Physiotherapy Management in Ischialgia Conditions

MODULE 5 PHYSIOTHERAPY MANAGEMENT IN ISCHIALGIA CONDITIONS Ischialgia is a condition where there is pain, weakness, burning, and tingling along the back of the leg (along the ischiadicus nerve) caused by compression or accident. Ischialgia has many terms such as Lumbosacral Radicular Syndrome, pain in the nerve roots, and nerve root entrapment. Ischialgia is usually related to age and a history of trauma. In this condition there are complaints of pain, limited LGS, and decreased muscle strength. 1. Physiotherapy Problems a. Anatomical Impairment - These are various problems that attack body functions or body structures, such as significant deviation or reduction/loss. - Namely: There is pain in the lower back and radiates to the right leg. Often feel tingling from the waist area to the toes. b. Activity limitations - Is difficulty in carrying out or completing activities. - Namely: Because the patient is a Muslim, so when performing prayers (especially bowing and prostrating) the patient experiences difficulties. The patient also experienced difficulties with the toilet because he could not squat. c. Participation Restricted - These are problems experienced in involvement in everyday life. - Namely: The patient cannot sit or stand for a long time when cleaning the house and cannot walk long distances. Patients also experience difficultiesin terms of picking up objects that are in high places and picking up heavy objects 2. Physiotherapy Intervention • MWD(MICRO WIVE DIATERMY) • INTERFERENCE • FRICTION • PASSIVE AND ACTIVE STRETCHING A. Equipment Required 1. Mattress 2. Bed Treatment 3. MWD 4. Electrical Stimulation/TENS B. Practical Activities 1. MWD Objective : Increases cell metabolism, improves blood circulation and increases tissue elasticity. Work procedures: After the preparation of the equipment and patient has been completed, therapy can begin. Place the condenser just above the piriformis muscle of the right leg, the distance between the condenser and the patient's body is ± 5 cm. The intensity was increased slowly according to the patient's tolerance, using continuous current, over a period of 10 minutes. And physiotherapy must continue to control the patient's condition during therapy. Dosage:2x/week - Frequency:MHz - Intensity:coplanar - Technique - Time:10 minutes 2. INTERFERENCE Objective: Reduces pain and stimulates nerve tissue Technique: The patient's position is to sleep on his back, the pad is placed on the lumbar spine and M. Piriformis Dosage:: coplanar with 2 pads - Frequency: 2 x a week - Intensity: 70 MHz - Technique - Time: 10 minutes 3. FRICTION Objective: To reduce spasm in the piriformis muscle Technique: The patient lies on his stomach on the bed and the physiotherapist is next to the bed.then Ft performs Friction usingthumb on M. Piriformis Dose: 2x/week Frequency: patient tolerance Intensity: transversal traction Time: 15-30x repetitions 4. ACTIVE STRETCHING Objective: To reduce spasm in M. Piriformis and increase muscle flexibility Technique: Position the patient supine then flex the right hip and knee closercontralateral chest. Dose : Frequency: 2 x a week Intensity: Maximum elongation Technique: active stretching Time: 8 x repetitions 5. PASSIVE STRETCHING Objective: To reduce spasm in M. Piriformis and increase muscle flexibility Implementation: • The position of the patient is lying on his back, the therapist is next to the patient on his sidecontralateralof the involved limb. • Then movementflexionAndadduct the hipaccompaniedinternal hip rotationusing both hands of the therapist. Dose: Frequency: 2 x a week Intensity: Maximum elongation Technique: Passive stretching Time: 8 x repetitions 6. McKenzie Exercise Patient position: lying on his stomach. Implementation Position: Prone position with arms beside the body and head facing to one side . Staying in this position, take a deep breath and then relax completely for two or three minutes.Then the patient is asked to perform trunk extension movements slowly with support on the patient's two elbows. Then the patient is asked to perform trunk extension movements slowly with support on both of the patient's hands.Keep your pelvis, hips and legs relaxed and allow your lower back to arch. After maintaining this position for two or three seconds, the patient again lowers himself to the starting position. Repeat this cycle each time, gradually lifting your shoulders slightly higher, until your arms are as straight as possible. Once your arms are straight, hold for a second or two. Arch can be maintained for more than a second or two if the pain is reduced or centralized.When used in the treatment of pain or stiffness, the exercises should be performed ten times per session, and sessions should be performed six to eight times in one day.