Managing Radiculopathy During COVID-19

What can patients with cervical or lumbar radiculopathy (Sciatica) do to decrease their pain and improve their quality of life during these circumstances of COVID-19 pandemic?

Patients with radiculopathy either cervical or lumbar (also known as Sciatica) have mild to severe to extremely severe radicular pain going down from their spine into their arm or leg.  This pain may be associated with tingling or numbness.  This pain can be aggravated by activities.  

These patients are initially treated with a short period of rest, physical therapy and medication.  If they do not get relief, they can be treated with nerve root blocks or epidural injections.  When every treatment option fails or in patients who have weakness or neurological worsening, surgery to relieve the pressure from the nerve may be required to improve the symptoms as well as the quality of life.  

We are in difficult circumstances of the COVID-19 pandemic outbreak especially in New York and Long Island. There has been a suspension of all elective procedures, which include spine surgeries as well as epidural injections and nerve blocks for such patients. These patients have limited options for pain relief.  

Also considering the social distancing norms as well as the closure of offices, not many physical therapy offices are open. At the same time, patients may be reluctant to go to such places to avoid social contact and the risk of getting exposed to COVID disease.  

There are certain things patients can do at home to treat themselves:

• Patients should keep themselves active and avoid bed rest. Prolonged inactivity will lead to muscle atrophy and deconditioning of the body, which can aggravate the disease process as well as lead to secondary medical comorbidities/diseases. A short period of rest for a day or two may be helpful in patients who have acute symptoms or acute exacerbation of symptoms.
• Stretching of the spine, which includes the neck and the lower back is helpful.  Stretching of both lower extremities including the hip and the knee joint can be helpful in lumbar radiculopathy or sciatica.  Similarly stretching of both upper extremities including the shoulder and elbow joint can help in cervical radiculopathy.
• The use of anti-inflammatory medications in the form of naproxen or ibuprofen with or without Tylenol can be helpful in decreasing the pain.  If the pain is severe enough and not relieved by these medications, the patient can consult a physician to get a prescription of stronger pain medication or other medications. 
• Patients who have stable radiculopathy should also perform physical therapy. It is preferable to go for outpatient therapy in a safe environment. If that is not possible then they can do home physical therapy in the form of stretching and strengthening of the spine muscles or the core muscles.  These exercises usually involve abdominals, planks, lunges as well as many others.  
• The patient can use online resources to look for these exercises.  Yoga and Pilates along with other cardio exercises are good examples of such exercises. Exercises can make the patient sore but they should avoid doing exercises that cause the onset of pain.

Which patients should seek attention or consultation with the physician?

 

• Patients, whose pain, tingling and numbness are not controlled by usual over-the-counter medications, therapy should contact the physician to look for other options.
• Patients who are developing weakness in arms or hand or in their hip, knee or foot or patients who are worsening neurologically should seek urgent attention. These patients may need intervention to halt the neurological deficit and optimize recovery.

What are we doing to help such patients?

We do understand that in this tough time of COVID-19 pandemic, patients do not want to be out to avoid any social contact and avoid getting infected by COVID-19.  We also stand by the same norms of social distancing and are trying to treat our patients in their homes themselves. 

We at Complete Orthopedics, are open for new and follow-up patients. We provide online consultations via phone or other apps, so as to help these patients using nonsurgical approaches or modalities.  We are trying to have the patients cope during these uncertain times of COVID-19 pandemic and hope to improve their symptoms and quality of life.  

We also guide them through medications as well as physical therapy at home or outpatient as per their preference. Patients can be seen in the office if needed after the phone consult. We are performing surgeries that are urgent and emergent in nature.

What are the red flags for patients with cervical or lumbar pain and radiculopathy?

The patients who have back or neck pain and radiculopathy with one or more of these following conditions should seek medical attention as soon as possible.

1. Cancer, neoplasia or malignancy.
2. Unexplained weight loss of more than 10 pounds in the last 6 months.
3. Immunocompromised comorbidities like on chemotherapy or radiotherapy or having a disease like HIV or AIDs or being on prolonged corticosteroid therapy.
4. IV drug users.
5. Urinary tract infection.
6. Fever of more than 100 degrees centigrade.
7. Significant trauma from a fall or accident.
8. Bowel or bladder involvement in the form of incontinence or retention.
9. Weakness in the major joint of the arm or leg.