5/10," worst "8/10," and current "7/10." His Oswestry Disability Index (ODI) was 44%. The pain was aggravated by bending and sitting, while lying prone and rubbing his back provided brief relief. His sleep was disrupted due to pain. The examination revealed the following:
🛑 Poor sitting and standing posture with accentuated lumbar lordosis.
🛑 Pain at the end range of flexion and when returning from full flexion to extension (painful arc), along with significant loss of extension and more pain with extension than flexion.
🛑 Positive prone instability test.
🛑 Repeated Movement (RM) assessment:
- Repeated Extension in Standing (EIS) and Extension in Lying (EIL) caused an increase in his familiar symptoms, and the patient reported worsening after testing. Additionally, 5 minutes of lying prone in extension worsened both mechanical and symptomatic baseline presentations.
- Sustained Flexion in Lying (FIL) led to significant improvement in baseline symptoms.
- Repeated FIL (30 reps) resulted in further improvement in pain, flexion range of motion (ROM), and the ability to return to standing from flexion, although there was no improvement in extension ROM.
- Repeated FIL with therapist overpressure (20 reps) showed the same improvements as repeated FIL, along with a marked increase in extension ROM.

🛑 Clinical learning points:

👉 Current evidence suggests that not all individuals with lumbar derangement require extension movements. A small percentage have a flexion directional preference (Hefford, 2008; Long et al., 2004). In fact, over 10% of those with a directional preference have a flexion preference rather than an extension preference (Donelson et al., 1991).

👉 This patient with LBP, classified as having anterior derangement syndrome, showed rapid aggravation with sustained, but not repeated, mechanical loading in the direction of lumbar extension and rapid improvement with repeated lumbar flexion.

👉 When expected responses are not achieved, it may be necessary to adjust sequentially: (1) the amount of force during mechanical loading, (2) the starting position of mechanical loading (e.g., standing, sitting, lying), (3) the direction of mechanical loading, and (4) subgroup classifications (McKenzie & May, 2003). This patient required several force modifications before achieving a directional preference and full symptom resolution. Failure to explore all force alternatives and loading strategies may reduce the effectiveness of this treatment method.

👉 The McKenzie RM testing system is recommended for identifying spinal pain subgroups who are rapid responders, as supported by multiple guidelines.
References:
Donelson R, Grant W, Kamps C, et al. Pain response to sagittal end-range spinal motion: a multi-centered, prospective, randomized trial. Spine. 1991;16(suppl):S206–S212.
Greer B, Tranquillo J, Maccio J. Flexion Directional Preference in a Patient with Low Back Pain, Utilizing Mechanical Diagnosis and Therapy: A Case Report. JOSPT Cases, 2(1):44–49, 2022.
Hefford C. Mechanical Diagnosis and Therapy for low back pain. 2008.
Long A, Donelson R, Fung T. Does it matter which exercise? A randomized control trial of flexion versus extension exercises in the treatment of acute low back pain. Spine. 2004;29:2593–602.
May S, Rosedale R. A case of a potential manipulation responder whose back pain resolved with flexion exercises. J Manipulative Physiol Ther. 2007 Sep;30(7):539-42.
McKenzie R, May S. The Lumbar Spine: Mechanical Diagnosis and Therapy (2nd ed.). Waikenae: Spinal Publications New Zealand Ltd., 2003.
Takasaki H PT, PhD, May S PT, PhD. Concerns related to the accurate identification of anterior derangement syndrome in mechanical diagnosis and therapy for low back pain: A case report. Physiother Theory Pract. 2020 Apr;36(4):533-541.

🧠 Dive into cervical Anatomy | Essential for Understanding Neuroanatomy

📍 Overview: The cervical is central to our body's function, both structurally and neurologically. Studying its anatomy, particularly the cervical regions, is crucial for grasping how the body moves and responds to pain or injury.

📍 Relevance to the Medical Field: Understanding the anatomy of the cervical is fundamental for all healthcare professionals, particularly physiotherapists. the cervical spine's complexity demands attention due to its role in neck mobility and its direct link to the brain.

📍 Conclusion:
1. Mastery of cervical anatomy aids in accurate diagnosis.
2. Cervical spine knowledge helps manage common pain conditions.
3. Physiotherapists benefit from a deeper understanding of nerve root involvement.
4.It shapes better treatment plans for radicular syndromes.
5.Applying anatomy helps in personalized, effective patient care.
For more insights, check out these detailed explorations of the cervical spine:

*Journey into the cervical spine | A primer on neuroanatomy:
https://www.orthopaedicmanipulation.com/journey-into-the-cervical-spine/

*Journey into the upper cervical segments | A primer on neuroanatomy:
https://www.orthopaedicmanipulation.com/journey-into-the-upper-cervical-segments/

🧠 Dive into Lumbar Anatomy | Essential for Understanding Neuroanatomy

📍 Overview: The Lumbar is central to our body's function, both structurally and neurologically. Studying its anatomy, particularly the lumbar region, is crucial for grasping how the body moves and responds to pain or injury.

📍 Relevance to the Medical Field: Understanding the anatomy of the Lumbar is fundamental for all healthcare professionals, particularly physiotherapists. The frequent involvement of lower lumbar segments in disc problems explains many cases of back pain.

📍 Conclusion:
1. Mastery of Lumbar anatomy aids in accurate diagnosis.
2. Lumbar spine knowledge helps manage common pain conditions.
3. Physiotherapists benefit from a deeper understanding of nerve root involvement.
4.It shapes better treatment plans for radicular syndromes.
5.Applying anatomy helps in personalized, effective patient care.
For more insights, check out these detailed explorations of the lumbar spine:

*Journey into the lumbar spine | A primer on neuroanatomy:
https://www.orthopaedicmanipulation.com/journey-into-the-lumbar-spine/

*Anatomical explanation | Why are upper lumbar nerve roots less frequently affected by disc problems, while lower lumbar segments are more frequently involved?:
https://www.orthopaedicmanipulation.com/why-are-upper-lumbar-nerve-roots-less-frequently-affected-by-disc-problems-while-lower-lumbar-segments-are-more-frequently-involved/

🧠 Dive into Spine Anatomy | Essential for Understanding Neuroanatomy

📍 Overview: The spine is central to our body's function, both structurally and neurologically. Studying its anatomy, particularly the lumbar and cervical regions, is crucial for grasping how the body moves and responds to pain or injury.

📍 Relevance to the Medical Field: Understanding the anatomy of the spine is fundamental for all healthcare professionals, particularly physiotherapists. The frequent involvement of lower lumbar segments in disc problems explains many cases of back pain. At the same time, the cervical spine's complexity demands attention due to its role in neck mobility and its direct link to the brain.

📍 Conclusion:
1. Mastery of spinal anatomy aids in accurate diagnosis.
2. Lumbar and cervical spine knowledge helps manage common pain conditions.
3. Physiotherapists benefit from a deeper understanding of nerve root involvement.
4.It shapes better treatment plans for radicular syndromes.
5.Applying anatomy helps in personalized, effective patient care.
For more insights, check out these detailed explorations of the lumbar and cervical spine:

👉 Lumbar Anatomy:

*Journey into the lumbar spine | A primer on neuroanatomy:
https://www.orthopaedicmanipulation.com/journey-into-the-lumbar-spine/

*Anatomical explanation | Why are upper lumbar nerve roots less frequently affected by disc problems, while lower lumbar segments are more frequently involved?:
https://www.orthopaedicmanipulation.com/why-are-upper-lumbar-nerve-roots-less-frequently-affected-by-disc-problems-while-lower-lumbar-segments-are-more-frequently-involved/

👉 Cervical Anatomy:

*Journey into the cervical spine | A primer on neuroanatomy:
https://www.orthopaedicmanipulation.com/journey-into-the-cervical-spine/

*Journey into the upper cervical segments | A primer on neuroanatomy:
https://www.orthopaedicmanipulation.com/journey-into-the-upper-cervical-segments/

📢 Join My Online Lecture: Understanding Spinal Radicular Syndrome

I'm excited to invite you to my upcoming online lecture on Understanding Spinal Radicular Syndrome, where I’ll be sharing valuable insights into this complex condition 🧠💡

🗓 Date: 11/10/2024
🕒 Time: 9:00 pm
💻 Platform: Google meet.

What you’ll learn:

1. Clarify the terminology: Understand radicular syndrome and how it differs from other spinal conditions.

2. Most common causes: Explore the primary causes, including disc herniation and spinal stenosis.

3. Clinical diagnosis: Learn how to diagnose radicular syndrome through patient history and physical exams.

4. Treatment options: Review conservative and surgical interventions to manage this syndrome effectively.

This session is ideal for medical professionals looking to deepen their knowledge of spinal conditions and improve their diagnostic and treatment skills.

Register now and enhance your understanding of spinal radicular syndrome!

🔗 for reservation and more information Send massages on Whatsapp: 01061910491

🔗 join telegram group: https://t.me/+iJIQTcxiapNhNWI0

Did you know that physical therapists in the U.S. weren’t always able to diagnose patients? 🤔

Initially, they worked only under physicians' orders. But over the years, as they gained more expertise and faced more complex cases, PTs started taking on diagnostic roles. Today, they can independently evaluate and treat patients, thanks to advances in education and changes in laws. This shift highlights the growing recognition of PTs as crucial healthcare providers.
Highly recommended paper 📜

🚨 Low Back Pain: It's More Than Just the Spine! 🚨

As healthcare professionals, we often focus on spinal causes when diagnosing low back pain, but there's so much more beneath the surface. From renal disease to endometriosis, tumors, and infections—non-spinal causes are often overlooked, yet crucial to accurate diagnosis and treatment.

I've just published a detailed blog that delves into these complex causes. Understanding them can make a real difference in patient care. I invite you to read it and share your thoughts!

👉link to the blog:
https://www.orthopaedicmanipulation.com/unraveling-the-complex-causes-of-low-back-pain-beyond-the-spine/

Let's broaden our approach to LBP and help our patients better! 💪

🧠 Comprehensive Overview of Herniated Disc Localization, Morphology, and Migration patterns 🧠

As physiotherapists and medical professionals, staying updated on disc morphology and classification is crucial for effective patient care. Here's a quick overview of some essential points:

🔹Normal vs. Bulging vs. Herniated Discs
- Learn the critical differences between normal discs, bulging, and herniated discs to ensure precise diagnosis and management.

🔹Localization Matters
- Did you know that the subarticular region is the most common site for disc herniations?
Understanding the specific localization helps in identifying the root cause of pain.

🔹Central Disc Herniation & Cauda Equina Syndrome
- Although rare, central disc herniations are the leading cause of Cauda Equina Syndrome—a condition we must never overlook.

🔹Migrated Disc Fragments
- Disc fragments often migrate downward more than upward, affecting clinical presentation and treatment approaches.

For a deeper dive into the latest research and classification systems (link: https://www.orthopaedicmanipulation.com/comprehensive-overview-of-herniated-disc-localization-morphology-and-migration-patterns/), understanding these nuances is key to improving patient outcomes.

📚 Stay informed. Keep learning. 📚

Review case (https://www.facebook.com/share/p/AzM4zCPhP6JgrJx3/?mibextid=oFDknk)

After about 1 month (from 9/7/2024 to 13/8/2024) of Extension-based program & core-based training, reported that:
- pain become intermittent in center of back, but can't localize or describe it's exact location.
- frequency of pain become better.
- NAS = 2/10.
- ODI = 15% (minimal disability).
- symptomatic response to treatment & with repeated movement = better.
- patient reported 85% improvement since initial assessment at 9/7/2024. & summarize overall process as good.
- patient classification as chronic discogenic back pain with movement incoordination deficit is confirmed.

Patient initial presentation can predict the overall improvement in follow up sessions as patients who responded to extension based program have more favourable outcome (Clare HA, Adams R, Maher CG. 2007; Long A, May 5, Fung T. 2008; Gregg 2014). after that reassessment I decided to follow up 1 session every 2 weeks.

References:
- Clare HA, Adams R, Maher CG (2007). Construct validity of lumbar extension measures in McKenzie's derangement syndrome. Manual Therapy 12.328-334.
- Gregg C, McIntosh G, Hall H, et al. Prognostic factors associated with low back pain outcomes J Prim Health Care 2014;6;1:23-30.
- Long A, May 5, Fung T (2008). The comparative prognostic value of directional preference and centralization: a useful tool for front-line clinicians? J Manual Manip Thera 16.248-254.