Dr Abdelrahman Taha

03/01/2026

When Buttock Pain Isn’t "Just" Sciatica: A Rare Vascular Catch

In the world of sports medicine and orthopedics, we often attribute buttock claudication to lumbar disc issues or piriformis syndrome. However, a fascinating case report reminds us that vascular pathology can hide in plain sight—even when pulses appear normal.

The Case at a Glance
A 79-year-old golfer presented with right-sided buttock pain that consistently appeared after walking 200m. Despite his symptoms:
- Femoral pulses were present.
- ABI (Ankle-Brachial Index) was normal at rest and post-exercise.
- Neurological examination was normal
- MRI and Spine Radiographs were noncontributory.

The "Hidden" Diagnosis
While standard front-view arteriography initially failed to show abnormalities, oblique projection films revealed a tight stenosis at the origin of the superior gluteal artery. This exceptional case highlights that isolated arterial stenosis can occur even with healthy proximal iliac arteries.

Key Clinical Takeaways:

👉 Mechanical vs. Vascular: If pain is consistently brought on by walking and relieved by rest, consider a vascular origin—even if the patient has strong femoral pulses.

👉 Anatomical Entrapment: The superior gluteal artery is "entrapped" between the piriformis and gluteal muscles. Much like popliteal entrapment, this can lead to post-traumatic lesions rather than standard atherosclerosis.

💥 The Bottom Line: Don’t rule out vascular causes based on a normal ABI alone if the clinical history of claudication is strong.

01/01/2026

السلام عليكم جميعاً!!

أنا بعمل دراسة بخصوص آلام الرقبة اللي بتسمع في الدراعات أو الكتف، وده موضوع منتشر جداً بسبب القعدة الغلط والموبايلات، ومحتاج أعرف أكتر عن تجاربكم مع الوجع ده.

لو بتحس بأي تعب في رقبتك أو تنميل ووجع واصل لدراعك، يا ريت تساعدني بملء الاستبيان البسيط ده:
https://docs.google.com/forms/d/e/1FAIpQLScvqNEWzY8S6HYVKNOg6j7VPAGPr5x22uCCewld4Kh5cW3gUg/viewform

💡 ملحوظة بخصوص اللغة:
الاستبيان مكتوب باللغة الإنجليزية، لكن تقدر تترجمه للغة العربية بسهولة جداً وأنت في نفس الصفحة من موبايلك (متصفح Google Chrome) عن طريق الخطوات دي:

1️⃣ دوس على الـ ٣ نقط اللي فوق بعض في أعلى الصفحة.
2️⃣ انزل لتحت واختار كلمة "ترجمة" أو "Translate".
3️⃣ لو مترجمش تلقائي، دوس على علامة الترس (الإعدادات) اللي هتظهر واختار اللغة العربية، وهيتحول فوراً.

مشاركتك بجد هتساعدنا نفهم المشكلة دي أكتر ونساهم في حلها. شكراً مقدماً لوقتكم ودعمكم! 🙏 شكراً جداً ليكم! ❤️
..............

Hello everyone!

I am currently conducting a study on neck pain that radiates to the arms or shoulders. This is a very common issue nowadays, often caused by poor posture and prolonged phone use, and I would love to learn more about your experiences with this type of pain.

If you experience any neck discomfort, numbness, or pain extending down your arm, please help me by filling out this brief survey:

https://docs.google.com/forms/d/e/1FAIpQLScvqNEWzY8S6HYVKNOg6j7VPAGPr5x22uCCewld4Kh5cW3gUg/viewform

💡 Note regarding the language:

The survey is in English, but you can easily translate it into Arabic (or any other language) directly from your phone (Google Chrome browser) by following these steps:

1️⃣ Click on the three dots in the top corner of the page.
2️⃣ Scroll down and select "Translate".
3️⃣ If it doesn't translate automatically, click on the Gear icon (Settings) that appears and choose Arabic. It will be translated instantly.

Your participation will truly help us understand this issue better and contribute to finding solutions. Thank you so much for your time and support! ❤️

01/01/2026

The Illusion of "Non-Specific" Low Back Pain: A Critical Appraisal of Pinto et al. (2025)

The narrative review by Pinto et al. (2025) propagates a problematic status quo in the physiotherapy profession by favoring the "diagnostic uncertainty" model. While the authors suggest that anatomical diagnoses reinforce fear and reduce confidence, this perspective conveniently overlooks a significant epistemological gap. The claim that 90% of Low Back Pain (LBP) is "non-specific" is often presented as an absolute truth, yet as noted by critics of international guidelines, this assertion frequently lacks primary evidence and is treated as a dogmatic consensus rather than a scientific fact (Koes et al., 2001; van Tulder et al., 2006).

Physiotherapists often embrace the "non-specific" label because it simplifies management to general activity and stress reduction, but this intellectual retreat ignores the nuances of pathology. Pinto et al. (2025) argue that imaging findings are common in asymptomatic individuals and thus lack prognostic value. However, this logic is flawed; just as advanced coronary artery blockage can exist before a myocardial infarction, spinal pathology may need to reach a threshold of severity before manifesting as pain (Duncan et al., 2007). Research demonstrates that severe disc degeneration and Modic changes are significantly more prevalent in symptomatic populations—43% in LBP patients versus only 6% in asymptomatic groups (Cheung et al., 2009; Jensen et al., 1994). Dismissing pathology simply because cross-sectional data shows it exists in healthy cohorts is a premature scientific conclusion that hinders our ability to predict recurrences and tailor specific interventions.

References:
Boden, S. D., Davis, D. O., Dina, T. S., Patronas, N. J., & Wiesel, S. W. (1990). Abnormal magnetic-resonance scans of the lumbar spine in asymptomatic subjects. A prospective investigation. Journal of Bone and Joint Surgery (American), 72, 403–408.
Cheung, K. M., Karppinen, J., Chan, D., Ho, D. W., Song, Y. Q., Sham, P., ... & Luk, K. D. (2009). Prevalence and pattern of lumbar magnetic resonance imaging changes in a population study of one thousand forty-three individuals. Spine, 34, 934–940.
Duncan, R., Peat, G., Thomas, E., Hay, E., McCall, I., & Croft, P. (2007). Symptoms and radiographic osteoarthritis: not as discordant as they are made out to be? Annals of the Rheumatic Diseases, 66, 86–91.
Jarvik, J. J., Hollingworth, W., Heagerty, P., Haynor, D. R., & Deyo, R. A. (2001). The longitudinal assessment of imaging and disability of the back (laidback) study: baseline data. Spine, 26, 1158–1166.
Jensen, M. C., Brant-Zawadzki, M. N., Obuchowski, N., Modic, M. T., Malkasian, D., & Ross, J. S. (1994). Magnetic resonance imaging of the lumbar spine in people without back pain. New England Journal of Medicine, 331, 69–73.
Koes, B. W., van Tulder, M. W., Ostelo, R., Kim Burton, A., & Waddell, G. (2001). Clinical guidelines for the management of low back pain in primary care: an international comparison. Spine, 26, 2504–2513.
Pinto, R. Z., Kongsted, A., Silva, S., Hayden, J. A., Downie, A., & Saragiotto, B. T. (2025). Recent highlights in low back pain research, Part I: Diagnosis and Prognosis. Journal of Physiotherapy.
Stanton, T. R., Henschke, N., Maher, C. G., Refshauge, K. M., Latimer, J., & McAuley, J. H. (2008). After an episode of acute low back pain, recurrence is unpredictable and not as common as previously thought. Spine, 33, 2923–2928.
van Tulder, M., Becker, A., Bekkering, T., Breen, A., del Real, M. T. G., Hutchinson, A., ... & On behalf of the Cost B. (2006). Chapter 3. European guidelines for the management of acute nonspecific low back pain in primary care. European Spine Journal, 15(Suppl 2), S169–S191.

01/01/2026

The fact that the back pain disappeared is a common report with disc prolapses!

01/01/2026

Most radicular pain / radiculopathy cases caused by disc prolapses start as back pain only and progress to dominant leg pain in days, weeks or months!

01/01/2026

Most radicular pain / radiculopathy cases caused by disc prolapses start as back pain only and progress to dominant leg pain in days, weeks or months!

01/01/2026

The scientific evidence is reasonably clear!

For patients with herniated discs and dominant radicular (lower limb) symptoms, mean outcomes are not significantly better after discectomy at 12–24 months, than if surgery is avoided (Peul, et al. 2007). Furthermore, of those patients satisfying internationally accepted criteria for discectomy, about 80% can recover with a combination of specific exercise programs and transforaminal epidural steroid injections (van Helvoirt, et al. 2014).

References:

- Peul WC, van Houwelingen HC, van den Hout WB, et al. Surgery versus prolonged conservative treatment for sciatica. N Engl J Med 2007;356(22):2245-2256.

- van Helvoirt H, Apeldoorn AT, Ostelo RW, et al. Transforaminal Epidural Steroid Injections
Followed by Mechanical Diagnosis and Therapy to Prevent Surgery for Lumbar Disc Herniation. Pain Med 2014.

This link will take you to a page that’s not on LinkedIn

01/01/2026

The development of neuropathic pain along with radicular pain and radiculopathy associated with lumbar disc herniation is reasonably common. A “neuropathic pain component”, has been detected at a rate of 40- 65% of patients with chronic low back and radicular pain.

Reference:
Sivas F, Uzun O, Baskan B, Bodur H. The neuropathic pain component among patients with chronic low back-radicular pain. J Back Musculoskelet Rehabil 2018;31(5):939-946. DOI: 10.3233/BMR-160786.

01/01/2026

Disc degeneration and disc protrusion, are more prevalent in those with LBP than in asymptomatic individuals.

References:
Brinjikji W, Diehn FE, Jarvik JG, Carr CM, Kallmes DF, Murad MH, et al. MRI Findings of disc degeneration are more prevalent in adults with low back pain than in asymptomatic controls: a systematic review and meta-analysis. Am J
Neuroradiol. 2015;36:2394–2399.

01/01/2026

📈 Research Update: Prevalence of Serious Spinal Pathology

How often is low back pain (LBP) actually a sign of something serious? A comprehensive 2025 systematic review and meta-analysis by Reginato et al. provides some much-needed clarity for clinicians.

By pooling data from 10 different studies, researchers found that the overall prevalence of serious spinal pathology sits at 2.9%. While LBP is incredibly common, these "red flag" conditions remain relatively rare in clinical presentations.
Key Findings (Pooled Prevalence):

1) Vertebral Fracture: 2.4%
2) Spinal Infection: 0.7%
3) Malignancy: 0.5%
4) Cauda Equina Syndrome: 0.3%

The Takeaway: While the vast majority of back pain cases are non-sinister, these statistics underscore the importance of vigilant screening—particularly for fractures, which represented the highest proportion of serious findings.



- Reference:
Reginato, L. S., Machado, G. C., Maher, C. G., Grande, G. H. D., Vidal, R. V. C., & Oliveira, C. B. (2025). Prevalence of serious spinal pathologies and non-spinal conditions in low back pain: A systematic review and meta-analysis. Pain Medicine, pnaf078.

AbstractObjective. To estimate the prevalence of serious spinal pathologies and nonspinal conditions in people seeking care for low back pain.Methods. Lite

22/12/2025

⚡️ Understanding Suprascapular Nerve Pain: A Deep Dive for Clinicians

While scapular and posterior shoulder pain are common, Suprascapular Nerve (SSN) pathology is a frequently overlooked driver. Though it accounts for 1–2% of general shoulder pain, that prevalence skyrockets to 33% in overhead athletes (volleyball and baseball) and 12% in patients with massive rotator cuff tears.

🔍 The Research: Identifying the Best Diagnostic Test
A recent observational cadaveric study evaluated the biomechanical strain on the SSN across five different neurodynamic positions. The goal? To find which movement most effectively targets the nerve's mechanosensitivity.
The study compared:
1. Cervical contralateral rotation + Scapular retraction.
2. Cervical contralateral sidebending + Shoulder girdle depression.
3. Shoulder girdle depression, retraction, posterior tilt, and downward rotation.
4. Position 3 + Contralateral cervical sidebending.
5. Scapular protraction + Cervical contralateral sidebending (The Protraction Sidebending Test).

🏆 The Key Finding: The Protraction Sidebending Test

The data revealed a clear winner for clinical practice. While all five positions induced strain in the prescapular portion of the nerve, Position 5 (Protraction Sidebending) stood out:

A) Highest Overall Strain: It induced the maximum strain on the intraspinal portion of the SSN.

B) Dual Impact: It is the only test likely to influence both the prescapular and scapular portions of the nerve simultaneously.

💡 Clinical Takeaway
For clinicians treating stubborn posterior shoulder pain or working with overhead athletes, the Protraction Sidebending Test should be your primary tool for assessing suprascapular heightened mechanosensitivity.

By strategically combining scapular protraction with contralateral cervical sidebending, you can more accurately provoke the nerve and differentiate SSN involvement from local muscular or joint dysfunction.

15/12/2025

✋ Interface Intervention Breakthrough: Manual Therapy Proves Effective for Carpal Tunnel Syndrome (CTS)

The neurodynamic approach utilizes techniques like neural mobilization, but what about directly treating the mechanical nerve interface? Limited evidence has existed on the effectiveness of manually treating the joints and soft tissues that surround and influence an entrapped nerve.
A recent systematic review aimed to assess the impact of mechanical interface treatment (including joint and soft tissue techniques) on pain and function in individuals with peripheral entrapment neuropathies.

Key Findings on Mechanical Interface Treatment for CTS:

👉 Effectiveness for Pain & Function: The review provides strong evidence that manual treatment of the nerve mechanical interface is effective for improving both pain and function in people with Carpal Tunnel Syndrome (CTS) in both the short and long term.

👉 Variety of Techniques: The effective interventions ranged broadly, including:
- Soft Tissue Techniques
- Articular Techniques (Joint Mobilizations)
- Instrument-Assisted Manual Therapy
- Combinations of the above.

👉 Superiority to Sham: Meta-analysis results suggest that mechanical interface treatment could be better than sham treatment for pain relief in CTS, though the evidence certainty remains low.

👉 Comparison to Neural Mobilization: The analysis also indicated that mechanical interface treatment showed similar effects to neural mobilization on CTS pain, though confidence in this result is also low.

👉 Comparison to Other Treatments: Interface techniques have been reported to be:
- More effective than splinting, electrotherapy, ultrasound, and low-level laser therapy.
- As effective as surgery.

Conclusion & Future Direction
Manual techniques targeting the nerve mechanical interface are an effective method to improve pain and function in CTS. They appear more effective than sham and similarly effective to neural mobilization. However, a strong clinical recommendation is currently limited by the methodological heterogeneity across the included studies regarding interventions and comparators.

💡 Future Research Needs: To solidify these findings and extend them beyond CTS, future high-quality Randomized Controlled Trials (RCTs) must focus on:
1. Other peripheral entrapment neuropathies (beyond CTS).
2. Improving methodological quality.
3. Standardizing comparators (e.g., using robust placebo or sham treatments).