You’ve probably heard the phrases “slipped disk” or “pinched nerve” before. What happens is that the main nerves exiting the spinal column get pushed on by swelling tissue or a disk or disk matter. These, and other, nerves are vulnerable when they go through small spaces but have little soft tissue protection. So, if a nerve gets pinched by a piece of disc material or bit of vertebra, wherever that nerve goes you are likely to feel pain or numbness all along it. For example, we see a lot of injuries at the L3-L4, L-4-L5, and L5-S1 areas of the low back. These refer to the 3rd, 4th and 5th vertebrae in the lumbar spine (your low back) and the 1st vertebra in the sacral spine (your tailbone). The nerves involved here go down the legs. If you have burning pain down the middle of the back of your legs you may well have an injury to the S1 nerve. Similarly, if the sole of your foot and your toes are numb you may have an injury to your L5 nerve. When you talk to a doctor you need to be clear on where you hurt and when. If the pain is strictly in your back/buttocks and not down your legs be clear about this. On the other hand if the pain extends down your legs it will help your doctor if you can be clear and specific about where precisely it hurts.
Category: Workers’ Compensation
I don’t think the doctor is really paying attention to me…he just taps my knees and ankles and a few other things.
It would be nice if a doctor could stop and explain everything he is doing and examining while he was in the process of doing the examination. Unfortunately in this day and age when a doctor may be seeing dozens of patients a day he may not have time, or take the time, to do so.
We’re lawyers, not physicians or doctors, but after having read thousands of pages of medical records here’s an educated guess as to what the doctor is doing. Damage to the sciatic nerve, the main nerve exiting the spinal column in the low back and going down the legs, will often result in certain abnormalities which a doctor can spot while doing a physical examination. These include weakness when bending the knee, loss of the ability to rotate your foot up or down (thus walking on your toes or heels), loss of reflexes to the knee and ankle, difficulty bending forward or backward at the waist, and pain when lifting your straightened leg up off the exam table.
In this situation what the doctor is looking for is objective evidence to confirm or supplement your subjective reports of an injury and subsequent pain.
The goal of physical therapy, or PT, is to improve your movement, improve your physical functioning, and reduce pain. It is not a stall that a doctor necessarily insists on prior to a surgery – although it may seem like it some times.
Why is that? A lot of injuries can be repaired with physical therapy. It’s non-invasive, and although it can cause some temporary pain and swelling, and is effective in some situations. Many people are cured with physical therapy and are quite happy. Some injuries, though, require much more. It’s pretty common, however, that your doctor will order PT prior to recommending surgery. If you’re one of the lucky ones whose problems are solved with PT then you’re good with this. If you’re one of the ones who requires surgery… well PT can be frustrating because you feel like it’s a waste of time. In most situations there isn’t any harm in trying the conservative approach first but it can be frustrating.
Following a surgery PT is often necessary to help rebuild your strength and prepare you for a return to work. And while PT often hurts during and afterwards you’ll likely hear your therapist explain that there is a difference between “hurt” and “harm.” As irritating as that is when you hurt… it’s true.
The insurance company can assign a “nurse case manager” or a “rehabilitation nurse” to be a go-between with you, the doctor, and the adjuster. In theory this is fine. However, many, if not most, of these nurses work almost exclusively for the insurance companies. In fact some of them work in cubicles right next to the adjuster. In that kind of situation it’s hard not to believe that the nurse is going to put your interests ahead of those of her employer. We aren’t saying all nurses are bad people – they aren’t. But human nature is… well, human nature. We’ve seen documented cases of nurses altering Functional Capacities results, turning a blind eye to known inaccuracies in job descriptions, even coordinating schedules with private investigators.
Maximum Medical Improvement, or MMI, is the point where a doctor says you are as good as you’re going to get. In all honesty you’ll probably get a bit better over time, and there’s always a chance you’ll decline some, but it’s when the doctor thinks he’s done what he can do and it’s time to cut you loose. At that point, you are eligible to a permanent award based on either loss of earnings or permanent injury to you. In an accepted claim this is the point where an adjuster will want to close her file. Even if you’ve not had an attorney up to that point it’s an excellent time to give us a call and get us to walk you through your options. If there’s a single point in your case where the adjuster has no obligation to explain all of your legal options to you this is it. What she’ll propose is quite likely just a fraction of what you could receive. Every case is different but yours is certainly worth a thirty-minute phone call. We don’t charge for this and you’ll have a far better idea of what your claim is actually worth.