Use of imaging examination in physiotherapeutic decision making in patients with low back pain and leg pain related to the spine

Abstract

Introduction: Technological advances in radiology equipment has supported the continuous training of health professionals, making it necessary to adapt radiodiagnostic competencies to request imaging examinations and promote efficiency of patient care. Physiotherapists need to be aware of potencial differential diagnoses when treating more severe cases with signs of concern. Ultrasound imaging has proven to be a valuable tool for the Physiotherapist in clinical, research, and various fields of practice, in addition to contributing to the knowledge of the structural and functional characteristics of the peripheral nerve. Objective: The aim of the study was to illustrate the use of imaging examination resources in patients with low back pain and spine-related leg pain. Methods: Two case reports exemplify the involvement of the Physiotherapist in radiodiagnosis. The third study cross-sectionally analyzed the cross-sectional area (CSA), echogenicity index (ECO) and skin-to-nerve distance (SNd) of the sciatic nerve, using ultrasound imaging in 31 patients with probable neuropathic pain. Ultrasound measurement outcomes were compared between symptomatic and asymptomatic lower limbs, in three different positions of sciatic nerve tension. Results: The two case reports demonstrated the effective participation of the physiotherapist in clinical decision-making, with use appropriate criteria of radiodiagnostic in low back pain and spine-related leg pain. The observational study revealed no significant differences in the comparison of CSA, ECO and SNd measurements between symptomatic and asymptomatic sides. The position with extended knee and the ankle dorsiflexion showed smaller CSA of the symptomatic side’s sciatic nerve compared to the position with flexed knee and neutral ankle. Both sides presented a more superficial nerve position in the extended knee with ankle dorsiflexion compared to the extended knee without dorsiflexion position. Conclusion: Radiodiagnosis contributes to the identification of severe conditions of low back pain and spine-related leg pain. Ultrasound imaging measurements can contribute to the understanding of structural and functional changes in patients with neuropathic pain.