The Impact of High Frequency Electrical Nerve Stimulation and Chiropractic Care on Sciatic Axonal Lesion Presenting as Painful Leg: Case Report

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.

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.

Eligibility Criteria:
Inclusion Criteria:

* Sciatica nerve pain
* Able to attend 20 sessions
* Children age 5-10 years

Exclusion Criteria:

* Chronic pain
* Pain in the spine other than Sciatica