Acute Low Back Pain in the Emergency Department

The physical therapist as a musculoskeletal specialist in the emergency department

Because patients with musculoskeletal injuries commonly seek intervention in the emergency department (ED), it has been proposed that practitioners with expertise in musculoskeletal practice can be of benefit in this setting. This clinical commentary describes the rationale for utilizing physical therapists as musculoskeletal specialists in the ED. Evidence indicates that physical therapists have the knowledge and skills to provide such expertise. Literature describing ED practice suggests that the management of patients with musculoskeletal conditions would be improved through the consistent integration of evaluation and treatment principles associated with physical therapy practice. Furthermore, early access to physical therapy, as can be provided in the ED setting, has the potential to positively influence patient recovery. Based on prior research and recent evolution of practice, further consideration of physical therapists as consultants in the ED is warranted, and, therefore, additional dialogue on the subject should be encouraged.

Physical assessment of lower extremity radiculopathy and sciatica

OBJECTIVE

The purpose is to describe active and passive physical maneuvers that provoke or alleviate lumbosacral radiculopathy and/or sciatica to demonstrate how these maneuvers function in common orthopedic and neurological tests/signs.

METHODS

Descriptions of the maneuvers and their countermaneuvers are provided to establish an understanding of their mechanisms and influence on lumbosacral nerve roots and the sciatic nerve. Common tests and signs for lower extremity radiculopathy and sciatica are described to demonstrate the clinical application of the maneuvers. Combinations of common tests are also offered to improve examination efficiency.

RESULTS

Understanding how each maneuver contributes individually or in combination with standard tests will enhance the reader's examination skills.

CONCLUSION

Improved examination skills lead to improved diagnosis and differential diagnosis of lower extremity radiculopathy and sciatica.