Sciatica!!!

[HadEnuff]

I have struggled from time to time with lower back issues for 30 years. I'm 63 and have been retired for 6 months.

About once a year, or every year and a half, I'll get a spell of a few days with lower back spasms, and just have to take a few days to chill. I have a few "go-to" positions that I can be comfortable in. I see a chiropractor, and am quite faithful with back stretching exercises, but eventually, it gets me.

So last week I felt it coming on. Took the Advil, stretched, saw the chiropractor. Felt great. Went to bed, woke up around 1AM to answer nature's call and WHAM, I got a pain from right butt cheek to right knee like nothing I've ever felt. It won't go away. I've been incapacitated now for nearly a week.

I don't think this one is going away without some intervention. I'm in pain, and worse, I'm scared.

I'm set up for an appointment on Wednesday at a pain intervention clinic. Normally they require a referral from the "primary", but I know a friend of one of the docs. Also, normally, they require an MRI. My chiropractor tried to get my insurance co (Excellus) to OK an MRI and they told him they wouldn't authorize an MRI unless I'd had 12 weeks of conservative therapy. How's that for a Catch 22. The pain clinic won't see me without an MRI, and my INSCO won't approve the MRI without 12 weeks of conservative therapy.

perfect.

 

[Nemo2]

I'm set up for an appointment on Wednesday at a pain intervention clinic. Normally they require a referral from the "primary", but I know a friend of one of the docs. Also, normally, they require an MRI. My chiropractor tried to get my insurance co (Excellus) to OK an MRI and they told him they wouldn't authorize an MRI unless I'd had 12 weeks of conservative therapy. How's that for a Catch 22. The pain clinic won't see me without an MRI, and my INSCO won't approve the MRI without 12 weeks of conservative therapy.

perfect.

My MRI will have been 3 months ago next week.....upon completion a copy was sent to a pain clinic 50 miles away......I'm no closer now to seeing them than I was before I had the MRI. Onwards & upwards.

 

[HadEnuff]

My MRI will have been 3 months ago next week.....upon completion a copy was sent to a pain clinic 50 miles away......I'm no closer now to seeing them than I was before I had the MRI. Onwards & upwards.

so, how are you feeling?

 

[Nemo2]

so, how are you feeling?

Better than I was; the lower back arthritis is currently more of a problem than the sciatica...........I take a couple extra strength Tylenol most days (substantially less than their 'recommended daily maximum'), and have been able to do around an hour a day, (sometimes more), on the elliptical, in two sessions.

Still not able to walk as far as I used to (nowhere near as far), but, after being in considerable discomfort previously, I'm (relatively) happy to take whatever 'improvements' I can get.

 

[frayne]

65 years old here, retired for eleven years and have suffered lower back issues for years. This summer started to experience pain from lower back, down left buttock to the knee. After six visits to my chiropractor and no relief went to my primary physician and he gave me a script for some prednisone and ordered an MRI. The MRI indicated a small cernovial cyst between L4-L5 vertebrae, plus normal disc degeneration. He then set me up with an orthopedic surgeon who has suggested PT and a series of shots, one a steriod epidural and the other to drain the cyst, called a facet shot. I get shots starting Monday next week and the following week, all done in conjunction with PT. I am hoping for the best but realize these shots may be a temporary stop gap to get me back active again. If they don't take care of the problem then I'm looking at back surgery to remove the cyst and probably having L4-L5 fused. Pain sucks and is a real demotivator as you just don't feel like doing a thing. This whole process has taken the better part of three months and I have been pretty much sedentary during the period. My suggestion is, get the MRI, and see a specialist and go from there and good luck.

As a side note, to alleviate the pain I have taken two tylenol every morning and then walked two miles, pretty much in pain at least starting out and then it mitigates about a mile or so into the walk. Standing still for any length of time is not an option, I have to kneel, bend or sit down to get any pain relief. I also do two miles in the evening after supper and take two night time tylenol in order to get to sleep. If you have any questions or just want to chat feel free to IM me. Seeking just pain relief through medication is fine but understand which I'm sure you do, it doesn't address the root cause of the problem and in fact going on without treating the condition may in fact make it worse.

 

[SteveNU]

I know what you are going through. This was my dilemma about four months ago. Started with my PCP to get some meds to see how they worked for the back and leg pain, same as yours. I had done PT previously and it helped a little but didn't last. After a few weeks it was bad enough that I was ready to go to the ER on a Saturday morning but ended up at the Ortho group as they had urgent care walk-in on Saturday morning. They were able to get an MRI approved based on failure of the previous PT and the x-rays they took showing spondylolisthesis of L3-L4.

Mine got progressively worse over about 3 weeks to the point where I couldn't walk or get off the couch for four days. Finally had to go to the ER in the ambulance and ended up in the hospital for a week getting fusion surgery. It's been 3 months now and other than minor aches and pains from the healing still going on I'm starting to get back to normal. Still doing PT and get sore and tired from being up. Have to try and lay down several times a day to rest but it gets better week by week.

I would suggest seeing an Orthopedic doctor or neurologist as they can try other treatments and drugs to control the pain and will be able to move things along quicker if need be.

My problem was impingement of the L3 nerve and it gave me excruciating pain in the right hip, thigh and knee to the point where I couldn't do anything but lay there and take pain meds. Good luck and don't be afraid to push your doctor's to help control the pain and get this diagnosed and treated. The longer it goes on without treatment, the longer the nerves are getting irritated and thus the longer it can take them to recover.

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[keegs]

Hi HadEnuff,

My wife went though something similar. It came on after a cross Atlantic flight and persisted for almost a year. She had the epidurals, the PT and eventually moved on to acupuncture. It's anecdotal but within a few sessions, the pain began to subside. The insurance didn't cover the treatments and they ran about $80 a pop. I think she had about 12 visits. Hope you're on the mend soon.

 

[eytonxav]

When I hear right butt cheek with pain radiating down thru right leg, to me it sounds like piriformis getting tight and pressing on the sciatic nerve. You can google piriformis syndrome and find some specific exercises to help with that. Worth a try.

 

[daylatedollarshort]

I stopped having problems most days with back pain and sciatica by practicing yoga and acupressure. Sometimes if I've exercised too hard or have been sitting on a hard bench during the day I'll still wake up with a pinched nerve in my rear. Then I lay on a massage ball (from Amazon) and it always goes away for me, 100% of the time. The pain for me usually goes from excruciating to zero after a few minutes. A tennis ball will also work in a pinch, but the massage balls have spiky things that push in and loosen up the muscles around the nerves and stop the pinching better than a plain tennis ball.

 

[HadEnuff]

When I hear right butt cheek with pain radiating down thru right leg, to me it sounds like piriformis getting tight and pressing on the sciatic nerve. You can google piriformis syndrome and find some specific exercises to help with that. Worth a try.

that is on my differential diagnosis. I'm hoping that's what it is in fact, because outcomes tend to be better. From what I've read in the net, symptoms aren't typically as severe as mine, so I'm not optimistic.

True sciatica,emanating from the spine, and piriformis sciatica have similar symptoms, so it's a possibility. I've been massaging the piriformis with a tennis ball, and trying to stretch it, but to no avail so far.

Also, the stretching exercises I typically do for my lower back are excruciatingly painful right now, and from what I read, if they are that painful, I shouldn't try to do them.

It's a quandary: you want to not be too sedentary, because that can exacerbate the condition, but they also tell you not to try to work through too much pain.

 

[splitwdw]

Had Enuff, Did your chiropractor suggest deep massage (this hurts!) therapy? More expensive than Daylate's massage balls but works the same.
You said a friend got you an appointment with a pain clinic but what can they do without an MRI. Sciatic pain is caused by many things so how will they know what to treat?

 

[HadEnuff]

Had Enuff, Did your chiropractor suggest deep massage (this hurts!) therapy? More expensive than Daylate's massage balls but works the same.
You said a friend got you an appointment with a pain clinic but what can they do without an MRI. Sciatic pain is caused by many things so how will they know what to treat?

no mention of deep massage.

as to your second question, I don't know. I think the better question would be, "why do they need an MRI to start?" I'm hoping that they will evaluate my symptoms and at least come up with a differential diagnosis of the most likely causes, and arrive at a course of action that will include conservative measures to palliate my symptoms and recommend appropriate diagnostic measures to try to pin down a diagnosis.

 

[W2R]

Sciatica is awful! I don't have any helpful suggestions, but I sure hope you find some relief.

 

[Car-Guy]

My chiropractor tried to get my insurance co (Excellus) to OK an MRI and they told him they wouldn't authorize an MRI unless I'd had 12 weeks of conservative therapy. How's that for a Catch 22. The pain clinic won't see me without an MRI, and my INSCO won't approve the MRI without 12 weeks of conservative therapy.

perfect.

Medical insurance companies have more loopholes, tricks, rules and gotcha's than the IRS. They can be (and often are) a real PIA (sorry for the pun) to deal with. In the past few years my DW has needed a MRI and multiple CT scans. Our insurance company requires notification/approval before either procedure is performed, unless it's an emergency, but when ordered by a doctor they have always been approved immediately.

"IMO" insurance companies are getting awfully close to practicing medicine in many of these cases, by "seemingly" second guessing the doctor.

 

[daylatedollarshort]

Had Enuff, Did your chiropractor suggest deep massage (this hurts!) therapy? More expensive than Daylate's massage balls but works the same.
You said a friend got you an appointment with a pain clinic but what can they do without an MRI. Sciatic pain is caused by many things so how will they know what to treat?

One other thing that used to help a lot until I found the spiky massage balls was a dolphin massage tool (also from Amazon). It is a hard plastic tool shaped just like a dolphin and I could stick the nose of the dolphin right where it hurt and eventually the pain would stop. In a pinch I've also used the end of a hair brush.

Laying on moist heat packs would also sometimes help - just laying down on them and letting the muscles relax.

 

[mystang52]

What works for one person doesn't guarantee the same result for someone else. With that disclaimer, FWIW: I had very bad sciatica (diagnosis was spinal stenosis) a few years back. I started a regular swimming regimen and it was like a miracle cure.
It wasn't instantaneous. I noticed a little improvement after 2 weeks or so, and it was 4 - maybe even 6 - months before I felt 100% better. I still swim 4 to 5 days a week, partly because I enjoy it and partly because I don't want the sciatica to recur. Something to consider, anyway.

 

[rdy2go]

I do hip and leg stretches and Piriformis stretches every morning before I get out of bed just to keep it at bay. I have found that a large ice pack (about 12" square) on the lower back and hips helps more than anything. I use it until I am numb, let it all warm up, then ice it again. Ice will stop the spasms better than any muscle relaxant from my experience. If I'm traveling, I carry two one-gallon Ziploc bags with me to put a layer of ice in from the hotel ice machine. I double bag them so as not to have a leak. When your back hurts, everything hurts.

 

[Sunset]

I had bad back issues, numbing leg, went for PT for weeks and didn't seem to do too much good.
Finally doc has an x-ray done, and it caused a BIG change in the doc view, and I was referred to surgeon.

Even not being a doc, I could see on the x-ray how bad it was.

OP - did you get an X-ray, they are cheap and insurance companies usually make them a first choice.

 

[eytonxav]

that is on my differential diagnosis. I'm hoping that's what it is in fact, because outcomes tend to be better. From what I've read in the net, symptoms aren't typically as severe as mine, so I'm not optimistic.

True sciatica,emanating from the spine, and piriformis sciatica have similar symptoms, so it's a possibility. I've been massaging the piriformis with a tennis ball, and trying to stretch it, but to no avail so far.

Also, the stretching exercises I typically do for my lower back are excruciatingly painful right now, and from what I read, if they are that painful, I shouldn't try to do them.

It's a quandary: you want to not be too sedentary, because that can exacerbate the condition, but they also tell you not to try to work through too much pain.

I have suffered from that it was very painful. I went to a PT who was well versed in MAT (muscle activation technique). If stretches are causing pain, don't do them. What helped me a lot was laying on my back on the floor, elevate right leg about 6-8 inches off the floor while holding it straight, then pronate your foot in a clockwise direction as far as you can go and hold it for 5 sec, do that 5 times. Do the same thing laying on your side, and also laying on your stomach. I did that a few times a day for a few weeks and it resolved the issue. I don't think rolling on a tennis ball is the way to go.

 

[Dash man]

I've have cervical disc degeneration disease at three levels, nerve damage, spinal stenosis at both cervical and lumbar spinal levels with a bulging disc at K5-S1.
Be patient and go to your GP for some pain meds and muscle relaxers as needed, but find a good physical therapist and work hard at it, including at home and not just during your appointments. My PTs saved my life by relieving the pain enough to get around. After I got my MRI facet joint injections by my pain management specialist keep me going for a few months. Tune ups are needed at the PT every couple of years and injections about four times a year. Pain meds and muscle relaxers as needed but careful not to over do it. Good luck, but there's no quick fix.


Enjoy life!

 

[Bamaman]

My wife has been under the care of pain management about 15 years. She's had surgery for spinal stenosis, a number of steroid shots (under flouroscope) and a couple of double nerve ablasions. Our observations:

1. Every person with back problems is going thru Physical Therapy--a number of times.
2. We're somewhat afraid of some chiropractor techniques are doing more damage than good.
3. We'd rather use a neurosurgeon than a orthopaedic surgeon.
4. Only accept steroid injections under a flouroscope. Otherwise, the doctor's just guessing where the canal is, and that's not the way to do it.
5. Steroid injections must be done in series of three--a month apart. That's quicker than Medicare wants to pay for. Often, it's the third shot that puts you over the top.
6. If controlled substances are required to relieve your pain, take them exactly as prescribed. Many get relief and don't take their whole prescriptions--bad. Take'em all.
7. Don't worry about getting addicted to the pain medicine. Your main concern should be to get yourself back into society. The meds can very often keep you from being an invalid.
8. If you continue in pain, get yourself to a pain management clinic that's run by an anestesioligist with a fellowship in pain management. They're real deal--not a regular M.D. claiming to be a pain specialist that gives shots.
9. If the pain management is just shots only and no medicine management, go to another clinic. It takes both to get pain relief.

Unfortunately, state regulations are getting tougher because of physicians that are "candy men" prescribing pain meds to those without physical ailments. We're now required to pickup written prescriptions for controlled substances in person, and Medicare is billed about $360 per month for the office visit AND a $120 mental health analysis. And many of our local pharmacies don't even stock controlled substances, and we have to chase around to find the meds.

 

[splitwdw]

no mention of deep massage.

as to your second question, I don't know. I think the better question would be, "why do they need an MRI to start?" I'm hoping that they will evaluate my symptoms and at least come up with a differential diagnosis of the most likely causes, and arrive at a course of action that will include conservative measures to palliate my symptoms and recommend appropriate diagnostic measures to try to pin down a diagnosis.

Because the pain runs down the sciatic nerve from your lower back through the buttock and down the back of your leg. This same pain can be caused by a herniated disc or spinal stenosis or disc disease or a stress fracture and without an MRI they can't tell what/where the problem is. I wouldn't want them to guess if it was me.

 

[Capwest28]

What works for one person doesn't guarantee the same result for someone else. With that disclaimer, FWIW: I had very bad sciatica (diagnosis was spinal stenosis) a few years back. I started a regular swimming regimen and it was like a miracle cure.
It wasn't instantaneous. I noticed a little improvement after 2 weeks or so, and it was 4 - maybe even 6 - months before I felt 100% better. I still swim 4 to 5 days a week, partly because I enjoy it and partly because I don't want the sciatica to recur. Something to consider, anyway.

Thanks for this. Just the kick in the sciatic I needed.


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[HadEnuff]

Because the pain runs down the sciatic nerve from your lower back through the buttock and down the back of your leg. This same pain can be caused by a herniated disc or spinal stenosis or disc disease or a stress fracture and without an MRI they can't tell what/where the problem is. I wouldn't want them to guess if it was me.

However, those things can be present and may not be the cause. Which is why symptom evaluation is important, as is developing a differential diagnosis of all of the most likely causes, based upon that.

I'm not saying that an MRI is not important. I just disagree with the premise that you can't start the process without one. I had an MRI nearly 20 years ago and it showed a herniated disc, however it was not the cause of my pain.

 

[JoeWras]

I have a 30 year history of this.

Since you got it all of the sudden, be conservative. Give it some time. I know you have a lot of pain, but try the exercise and maybe an injection. Your body has a way of healing this. A bulge or herniation can relax and actually shrink if given time.

Exercise saved me -- for 30 years. You see other posters have previously said the same thing. Swimming really helped me.

But, sometimes, your options run out. After almost a year of suffering again, without improvement (only deterioration), I finally had surgery. No fusion, just a laminectomy/disectomy. I was to the point my life was ruined. I could no longer stand for more than 1 to 2 minutes without sitting or laying down. All the conservative stuff failed, but it did work for 30 years previously.

Now that it is done, I wondered why I waited. As far as surgery goes, it was the most conservative back surgery you can have. It has been positively life changing. DO hold off surgery and try other options first, but DON'T rule it out. You will read horror stories on the internet. However, the right candidate with the right surgeon can result in very successful outcomes.

One more thing, I never really had any "back pain" the last 10 years. It has been 100% in legs and butt. In my case (and I've read others' too), if your pain is mostly in the back, you have a better chance of recovery from conservative treatment.