High-Grade Partial and Retracted (<2 cm) Proximal Hamstring Ruptures

Background: High-grade partial proximal hamstring tears and complete tears with retraction less than 2 cm are a subset of proximal hamstring injuries where, historically, treatment has been nonoperative. It is unknown how nonoperative treatment compares with operative treatment. Hypothesis: The clinical and functional outcomes of nonoperative and operative treatment of partial/complete proximal hamstring tears were compared. We hypothesize that operative treatment of these tears leads to better clinical and functional results. Study Design: Case series; Level of evidence, 4. Methods: A retrospective review identified patients with a high-grade partial or complete proximal hamstring rupture with retraction less than 2 cm treated either operatively or nonoperatively from 2007 to 2015. All patients had an initial period of nonoperative treatment. Surgery was offered if patients had continued pain and/or limited function refractory to nonoperative treatment with physical therapy. Outcome measures were each patient’s strength perception, ability to return to activity, Lower Extremity Functional Scale (LEFS) score, Short Form–12 (SF-12) physical and mental component outcome scores, distance traversed by a single-leg hop, and Biodex hamstring strength testing. Results: A total of 25 patients were enrolled in the study. The 15 patients who were treated nonoperatively sustained injuries at a mean age of 55.73 ± 14.83 years and were evaluated 35.47 ± 30.35 months after injury. The 10 patients who elected to have surgery sustained injuries at 50.40 ± 6.31 years of age ( P = .23) and were evaluated 30.11 ± 19.43 months after surgery. LEFS scores were significantly greater for the operative group compared with the nonoperative group (77/80 vs 64.3/80; P = .01). SF-12 physical component scores for the operative group were also significantly greater ( P = .03). Objectively, operative and nonoperative treatment modalities showed no significant difference in terms of single-leg hop distance compared with each patient’s noninjured leg ( P = .26) and torque deficit at isokinetic speeds of 60 and 180 deg/s ( P = .46 and .70, respectively). Conclusion: Patients who undergo operative and nonoperative treatment of high-grade partial and/or complete proximal hamstring tears with <2 cm retraction demonstrate good clinical and functional outcomes. In our series, 40% of patients treated nonoperatively with physical therapy went on to have surgery. For those patients with persistent pain and/or loss of function despite conservative treatment, surgical repair is a viable treatment option that is met with good results.

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Functional outcomes and survival in patients with high-grade gliomas in dominant and nondominant hemispheres

Journal of Neurosurgery ◽

10.3171/jns.2005.102.2.0276 ◽

2005 ◽

Vol 102 (2) ◽

pp. 276-283 ◽

Cited By ~ 26

Author(s):

Richard S. Polin ◽

Nicholas F. Marko ◽

Matthew D. Ammerman ◽

Mark E. Shaffrey ◽

Wei Huang ◽

...

Keyword(s):

Functional Outcome ◽

Functional Outcomes ◽

Outcome Data ◽

Karnofsky Performance Scale ◽

Sample Population ◽

High Grade ◽

Content Type ◽

Significant Difference ◽

High Grade Gliomas ◽

Fine Print

Object. The goal of this study was to investigate survival and functional outcomes in patients with high-grade intracranial astrocytomas as a function of the location of the lesion in the dominant or nondominant hemisphere (DH and NDH, respectively), and to suggest management strategies for such patients based on these data. Methods. Data were collected from the Glioma Outcomes Project database, a longitudinal database of demographic, clinical, and outcome data for patients with high-grade intracranial gliomas. From the entire database of 788 patients, a subset of all 280 right-handed patients with newly diagnosed, unilateral gliomas involving potentially eloquent cortex was selected as the sample population. Two cohorts were defined based on the location of the tumor in the right or left cerebral hemisphere. All other relevant demographic and clinical data were nearly identical between the cohorts. A Kaplan—Meier analysis was conducted to assess survival, and Karnofsky Performance Scale scores assigned at 6 and 12 months postoperatively were compared as a measure of functional outcome. The analysis demonstrated no difference in survival between patients with lesions in the DH and those with tumors in the NDH. Additionally, no statistically significant difference in functional outcomes was observed between the two groups. Conclusions. Laterality of high-grade gliomas is not an independent prognostic factor for predicting survival or functional outcome. The findings in this study demonstrate that fears of increased postoperative morbidity or mortality in otherwise resectable tumors of the DH are unfounded, and the authors therefore advocate that the surgeon's decision to operate be guided by validated outcome predictors and not biased by tumor lateralization.

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Fractures of the Clavicle: An Overview

The Open Orthopaedics Journal ◽

10.2174/1874325001307010329 ◽

2013 ◽

Vol 7 (1) ◽

pp. 329-333 ◽

Cited By ~ 21

Author(s):

Thomas D Donnelly ◽

Robert J MacFarlane ◽

Mathias Thomas Nagy ◽

Peter Ralte ◽

Mohammad Waseem

Keyword(s):

Surgical Treatment ◽

Operative Treatment ◽

Functional Outcomes ◽

Surgical Approaches ◽

High Grade ◽

Non Union ◽

The Past ◽

Clavicle Fractures ◽

Surgical Treatments

Fractures of the clavicle are a common injury and most often occur in younger individuals. For the most part, they have been historically treated conservatively with acceptable results. However, over recent years, more and more research is showing that operative treatment may decrease the rates of fracture complications and increase functional outcomes. This article first describes the classification of clavicle fractures and then reviews the literature over the past decades to form a conclusion regarding the appropriate management.A thorough literature review was performed on assessment of fractures of the clavicle, their classification and the outcomes following conservative treatment. Further literature was gathered regarding the surgical treatment of these fractures, including the methods of fixation and the surgical approaches used. Both conservative and surgical treatments were then compared and contrasted.The majority of recent data suggests that operative treatment may be more appropriate as it improves functional outcome and reduces the risk of complications such as non-union. This is particularly evident in mid shaft fractures, although more high grade evidence is needed to fully recommend this, especially regarding certain fractures of the medial and lateral clavicle.

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Does it Need Operation in Pediatric Triplane Fracture?

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000316 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0003

Author(s):

Chul-Hyun Park ◽

Hongjoon Choi ◽

Dong-Il Chun ◽

Jaeho Cho ◽

Jaewoo Park

Keyword(s):

Growth Plate ◽

Operative Treatment ◽

Clinical Results ◽

Nonoperative Treatment ◽

Posttraumatic Arthritis ◽

Leg Length ◽

Premature Closure ◽

Significant Difference ◽

Triplane Fracture ◽

Nonoperative Group

Category: Ankle, Trauma Introduction/Purpose: The proper treatment of triplane fractures is still controversial. The purpose of this study was to compare the clinical and radiographic outcomes of nonoperative and operative treatments of triplane fractures and to clarify whether operative treatment is always necessary for triplane fractures with displacements of >2 mm. Methods: Thirty-three patients who were diagnosed as having triplane fractures between January 2007 and January 2014 were reviewed. The first 19 consecutive patients were treated conservatively with closed reduction regardless of age, sex, and fracture severity (nonoperative group), and the latter 14 patients were treated surgically (operative group). Clinical results were assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) scale and modified Weber protocol (MWP) scores. Bone union, plafond varus and valgus, presence of, leg-length discrepancy (LLD), premature closure of the growth plate, and posttraumatic arthritis were radiographically examined. Results: The mean AOFAS score was 100 for the nonoperative group and 98.1 for the operative group, showing no statistically significant difference between the groups (P = 0.304). The MWP scores were excellent in both groups. One patient in each group showed a LLD of >10 mm at the last follow-up. None of the patients had nonunion, plafond deformity, premature closure of the growth plate, and posttraumatic arthritis. Conclusion: Nonoperative treatment of triplane fracture is comparable with operative treatment in terms of clinical and radiographic results. Therefore, we suggest that nonoperative treatment may be a better option than operative treatment for triplane fracture, considering the risk of psychiatric trauma from surgery and the necessity of implant removal.

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A Novel Technique for Proximal Hamstring Tendon Repair: High Reoperation Rate in a Series of 56 Patients

Advances in Orthopedic Surgery ◽

10.1155/2014/891875 ◽

2014 ◽

Vol 2014 ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

William Blakeney ◽

Simon Zilko ◽

Wael Chiri ◽

Peter Annear

Keyword(s):

Functional Outcomes ◽

Assessment Tool ◽

Tendon Repair ◽

Return To Sport ◽

Hamstring Tendon ◽

Reoperation Rate ◽

Ischial Tuberosity ◽

Novel Technique ◽

Proximal Hamstring Rupture ◽

Proximal Hamstring

This investigation looked at functional outcomes, following a novel technique of surgical repair using table staples. Patients underwent surgery for proximal hamstring rupture with table staples used to hold the tendon reapproximated to the ischial tuberosity. Functional outcomes following surgery were assessed. We also used a combined outcome assessment measure: the Perth Hamstring Assessment Tool (PHAT). A total of 56 patients with a mean age of 51 (range 15–71) underwent surgery. The mean follow-up duration was 26 months (range 8–59 months). A large proportion of patients (21/56, 37.5%) required reoperation for removal of the staple. Patients that did not require removal of the table staple did well postoperatively, with low pain scores (0.8–2 out of 10) and good levels of return to sport or running (75.8%). Those that required removal of the staple had a significantly lower PHAT score prior to removal, 47.8, but this improved markedly once the staple was removed, with a mean of 77.2 (P<0.001). Although our patients achieved similar outcomes in terms of pain and function, we thought the reoperation rate was unacceptably high. We would not recommend proximal hamstring tendon repair using this technique.

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Comparison of Traditional Physical Therapy to Internet-Based Physical Therapy after Knee Arthroscopy: A Prospective Randomized Controlled Trial Comparing Patient Outcomes and Satisfaction

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119s00344 ◽

2019 ◽

Vol 7 (7_suppl5) ◽

pp. 2325967119S0034

Author(s):

Christopher Hadley ◽

Mikayla McGrath ◽

John P. Prodoehl ◽

Steven B. Cohen ◽

William D. Emper ◽

...

Keyword(s):

Physical Therapy ◽

Outcome Measures ◽

Functional Outcomes ◽

Primary Outcome ◽

Knee Arthroscopy ◽

Therapy Group ◽

Partial Meniscectomy ◽

The Internet ◽

Significant Difference

Objectives: Knee arthroscopy results in significant improvements in functional outcomes, pain and quality of life for patients suffering from meniscal tears. Traditionally, patients have undergone formal physical therapy (PT) after knee arthroscopy to regain function. Prior studies have demonstrated that patients who undergo internet-based PT after total knee arthroplasty performed as well as patients receiving traditional PT, but this has not been studied in the knee arthroscopy population. The goal of this study is to compare traditional outpatient physical therapy to internet-based physical therapy in patients undergoing knee arthroscopy for partial meniscectomy. Methods: Patients undergoing knee arthroscopy from October 2017 to September 2018 for partial meniscectomy were enrolled. Patients were randomized to either an outpatient or internet-based physical therapy program. Participants in the outpatient physical therapy were prescribed PT for 2 sessions per week for 4-6 weeks while participants in the online physical therapy group were instructed to login daily to track progress and complete their exercises a minimum of 3 times per week. Additionally, participants completed 4 questionnaires: VR-12 mental and physical health, International Knee Documentation Committee (IKDC), Modified Cincinnati Rating System (MCRS) and Lysholm pre-operatively, 1 week, 6 weeks and 6 months after surgery. The primary outcome of knee function was measured via the IKDC. Results: Of the 97 patients who met the inclusion criteria, 51 (52.6%) were in the internet-based physical therapy group and 46 (47.4%) were in the outpatient PT group. There were 57 males (58.8%) and 40 females (41.2%). Participants in the online physical therapy group logged into the platform an average of 2.74 times pre-operatively and 14.99 times post-operatively. Additionally, patients viewed their PT exercise videos, on average, 5.58 times pre-operatively and 36.71 times post-operatively. At final follow-up, there was no significant difference in the primary outcome with an average IKDC score for the online physical therapy (71.83) compared to outpatient PT group (74.23) [p = 0.699]. Additionally, there was no significant difference noted in the three secondary outcome measures between the internet-based physical therapy group and the outpatient PT group at final follow-up (Table 1). Furthermore, no significant difference was noted between the two patient cohorts pre-operatively and 1 week and 6 weeks after surgery in all four outcome measures (Table 1). Conclusion: The results of our study indicate that patients using internet-based PT had similar functional outcomes as patients using traditional outpatient PT following knee arthroscopy for partial meniscectomy. [Table: see text]

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Distal Radius Fractures: Does Obesity Affect Fracture Pattern, Treatment, and Functional Outcomes?

Hand ◽

10.1177/1558944717750915 ◽

2018 ◽

Vol 14 (3) ◽

pp. 398-401 ◽

Cited By ~ 1

Author(s):

Michael D. Montague ◽

Jesse T. Lewis ◽

Obadah Moushmoush ◽

Jaiyoung Ryu

Keyword(s):

Distal Radius ◽

Retrospective Review ◽

Functional Outcomes ◽

Nonoperative Treatment ◽

Fracture Pattern ◽

Distal Radius Fractures ◽

Radius Fractures ◽

Complex Part ◽

Point Increase ◽

Significant Difference

Background: Distal radius fractures (DRFs) are 16% of fractures treated by orthopedic surgeons. Obesity’s influence on DRF complexity has not been studied. This study was undertaken to determine if body mass index (BMI) affects DRF pattern, treatment, and functional outcomes. Methods: Part 1 was a retrospective review of patients who sustained a DRF after a fall from standing height with no prior reduction or treatment. Radiographs were classified as “simple” or “complex.” Part 2 consisted of contacting patients from Part 1 and obtaining a Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score. Retrospective review also identified patients who failed initial nonoperative treatment. Fracture pattern, failure of nonoperative treatment, and QuickDASH scores were compared with BMI at the time of injury. Results: For Part 1, 130 patients (132 wrists) were identified. Average age was 57 years, 77% were female, and average BMI was 28.2 kg/m2. Each point increase in BMI increased the chance of having a complex DRF (odds ratio = 1.07). Part 2 identified 50 patients who completed a QuickDASH at an average of 4.6 years after injury. Those with a BMI <25 kg/m2 (n = 15) had an average QuickDASH score of 37; patients with a BMI ≥25 kg/m2 (n = 35) had an average QuickDASH score of 18. Increasing BMI was suggestive of a lower QuickDASH score ( P = .08). No significant difference was found with respect to BMI and failure of nonoperative treatment. Conclusions: A higher BMI increases the odds of a complex DRF. Despite more complex fractures, overweight patients may experience less disability after sustaining a DRF.

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Retrospective review of chronic pain causes and management in multiple myeloma patients.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e20552 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e20552-e20552

Author(s):

Ami Atulkumar Dave ◽

Jaime K Lewis ◽

Agne Paner

Keyword(s):

Multiple Myeloma ◽

Chronic Pain ◽

Peripheral Neuropathy ◽

Physical Therapy ◽

Medical Center ◽

Proteasome Inhibitors ◽

Anticonvulsant Therapy ◽

Treatment Modalities ◽

Duration Of Treatment ◽

Significant Difference

e20552 Background: The survival of patients with multiple myeloma has improved dramatically since the introduction of proteasome inhibitors such as bortezomib, which can have the adverse effect of peripheral neuropathy. This study retrospectively examines causes of chronic pain in myeloma patients and the modalities and duration of treatments used for pain control. Methods: Rush University Medical Center multiple myeloma patients who were diagnosed and treated between 2000-2019 were included. Outcome measures were abstracted from the medical record and included: classes of pain medication used, duration of treatment, prevalence of peripheral neuropathy symptoms, and use of adjunct treatment modalities. Descriptive statistical models including Chi-square and Fisher’s exact test were used for categorical variable analysis. Results: In all, 134 patients were included, of which 75.4% (N = 101) patients received at least one cycle of bortezomib. 42.5% (N = 57) patients were seen in palliative clinic. 72.9% (N = 97) reported bone pain symptoms. A total of 73.7% (N = 98) patients experienced peripheral neuropathy symptoms. 86.1% (N = 87) of patients who received bortezomib reported neuropathy, as compared to 34.4% (N = 11) of patients who did not have bortezomib therapy (OR 11.8, p < 0.0001). 66.4% (N = 67) patients who received bortezomib took anticonvulsants as compared to 31.3% (N = 10) of those who did not receive bortezomib (OR 4.3, p < 0.0005). Patients were on anticonvulsant therapy for a mean of 32.6 months (SD = 26.7) with no significant difference in the bortezomib group. 79.7% (N = 106) patients took opioid medications. Norco was the most commonly used opioid (N = 55) and average duration of use was 36.6 months (SD = 34). 18.8% (N = 25) took antidepressant medications such as TCAs or SNRIs for pain, and all of these patients received bortezomib therapy (p = 0.0003). 36.6% (N = 45) of patients received radiation and 16.5% (N = 22) underwent kyphoplasty. 70.7% (N = 94) patients attended at least one physical therapy session. There was no statistically significant difference in radiation or kyphoplasty utilization between patients who had received bortezomib and those who had not, but there was a significant difference in physical therapy (OR 4.9, p < 0.0001). Conclusions: Patients who received bortezomib as part of their myeloma treatment were more likely to experience peripheral neuropathy and required anticonvulsant therapy more frequently. It is important to better understand and define the health burden of chronic pain and use of pain medications in patients with multiple myeloma.

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Incidence of Deep Venous Thrombosis Associated With Proximal Hamstring Rupture

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119888486 ◽

2019 ◽

Vol 7 (12) ◽

pp. 232596711988848

Author(s):

Ian D. Engler ◽

Jack T. Bragg ◽

Suzanne L. Miller

Keyword(s):

Risk Factors ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Case Series ◽

Senior Author ◽

Level Of Evidence ◽

Dvt Prophylaxis ◽

Hamstring Injuries ◽

Proximal Hamstring Rupture ◽

Proximal Hamstring

Background: Rates of deep venous thrombosis (DVT) have been studied for most common orthopaedic injuries. However, rates and risk factors have not been published for proximal hamstring injuries. Purpose: To determine the incidence of symptomatic DVT associated with proximal hamstring rupture and associations with prophylactic anticoagulation. Study Design: Case series; Level of evidence, 4. Methods: Inclusion criteria included all complete and, in a separate cohort, partial proximal hamstring ruptures treated by the senior author from 2007 through 2018 with at least 8 weeks of follow-up. Tendinopathy without tear was excluded. No DVT screening was performed. Charts of patients with symptomatic DVT were reviewed for the treatment method, the presence of imaging-confirmed DVT or pulmonary embolism, and risk factors for DVT. No patients received postinjury DVT prophylaxis. Surgical patients were routinely instructed to take aspirin (325 mg bid) or apixaban (2.5 mg bid) for 4 weeks. Patients with risk factors for DVT received enoxaparin (40 mg daily) for 2 weeks followed by aspirin (325 mg bid) for 2 weeks. Results: A total of 144 complete proximal hamstring ruptures were included: 132 treated operatively and 12 treated nonoperatively. There were 10 DVTs associated with the injury, for an overall rate of 6.9%. Five of the DVTs were diagnosed preoperatively in patients who had not received DVT prophylaxis; the other 5 were diagnosed postoperatively in patients on DVT prophylaxis. Six of the 10 DVTs had identifiable risk factors. All patients with postoperatively diagnosed DVTs were on prophylactic aspirin or enoxaparin. In the partial proximal hamstring rupture cohort of 114 ruptures, there were no DVTs. Conclusion: There is a high incidence of DVT associated with complete proximal hamstring ruptures (6.9%) despite many patients receiving DVT prophylaxis. This is substantially higher than that in other lower extremity injuries. Clinicians should have a high index of suspicion for DVT after these injuries, and postinjury DVT prophylaxis may be warranted.

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Platelet-Rich Plasma Shortens Return to Play in National Football League Players With Acute Hamstring Injuries

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120911731 ◽

2020 ◽

Vol 8 (4) ◽

pp. 232596712091173 ◽

Cited By ~ 1

Author(s):

James P. Bradley ◽

Tracye J. Lawyer ◽

Sonia Ruef ◽

Jeffrey D. Towers ◽

Justin W. Arner

Keyword(s):

National Football League ◽

Platelet Rich Plasma ◽

Nonoperative Treatment ◽

Return To Play ◽

Professional Athletes ◽

Hamstring Injury ◽

Level Of Evidence ◽

Hamstring Injuries ◽

Recurrent Injury ◽

Significant Difference

Background: Hamstring injuries are prevalent in professional athletes and can lead to significant time loss, with recurrent injury being common. The efficacy of platelet-rich plasma (PRP) for augmentation of nonoperative treatment of partial musculotendinous hamstring injuries is not well established. Hypothesis: The addition of PRP injections to nonoperative treatment for acute partial musculotendinous hamstring injuries will lead to a shortened return to play in National Football League (NFL) players. Study Design: Cohort study; Level of evidence, 3. Methods: NFL players from a single team who sustained acute grade 2 hamstring injuries, as diagnosed on magnetic resonance imaging (MRI) by a musculoskeletal radiologist from 2009 to 2018, were retrospectively reviewed. Average days, practices, and games missed were recorded. Players who did and did not receive PRP (leukocyte-poor) injections were compared. Those who received PRP did so within 24 to 48 hours after injury. Results: A total of 108 NFL players had MRI evidence of a hamstring injury, and of those, 69 athletes sustained grade 2 injuries. Thirty players received augmented treatment with PRP injections and 39 players underwent nonoperative treatment alone. Average time missed in those treated with PRP injections was 22.5 days, 18.2 practices, and 1.3 games. In those who did not receive PRP injections, time missed was 25.7 days ( P = .81), 22.8 practices ( P = .68), and 2.9 games ( P < .05). Conclusion: Augmentation with PRP injections for acute grade 2 hamstring injuries in NFL players showed no significant difference in days missed or time to return to practice but did allow for faster return to play, with a 1 game overall difference. Owing to the possible large financial impact of returning to play 1 game sooner, PRP injections for treatment of grade 2 hamstring injuries may be advantageous in professional athletes.

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A Comparative Study on Indomethacin Suppositories with Physical Therapy and Conventional Treatment Modalities for Lumbago Sciatica

Journal of Armed Forces Medical College Bangladesh ◽

10.3329/jafmc.v13i1.41012 ◽

2017 ◽

Vol 13 (1) ◽

pp. 28-32

Author(s):

SM Shahidul Haque ◽

Md Abdul Ali Miah ◽

Mohammad Yousuf ◽

Md Fashiur Rahman ◽

Wahida Rahman ◽

...

Keyword(s):

Physical Therapy ◽

Physical Exercise ◽

Conventional Treatment ◽

Armed Forces ◽

Treatment Modalities ◽

Military Hospital ◽

Physical Medicine ◽

Treatment Comparison ◽

Significant Difference ◽

Group A

Introduction: Most of the patients with Lumbago sciatica can be managed conservatively in a primary care setting with the expectation of a good outcome. It is one of the most common causes of pain and disability pertinent to lumbar spine. There are many alternative forms of treatment for this condition but the evidence of the efficacy of Indomethacin suppositories is yet to be established from clinical trials. Though several interventions are used in combination with physical therapy but indomethacin suppositories is commonly employed as a first line agent in the management of lumbago sciatica. Objective: To ascertain whether a comparative effect of Indomethacin suppositories with other conventional treatment modalities produce a significant difference in the outcome. Materials and Methods: This experimental clinical study was carried out at the Department of Physical Medicine, Combined Military Hospital (CMH), Dhaka and Department of Physical Medicine and Rehabilitation BSMMU, from 01 September 2015 to 28 February 2016. A total of 153 patients were randomly selected for trial and they were divided by lottery into 3 Groups. Group-“A” received Indomethacin suppositories with physical exercise and patients were 54 in number. 'Group-B' received NSAIDs (except indomethacin suppositories), SWD /MWD/IFT/TENS and patients were 47. In 'Group-C' there were 52 patients who received counseling with only physical exercises. Each Group received above-mentioned treatment modalities 5 days in a week for 6 weeks. Results: The results were observed and noted with the help of visual analogue scale (VAS). The highest significant improvement was observed in 'Group-A' throughout the whole treatment period. The significant difference of improvement was found between groups finally in week 4 (W4) to week 6 (W6). The group received Indomethacin suppositories with physical exercise shows improvement of patients with lumbago sciatica. Conclusion: The use of Indomethacin suppositories with physical therapy and the conventional modalities of treatment comparison help the physician to provide treatment facilities. The result was found better in groups those who received Indomethacin suppositories (Group-A) rather than those Groups who received other conventional treatment modalities. Journal of Armed Forces Medical College Bangladesh Vol.13(1) 2017: 28-32

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