The Impact of High Frequency Electrical Nerve Stimulation and Chiropractic Care on Sciatic Axonal Lesion Presenting as Painful Leg: Case Report
Condition: Sciatica Pain
MeSH terms: Sciatica
Study type: Observational

Summary: 
      To present an evidence-based case report on the prognosis of a pediatric patient with right
      sciatica and painful leg. A 5-year-old girl with limping gait, presented with right-sided
      buttock and lower extremity pain and numbness. There has been a history of trauma prior to
      this 18-month ago. Following clinical examination, she was found to have numbness along the
      entire length of her right leg, in addition to a little sensory disturbance, accompanied by
      weakening in that leg. There was a generalized loss in sensation to pinprick as well as light
      touch, but it was most noticeable above the right knee joint. The remaining of the clinical
      exam was normal.

      High frequency electrical stimulation was done for thirty minutes per day for five days a
      week for four consecutive weeks. The stimulator provides a biphasic current of 100 Hz
      frequency. The pulse duration was 200 msec with an (on-off). Stimulus mode (20sec
      stimulation, 20 sec pause). The maximal stimulation amplitude was 40 - 60 mA.
    

Detailed description: 
      A 5-year-old girl with limping gait, presented with right-sided buttock and lower extremity
      pain and numbness. There was a history of trauma preceding this eighteen months ago. There
      was diffuse decreased sensation to pinprick and light touch but mainly from above the right
      knee joint. The rest of the clinical examination was normal. The patient attended 20
      sessions, which were structured to include High-frequency transcutaneous neuromuscular
      electrical nerve stimulation (TENS), chiropractic care, strengthening exercise for hamstring
      and back muscle and gait training (figure 1). Electrical stimulation was performed for 30 min
      /day for five days a week for four consecutive weeks, 100 Hz frequency with pulse duration
      200 m sec with an (on-off) (20 sec stimulation, 20 sec pause) and maximum amplitude 40 - 60
      mA. Two electrodes were placed on the back at the level of L5, S1 lumber spine and the other
      two electrodes were placed along the course of sciatic nerve on the back of the thigh.
      Chiropractic treatment sessions (manual manipulation refers to a high-velocity, short lever
      arm thrust that is applied to abnormal vertebra with the goal of improving functionality,
      reducing nerve irritability and restoring range of motion in the back) were scheduled for one
      month with frequency 5 sessions per week. strengthening program was three sets, ten
      repetitions and rest period of 1-2 minutes for low intensity or low repetition activity
      started by 2-3 days a week, then increase to 3-5 days a week as the strength progresses,
      amount of resistance 40%-60% of one-repetition maximum (1 RM). Mirror imaging and verbal
      promoting, Balance training and coordination to encourage normal gait.

      EMG examination using concentric needle electrodes was carried bilaterally for the vastus
      medialis, tibialis anterior, extensor digitorum brevis and abductor halluces muscles and the
      right biceps femoris muscle. Motor conduction studies were carried out for both common
      peroneal, tibial and right main trunk of the right sciatic nerve.
    

Intervention name(s): TENS and Exercise
Intervention type(s): Other
Intervention description(s): High frequency electrical stimulation was done for thirty minutes per day for five days a week for four consecutive weeks. The stimulator provides a biphasic current of 100 Hz frequency. The pulse duration was 200 msec with an (on-off). Stimulus mode (20sec stimulation, 20 sec pause). The maximal stimulation amplitude was 40 - 60 mA
Observational model: Case-Only
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Children with sciatica nerve pain
      
Keywords: High frequency electrical stimulation; lumber spine; sciatic nerve; painful leg; gait training; chiropractic