She is a 32-year-old European woman who has experienced severe pain in her left lower back and leg for two years.
She strained her left hamstring while training for yoga and heard a popping noise in the hamstring. She has been taking painkillers and seeing a physiotherapist but it has not improved. She could not walk normally for a whole year, especially on hills. Her doctor suggested she get a steroid injection.
She received the steroid injection in November last year. Afterward, she experienced severe left lower back pain that radiated to her left leg. She took sleeping pills and painkillers to relieve the pain. She consulted a neurologist and had four MRIs, but nothing was found. The specialist guessed that the nerve might have been bruised and damaged by the injection needle and advised her to wait for nerve recovery over two years. because she can not live and work normally, she does not want to wait, so her friend recommended me to her, and she wants to try acupuncture.
She is a little bit nervous and worries about the sequelae of nerve damage and her future.
Examination: Reflexes are normal, foot strength is normal, sensation in the legs is normal, and sensation in the lower back is normal. The straight leg raise test causes slight pain in the left hamstring and left lower back at 60-70 degrees. There is more tenderness in the left hip, and the pain radiates to the left leg.
I performed cupping and acupuncture, and she felt much better after the treatment. I suggested she relax, do regular exercises that I taught her, and engage in activities she can handle. I will continue to meet with the patient.
My opinion：
1, What caused her to have a concept of nerve damage?
First, she had a steroid injection and experienced lower back pain afterward. She never had lower back pain before, so she believes the injection is the cause.
Second, her lower back pain worsened progressively after the injection, causing her to walk with a limp. She couldn’t identify any other reason, so she attributed the pain to the injection.
Third, the neurologist suspected she might have nerve damage. However, the specialist did not perform a thorough neurological examination, such as testing reflexes, sensation, and motor function. especially, after the MRI, the specialist should explain to the patient that she did not have nerve damage.
2, This diagnosis of nerve damage has caused more harm to the patient than the disease itself.
In general, people believe that it is harder to recover from nerve damage than from muscle damage. It is also easier to experience aftereffects from nerve damage than from muscle damage, such as paralysis and chronic nerve pain. Therefore, she is under immense stress due to the nerve damage and will undergo many medical consultations, even if she is not working.
3, From my examination, I believe it should be a muscle injury, particularly involving the gluteus medius and gluteus minimus. She felt much better after my first treatment. Currently, her biggest problem is anxiety.
Her anxiety is called "iatrogenic anxiety." In other words, this refers to anxiety caused by a doctor's diagnosis, treatment, medication, or other medical actions.
We should explain her situation, emphasizing that the neurological examination was normal, the lower back pain was due to muscle issues, and it is easy to recover from this condition. Let her know that acupuncture is effective for both muscle and anxiety problems.
4, Education for her:
Doing regular exercises as I taught.
Learning how to move past the idea of nerve damage.
Engaging in activities she is capable of doing.
What are your thoughts on the medical case? Please share your thoughts with me.
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