The Rheumatology Physio

I ran a poll this week which showed that 77% of clinicians screen for Cauda Equina every new back pain consultation. That’s nearly a quarter who DONT… I refer patients to the ED for CES multiple times a year. The ones that nearly got missed didn't present with obvious red flags. They said their legs felt "a bit heavy." 🦵 Their saddle area felt "different." One said nothing — until I asked directly. CES symptoms can be subtle. Patients often don’t articulate them without prompting. We need to ask. Every time. Regardless of how they present. It takes less than 2 minutes. ⏱️ Ask it. Document it. ✅ If you want more info Reply ‘Cauda Equina’ and I’ll send you my screening question framework 📋

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Consent✅ Runner Rapid onset L mid hamstring pain, which he felt was a "pull" This settled, but then became more proximal and deep gluteal (not inferior / ischial) - continued to radiate "like a nerve pain" into the posterior thigh Rehabbed as a muscle tear, then proximal hamstring tendinopathy (possibly starting as a partial tendon origin tear), but no response Then developed similar R gluteal pain Worse in the morning, reliant on NSAIDs, warmed up with exercise US - did indeed show proximal hamstring tendinopathy on the L side with 'peel away' tear - confirmed on MRI (see T2 axial image) - but the R PHT was completely normal MRI pelvis - bilateral sacroiliitis, much more florid on L side (see T2 / STIR coronal images) Sacroillitis is a well recognised cause of gluteal pain and behave in a pseudo-sciatic fashion