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41 Comments
Mali
September 2, 2011Please sent me the pictures about sciatica exercises for reduce my pain, thanks
Dr. George Best
September 2, 2011You can download the free ebook that has basic sciatica exercises and other tips at:
http://www.sciaticaselfcare.com/SciaticaSelfCareEbook2011.pdf
You will need the Adobe Reader software to be able to view the ebook. If you don’t already have it, you may download it for free at:
http://get.adobe.com/reader/
Good luck!
Dr. Best
Mary Acen
April 24, 2018I have been suffering from sciatica since December 2017. when it reached February 2018 it was so severe that I could hardly do any thing on my own leave alone walking. In a bid to try to get solution to my problem I came across your website and I started doing the exercises right away. I am now glad to tell you that I can now walk and only feel a very mild pain which i believe will disappear completely soon. Thanks so much doctor may God bless you abundantly.
Dr. George Best
April 25, 2018Thank you for your message. I am very glad that you found relief with my methods!
Dr. Best
Hamid
January 14, 2012Thanks you for posting this !
Dr. George Best
January 14, 2012You’re welcome!
Dr. Best
patty arnold
July 15, 2012How do I go straight to Physical therapy or exercises for sciatica. I have suffered with degrees of low back pain for many (at least 20) years. I am 68 years old and was employed as a Registered Nurse up til 6 years ago when I could retire. The past 2 years it has become pretty incapacitating. Even with strong narcotic pain meds, physical therapy, therapeutic massage, chiropractic, tapping, yoga, much reading, steroid injections(3 in 2007 and 2008 then they stopped working, then again Dec, 2011, May 2012 and one last week (July 12) , life is getting harder. I have enrolled in your program. My most recent MRI Sept, 2011, gave the following dx: L3-4 mild spinal stenosis related to a combination of broad-based bulging annulus, spondylosis, right greater than left-sided degenerative facet disease with bony hypertrophy and shortened pedicules. Ligamentum flavum hypertrophy is also noted. Marked rt. sidedand mild left-sided intervertabralforminal narrowing is noted. L4-L-5 moderate spinal steosis is produced by a combination of circumferentially bulging annulus, lt. greater than rt-sided degenerative facethypertrophy and shortened pedicles with ligamentum flavum redundancy. There is marked rt. and lt.-sided foraminal narrowing. S-shaped scoliosis, as well as straightened lordosis with reduced spinal canal diameter at lower lumbar levels, associated with shortened pedicles. There is anterior and posterior lower lumbar spondylosis. There is mid to loser lumbar disc height narrowing attributable to widespread degenerative disc disease. The vertebral bodies are normally aligned and preserved in height with marrow signal pattern, aside from degenerative sub endplate signal changes. My next step is attempting a consultation at Cleveland Clinic as I reside with 200 miles from Cleveland. I have purchased your program but I do not seem to be able to navigate it in such a way that I get so far and when I need to stop, can not pick up where Ieftoff. I’m not even sure I have located your e-book. Any ideas specific to controlling the pain, getting a better quality of life and navigating your program. Thank you in avance for your assistance. Patty Arnold
Dr. George Best
July 16, 2012I have replied to your other email, but just in case, I’ll post my comments here as well:
From the MRI findings, unfortunately it is unlikely that you’ll get a satisfactory long-term outcome with conservative treatment measures.
In your case, the openings for the nerves are being narrowed by bulging discs in the front of the spine and a combination of degenerative bone overgrowth, ligament thickening/buckling, and short pedicles (the portion of the vertebra that joins the vertebral body with the arch that surrounds the spinal cord and nerves) in the back of the spine. With this situation, it only takes a small amount of inflammatory swelling to cause nerve compression and trigger symptoms.
Because a significant part of the narrowing around the nerves is due to bony issues and degenerative ligament thickening, exercises and conservative management strategies will typically not work very well.
For long term relief, my suggestion would be to consult with a surgeon who does “minimally invasive” back surgery. There are various techniques used for this, but the basic idea is they do the surgery through small incisions using a scope. The surgeon trims away the extra bone and ligament tissue and trims back the bulging discs to open up space around the nerves. In most cases, people are feeling much better and able to return to most normal activities within a week or so.
The main disadvantage of minimally invasive surgery (other than the usual risks of all surgeries) is that by trimming away the bulging part of the disc, the disc wall is left thinner and is prone to re-injury (re-herniation or rupture) in individuals who engage in a lot of heavy exertion or high-impacy activities. Given your age and activity level, I would say that this would be an unlikely issue in your case. Minimally invasive surgery has a much lower incidence of post-surgical complications than more aggressive procedures, and of the patients I’ve seen who have had it, most are quite happy with the results as long as they take good care of their backs after the surgery and don’t engage in the previously-mentioned activities that are prone to causing reinjury.
If you have further questions, let me know.
Good luck!
Dr. Best
Annie James
July 17, 2013Dear Doctor,
Please tell me the ‘Don’ts’ that are impt. to reduce the sciatica pain.
Dr. George Best
July 17, 2013Annie,
The most important do’s and don’t’s are covered in detail in my free ebook. If you have not already downloaded it, you may do so from the link on the right sidebar of this page:
http://www.sciaticaselfcare.com/basic-sciatica-exercises/
Good luck,
Dr. Best
Starr
February 15, 2014I have never had back problems and was in shock when I all of a sudden could barely move or do anything because of a sciatica problem. I searched all over and talked to everyone I could to find some relief.I watched your videos and took your advice. Doing the exercises, using ice, naprosyn and a mild muscle relaxer, within one day I was 60% better and 100% better within 3 days. I will continue the stretching exercises on a weekly basis.Also, I only took the muscle relaxers 3 times and naprosyn for 72 hours Thanks so much for your help Dr. Best.
Dr. George Best
February 15, 2014You’re welcome. I’m glad you found my information helpful.
Dr. Best
Larry
May 21, 2014Thank you for your fantastic help. I was told by a test, where I had needles and shocks to my legs to diagnose that I have a slight pinched nerve in my L-5/S-1. I did have a slip and fall the right side of my body about 3 years ago and I did feel like I may have hurt myself or knocked something out of line in my lower back. I have been trying your two main exercises and it seems to help relieve my discomfort, mostly in my feet, but only for short periods of say 1 or 2 hours. I also found relief when I lie on the living room floor and I put my feet up onto the couch seat and try to keep my back as close to the couch front, for a period of about 30 minutes. So is this like a mini traction and do I maybe need real traction to fix my problem better or for good, this procedure seems to help my feet a lot. I do not read here that many folks describe what my main main problem is. My feet fill like there is a huge callus on the bottom of them even though they appear to have no callus and appear normal. Also my toes feel numb, my right foot is much worse than the left foot. I thought maybe my knees could be causing this problem so I gave up my daily walks of about 30 minutes per day. I am 61 years old and walking to me has always been my medicine and now I fear walking it is contributing to my foot burning, numbness and on rare occasion my feet feel like I am walking on rocks. I was told years ago that I have flat feet and read here that this too could cause some problems.When i mention burning feet, the first words out of most peoples mouths are, sugar diabetes, but I am pretty sure I do not have this disease. So what do you think is my problem. It is driving me nuts and has interfered with my everyday well being and my also my sleep, since at times when lying in bed it burns so bad I can not sleep. Could it also be possible that my foam mattress could be not supporting my back and even possibly the heat from the foam could be emitting heat affecting my back and my feet. I have seen TV commercials saying these foam mattresses emit heat. Sort of like when you rub a balloon or any rubber material, it creates heat between the rubber material and ones body. I am surprised you never a soft or non supportive mattress could be causing lower back pain or other related ailments. I even though maybe I am allergic to rubber sneakers. I take no meds, I feel they do more harm than good. Please help and let me know if you can have any idea what is wrong with me.
Dr. George Best
May 21, 2014Hello Larry,
What you described sounds like peripheral neuropathy, which just means that the nerves aren’t functioning at normal levels. This is commonly associated with diabetes, but can be caused by various other conditions and in many cases (especially in people over 60) it is idiopathic, meaning that no particular cause can be identified. It might be related to the fall you took and since the exercises help temporarily, I suspect that there’s at least some contribution from disc protrusion and/or muscular contraction, but that may not be the entire issue.
It is possible that your bed is not supporting you adequately. Foam mattresses don’t emit heat per se, but they can trap heat from your body where you are in contact with the mattress, but even if that’s the case, it’s unlikely that the mattress is trapping enough heat to be causing your symptoms. In any event, before you spend a lot of money on a new mattress, I suggest you try a few things to see if they help.
Besides continuing the exercises and perhaps doing them more frequently for a few weeks, I suggest you try supplementing with B-complex vitamins and a supplement known as alpha lipoic acid, which is a strong anti-oxidant that is sometimes helpful for neuropathy. You might also want to try getting some magnetic insoles to wear in your shoes, as these help in some cases too. Finally, acupuncture is worth considering as it is often helpful for peripheral neuropathy symptoms.
Good luck!
Dr. Best
Bruce
August 5, 2014I am one of those who has difficulty following through after seeing the physical therapist. Some of the exercises were too difficult for me to remember and I did them incorrectly. So I am going to try again. And you’re right; it is difficult to do these exercises for life.
I am also suffering from numbness on my two pinkies and think this is due to my spinal stenosis. Is there anything that can be done to get rid of the numbness, short of hand surgery or something like that?
Dr. George Best
August 6, 2014Hello Bruce,
The easiest way I know for people to be consistent with the exercises once they get to the prevention stage is to make them a part of your daily routine done the same time (or at least in the same order as your other daily activities) just like brushing your teeth. I actually do back exercises myself every night before going to bed. Some people prefer to do them first thing in the morning. You might have another preference, but the key is to do them at a set time every day.
With regards to the numbness in your fingers, depending on how long the numbness has been there, there may not be anything that can be done to get rid of it, including surgery. If it’s been a constant thing for several years, chances are you’re probably stuck with it, but there are some things that should at least help keep it from getting worse and might possibly get rid of it. The most important thing for slowing the progression of spinal stenosis is to keep the spine as flexible and movable as possible. Stretching the neck is relatively simple, as you’re just moving through the basic ranges of motion: bending your head forwards and back, bending side to side, and turning side to side. Just carefully go as far as you can in the pain-free (or at least not extra painful if your neck hurts all the time) range of motion in each direction. It’s best to do the stretching a few times throughout the day, but even once a day is helpful. Another thing that may help is traction. There are a number of home traction devices available ranging from a simple pulley system that hangs on a door and uses a water bag or weight to apply the traction to devices that you use lying down that have some sort of pump to inflate an air bladder or hydraulic cylinder to provide the traction. All of them work to some extent and are available from health care providers or from various direct-to-consumer companies (Amazon.com has a number of different devices available from different companies for example). The pump devices tend to be more expensive than the pulley type, but they’re also more convenient to set up and use, so since you have trouble with follow-through, you might tend to use the pump type more consistently and therefore get more benefit.
One other thing that sometimes helps with numbness and symptoms from spinal stenosis is acupuncture. Again, the longer the numbness has been there, the less likely it is that it can be eliminated, but an acupuncturist can evaluate you and give you an opinion on what the likelihood is that it can be helped. If it did help, you’d probably need periodic treatments to keep it at bay, but that’s also something an acupuncturist can give you a better idea of what to expect.
Good luck!
Dr. Best
samantha
January 30, 2015Dr. Best:
I am a new member of your website and consider it well worth the money. Your generous sharing of knowledge at no charge to the public is unusual with many websites charging for less information than you are giving away.
I think my sciatica flare actually started in Physical Therapy with the PT insisting on my doing The Bridge and squeezing the butt. Instantly I felt a sharp pain down thigh and into the side of calf. Much of that rehab was trying to get strength back into leg after an injury to the Achilles tendon muscle overload. In PT too many side kicks and monster walks soon ended up in a miserable case of inflammatory sciatica. I havent been back to PT since but joined your website and just got your most informative and easy to follow book. It has been about three weeks and the sciatica is gradually ebbing and symptoms retracting into the glute area. Next challenge will be to regain strength in the thigh area but I think the PT just rushed the healing beyond what I was able to process at that time.
Dr. George Best
January 30, 2015Hello Samantha,
I’m glad that you’ve found my website beneficial.
It’s not uncommon for practitioners to be a little too aggressive with their treatment regimen. Every patient is different, and while it is sometimes necessary to push patients a bit to get them the maximum results as fast as possible, it’s easy to push things too far too fast especially at the beginning of the therapy program before the practitioner is familiar with the patient’s limits. Hopefully now you’ll be able to get things settled down and then progress to strengthening the thigh a bit more slowly and get things back to normal.
Good luck!
Dr. Best
Jaya Singh
July 21, 2015My sciatica started at chiropractor. I was getting treatment for low back pain. One day he adjusted my low back and I started feeling my hamstring was pulled. Gradually the pain started in my butt and legs with pins and needles. I continued the treatment but pain kept on increasing. One day he told me that since it is not going away I should try accupuncture. I went to another chiropractor and he told me that from the symptoms of it my L5 S1 dis was herniated and pinching the nerve. Continued the treatment for 3 weeks with little relief. Tried accupuncture for 2 times and my tingling was reduced. Tried my old physiology who said the same thing and performed some stretches. next morning I could not get out of my bed. I had to call ambulance to go to the hospital. I was there in the hospital no diagnostic was done. I was sent home with just painkillers. I’m in my bed since then, cannot walk how excruciating pain in my leg every time I get up and go to the washroom. I am consulting Ayurvedic medicine and have advised for complete bed rest for seven days and use heat on my legs but for pain during this time. I’m scheduled for an MRI in November until now everyone is guessing about my problem. No tests were done to confirm the disc herniation. Could you please suggest what am I supposed to do. I’m off work for next six weeks on short term disability. I have two little kids to take care off.
Dr. George Best
July 22, 2015Hello Jaya,
It does sound to me like your symptoms are probably disc-related. Although it’s generally thought that chiropractic manipulation does not cause disc protrusions, it can irritate and inflame and existing disc problem and provoke increased symptoms in some cases. The same is true of physical therapy and it sounds like things were starting to settle down with the acupuncture when it got fired up again by the stretching. The low back pain you started with was probably due at least in part to the disc issue and the treatment resulted in inflammation that caused increased nerve involvement and extension of the symptoms. With regards to testing to confirm the disc herniation, an MRI is the primary tool for that. I’m assuming the wait until November for the MRI is due to the availability within the Canadian health care system. While I’m sure it is very frustrating that you didn’t have any testing to confirm the disc herniation before now (or before November I suppose is more correct), I suspect that the reason you didn’t is that most cases like yours, within the type of health system you have, resolve or improve enough before you can get the test done that the test is no longer needed.
What I suggest you do is begin with the methods in my free ebook – if you don’t already have it, you may download it from the link on the right sidebar of this page:
One point I want to emphasize is the importance of frequency with regards to the exercise and application of cold packs as discussed in the ebook. Generally the more frequently you use them (up to the maximums in the ebook), the faster you will recover.
Although I have great respect for Ayurvedic medicine, I have to disagree with one of the recommendations you were given. Prolonged bed rest has been repeatedly shown to be not only ineffective for back pain and sciatica, but even counterproductive in most situations because it leads to de-conditioning of the postural support muscles making you susceptible to re-injury. The exception to this would be in cases of actual disc rupture for which surgery is necessary, but this is relatively unusual, so I would approach it as a disc herniation until proven otherwise. Heat is usually a bad idea when applied over a disc herniation as it tends to increase inflammation and swelling, but it is usually all right to use over the areas of pain in the legs as was recommended to you,and may help temporarily ease the leg pain. I think you’ll find that applying cold packs to the lower back area per the instructions in my ebook is more effective though.
It sounds like the acupuncture was starting to help when the stretching re-irritated things, so if that’s available to you, I would suggest trying it again.
If you are not getting any improvement with the methods suggested above within one to two weeks, then I would recommend trying to get an MRI sooner. The fastest option is probably to take a trip to the U.S. to have it done. Cost varies by location, but if you check with the facilities nearest you, you can probably find one that will do it for around $500 (US) paid at the time of service. The other option that may work is trying to get your case upgraded to emergency status to get scheduled sooner within the Canadian system. I don’t know the ins and outs of that, but I have talked with a few people who “embellished” their symptoms a bit to get what they needed a lot faster. Not that I’m suggesting you do it, but one gentleman I know of essentially faked a severe disc-related condition known cauda equina syndrome to get an MRI and subsequently surgery, all within a few days when he was originally told it would be a few months for the MRI and several months after that for surgery if it was deemed necessary. Hopefully the treatment suggestions I’ve made will negate the need for a more prompt MRI.
Good luck,
Dr. Best
Geirge
September 17, 2015Dear Doc, I have read most of your suggested therapies.I have a herniated disc confirmed by an MRI.Have been on medication for 3 years but the pain in the lower back and the leg persists. My work calls for long hours of sitting at meetings, at the computer or flying across Africa. What options are there for me?The pain is severe.
Dr. George Best
September 18, 2015Short of getting a different job that doesn’t require you to sit as much, the best you can do is to use the self treatments, particularly the McKenzie method (in the position that best centralizes your symptoms as discussed in my free ebook), as frequently as possible, as well as minimize your sitting as much as you can (get up and move during flights as much as is allowed, for example). While a surgery might give you good relief for a while, I would expect the excessive sitting to begin to take a toll on other discs eventually and you’d start having significant symptoms again. Unfortunately, sitting is one of the worst things for a disc herniation, and so my advice is to do everything you can to reduce the amount of sitting you do.
Good luck!
Dr. Best
Shitu
July 27, 2016Hello doctor
I did all the exercises mention in your videos but my pain in the glute is still severe especially when sitting in the car it’s very painful
Dr. George Best
July 27, 2016There’s a lot more in the ebook, so I recommend you go through it and follow the instructions carefully. If you have not already downloaded it, you may do so from the link on the right side bar of this page:
http://www.sciaticaselfcare.com/basic-sciatica-exercises/.
Bear in mind that the underlying problems that cause sciatica can be severe, and it may take doing the exercises on a frequent basis (discussed in the ebook) for several days to get good results. While the methods in the ebook work well for most people, there are cases in which the underlying problem is too severe to be managed with those methods alone. If you fail to achieve significant improvement within two weeks, I would strongly recommend seeing a doctor for a professional evaluation, and probably an MRI or CT scan to determine the specific nature of your problem and your best treatment options.
Good luck!
Dr. Best
Kabeer
July 28, 2016Hello doctor
I already did MRI this is the report
(1) straightened lumbar lordosis
(2) early spondylo-degenerative change with degenerated disc and multilevel schmorl’s nodes
(3) normal dimension of bony lumber canal
Multilevel disc lesions as follows:
(1) L3-4 minimal diffuse posterior annular disc relaxation inclined to right side
(2)L4-5 minimal diffuse posterior disc bulge smoothly intending the ventral theca and encroaching upon inferior recesses of both exist neural canals
(3)L5-S1 mild posterior disc bulge
(4) Normal facet joint
(5)No paraspinal masses or collections
Need your help
Dr. George Best
July 28, 2016My apologies. I forgot that you had already sent your MRI findings. As I said before, I have to take issue with calling a disc bulge that is large enough to indent the thecal sac and narrow both spinal canals as a “minimal diffuse bulge”. If the bulge is large enough to affect the central spinal canal and both neural canals, it is certainly more than a “minimal bulge”. Unfortunately, I suspect it is that description that has led your doctors to believe there is not a significant problem, when there very much is. Anytime there is encroachment of disc material into the neural canals, there is a strong likelihood of direct nerve irritation as well as indirect nerve irritation from inflammatory swelling. Furthermore, in some instances, the amount of disc bulging and narrowing of the nerve canals can be substantially greater when you are upright (standing or sitting), as compared to lying down. Since most MRIs are performed lying down, the severity of the problem can be misleading. So, in your case, there is a substantial problem visible on the MRI which may actually be even worse when you are in an upright position.
In terms of treatment, you may still find relief by using the methods in my ebook on a frequent basis (as discussed in detail in the ebook). In addition, I would recommend discussing your treatment options with your doctor on the basis that although the MRI report calls the L4-5 disc bulge “minimal”, it is bad enough to be narrowing the nerve canals and therefore is a likely cause of your symptoms.
If you can’t convince your doctor that your condition requires some other treatment beyond what is already being done, I would suggest inquiring about the possibility of getting an upright or “loaded” MRI if it is available in your area. This would show what is happening with the discs when you are sitting and would give a much better assessment of your problem.
Good luck!
Dr. Best
Lilia
September 16, 2017Thanks doctor it works, I just have a question do you think in my daughter the cold pack is better or the hot is better.
Thanks again
Dr. George Best
September 16, 2017With disc-related symptoms, cold packs are almost always better because they help reduce the inflammatory swelling that usually participates in nerve compression.
Dr. Best
Monique
December 3, 2017Hello Dr. Best,
I have recently stumbled upon your website and love the feedback you have been providing people. You seem to be very knowledgeable and care!
I am a 48-year-old female who used to be VERY active. An avid soccer player and worked out every day, high intense including weightlifting. My job requires me to sit for long periods often times leaning over a table working with children.
I have been dealing with lower back (nerve) pain that radiates down my leg into foot involving the front, back and side of my leg and hip area. Every day is different. I have had 3 cortisone/nerve block injections, PT and recently (2 weeks) had a nerve ablation. Additionally, I have done acupuncture and myofascial release but this was roughly a year ago as I was originally diagnosed with Piriformis Syndrome and a locked facet (right side).
Here is the results of my CT scan that was done 2 months after an MRI which did not show some new information. DO you think that continuing PT will benefit me?
FINDINGS: There are 5 lumbar type vertebral bodies. The vertebral body heights are normally maintained, and there is no compression fracture deformity.
L5-S1: Moderate disc space narrowing. No facet degenerative changes. No significant change in previously noted posterior disc protrusion with extrusion. No central canal stenosis. Mild bilateral neural foraminal narrowing.
L4-L5: Moderate disc space narrowing. Prominent facet degenerative changes and mild ligamentum flavum hypertrophy. No significant change in 4 mm broad-based posterior disc protrusion. No central canal stenosis. Moderate bilateral neural foraminal narrowing.
L3-L4: Moderate disc space narrowing. Mild bilateral facet degenerative changes. A 2-3 mm retrolisthesis of L3 on L4, unchanged. No significant change in 4 mm broad-based posterior disc protrusion, and 5 mm left far lateral disc protrusion. No central canal stenosis. Moderate-severe bilateral neural foraminal narrowing.
L2-L3: Moderate disc space narrowing. Mild bilateral facet degenerative changes. A 2-3 mm retrolisthesis of L2 on L3. No significant change in broad-based central and left paracentral disc protrusion measuring approximately 4 mm. Mild-moderate central canal stenosis. There is mild left lateral recess narrowing. There is mild left neural foraminal narrowing. No significant right foraminal narrowing.
L1-L2: No disc space narrowing. No significant facet arthropathy. No central canal stenosis. No significant neural foraminal narrowing.
T12-L1: No disc space narrowing. No significant facet arthropathy. No central canal stenosis. No significant neural foraminal narrowing.
Paraspinal soft tissues are unremarkable.
IMPRESSION:
Multilevel degenerative disc and facet disease involving the lumbar spine as detailed above. Allowing for differences in technique, there does not appear to be a significant interval change since the prior lumbar spine MRI of 8/12/17.
Monique
December 3, 2017Correction, I was originally diagnosed with Piriformis Syndrome and a locked SI joint and facet syndrome (right side)
Dr. George Best
December 4, 2017Hello Monique,
Yours is a very complicated case. While it’s not too unusual to have some issues at more than one disc, not only do you have significant protrusions at multiple levels, your symptoms indicate that multiple nerves are being affected. You didn’t say specifically what your physical therapy entails (“physical therapy” is a broad term and can encompass a lot of different treatments), so I can really say much about that without more details. What I can tell you is that due to the complexity of the problems you have, pretty much any treatment is going to be hit or miss. This is not to say that you can’t or won’t get better, but it’s probably going to take some time and probably some experimenting with various treatment approaches to try to find something that works for you.
From a self-treatment perspective, the methods from my free ebook may work, but my guess is that it will take a fairly long period of the “intensive” treatment regimen to make progress. I’d focus on the McKenzie method, probably one of the extension positions, but test them all. Cold packs and any other anti-inflammatory measures you wish to use will be important as well.
Traction / spinal decompression, or possibly inversion may help, but again, it may take some time. If you found acupuncture or myofascial release helpful before, it may be worth combining those with other treatment methods.
Ordinarily, with an extrusion (which the report you gave is at L5/S1), I would automatically suggest consulting with a surgeon who does minimally invasive procedures (extrusions generally don’t respond that well to non-surgical treatment), but you’ve got three other levels where there are significant problems and it is my understanding that’s a lot more than what they’ll try to fix with a minimally invasive technique.
I’m sorry I don’t have anything really concrete to recommend, but yours is just one of those cases where there’s a lot going on and it’s hard to know how to approach it.
If you have further questions or would like to give me more info about what your physical therapy consists of, I’ll be happy to provide what information I can.
Dr. Best
Monique
December 6, 2017Thank you, Dr. Best, for taking the time to respond to my question.
The neurologist told me before I had the CT he did not want to do surgery. However, the MRI noted the same thing you pointed out regarding the extrusion.
He ordered PT, a CT, Xrays and a nerve test on my leg which I have not done yet. I have gone to PT one time but he needed to get a new auth because my pain is considered chronic.
Thay gave me the following exercises to do:
Single knee to chest stretch-bent
Double knee to chest DKTC
Pelvic tilt
Supine hip abduction- elastic band clams
Hip hinge at wall
Abdominal brace
After, my session they did heat and a tens unit. I have a tens unit I use at home often. I also, have an inversion table that I have not been good at using but will get back on it!
**These were given to me before the CT scan was done.
In the past I did PT for the piriformis Syndrome but was DC’ed due to no real progress. I told this to the nuero-surgeon but he wanted me to try again because its been 2 1/2 – 3 years.
Although I am not sure it makes much of a difference, here are the results from the MRI I had 2 months prior to the CT scan.
There are no vertebral body masses or fractures. Conus is at the L1 level, which is within normal limits. There are no intradural lesions or paraspinous masses.
T12-L1: There is 2 to 3 mm right paracentral disc protrusion with no spinal stenosis or neural foraminal narrowing.
L1-2: There is no disc protrusion or extrusion, spinal stenosis or neural foraminal narrowing.
L2-3: There are mild bilateral facet degenerative changes. There is moderate disc desiccation and disc space narrowing. There are are mild to moderate degenerative endplate changes with mild edema. There is broad-based disc protrusion, measuring a maximal of 4 mm in AP diameter. There is mild-to-moderate narrowing of the left side of the canal. There is mild left lateral recess and neural foraminal narrowing.
L3-4: There is moderate disc desiccation and disc space narrowing. There are mild bilateral facet degenerative changes. There is 4 mm broad-based disc protrusion. There is no spinal stenosis. There is moderate bilateral lateral recess and neural foraminal narrowing, more severe on the left side. There is also a left far lateral disc protrusion, measuring 5 to 6 mm in AP diameter.
L4-5: There is moderate disc desiccation and disc space narrowing. There is 4 mm broad-based posterior disc bulge. There mild bilateral facet degenerative changes. There is no spinal stenosis. There is moderate bilateral lateral recess and neural foraminal narrowing.
L5-S1: There is moderate disc space narrowing. There is 3 to 4 mm broad-based posterior disc bulge along with right paracentral disc extrusion, extending slightly posterior to S1 vertebral body. There is no spinal stenosis. There is displacement of the right S1 nerve root posteriorly with mild right lateral recess narrowing. There is also mild left lateral recess and neural foraminal narrowing.
IMPRESSION: L2-3: There are mild bilateral facet degenerative changes. There is moderate disc desiccation and disc space narrowing. There are are mild to moderate degenerative endplate changes with mild edema. There is broad-based disc protrusion, measuring a maximal of 4 mm in AP diameter. There is mild-to-moderate narrowing of the left side of the canal. There is mild left lateral recess and neural foraminal narrowing.
L3-4: There is moderate disc desiccation and disc space narrowing. There are mild bilateral facet degenerative changes. There is 4 mm broad-based disc protrusion. There is no spinal stenosis. There is moderate bilateral lateral recess and neural foraminal narrowing, more severe on the left side. There is also a left far lateral disc protrusion, measuring 5 to 6 mm in AP diameter.
L4-5: There is moderate disc desiccation and disc space narrowing. There is 4 mm broad-based posterior disc bulge. There mild bilateral facet degenerative changes. There is no spinal stenosis. There is moderate bilateral lateral recess and neural foraminal narrowing.
L5-S1: There is moderate disc space narrowing. There is 3 to 4 mm broad-based posterior disc bulge along with right paracentral disc extrusion, extending slightly posterior to S1 vertebral body. There is no spinal stenosis. There is displacement of the right S1 nerve root posteriorly with mild right lateral recess narrowing. There is also mild left lateral recess and neural foraminal narrowing.
Thank you again for your time.
(Wondering now if I may need to go get a second opinion)
Dr. George Best
December 6, 2017As I said before, you have a complicated case, and treatment is going to be hit and miss. That being said, what you’re getting is pretty much a generic set of back exercises that is unlikely to cause any harm, but I doubt it’s going to help much either. To be fair, your doctor and PT may be as much trying to avoid irritating things further. With the way insurance works these days, you pretty much have to “jump through the hoops” of PT and medication, injections, etc, before they’ll consider covering surgery or other more aggressive (and more expensive) treatments.
The main thing I would suggest reconsidering with your treatment is using heat. I generally go with cold packs in cases like yours to try to reduce inflammation, and I’m not a fan of using heat in such circumstances. There are differences in opinion and what it comes down to is what works best (if either seems better than the other or neither) for a given person. TENS is fine as a pain control modality. Inversion is worth a try, just go slow with it, starting with a small angle of inversion for short periods and work up to more if you don’t have any increased symptoms with using it.
Good luck!
Dr. Best
Monique
December 7, 2017Great, thank you very much! I can say since watching your videos I have personally stopped using heat and have noticed a little difference. It is quite soothing while using it but I can tell a difference in my pain levels without it.
Luckily I think I am on my last leg of hoops! With 3 injections/nerve blocks and an ablation, I am not sure I will have much longer(I hope anyhow). I really do not want surgery but if that is the best thing to cure my pain then I will.
Again, thank you very much for your time! Hava wonderful holiday season!
Dr. George Best
December 7, 2017You’re welcome. Good luck to you, Monique!
Dr. Best
Cindy
March 27, 2018Hi doc,
Could u tell me if this is a surgery case or the therapy and excercises will help me, and could u tell me what is the best exercise position for me to do. This is the MRI result:
The vertebral bodies are normal with normal alignment.No compressive of infiltrative abnormality. There is reduction of L4-L5 and L5-S1 disc space with disc desiccation changes.The remaining disc spaces and signal intensities are within normal limits. The conus medullaris terminates normally ends at L1 and demonstrates normal MR morphology. At L4-L5 level there is is mild diffuse posterior annular disc bulge causing mild foraminal and spinal canal narrowing. The exiting nerve root appears normal. L5-S1 level there is a diffuse posterior annular disc bulge with right paracentral bulge causing moderate foraminal and severe right lateral recess stenosis impinging and preexiting right S1 nerve root. The exiting nerve roots appear normal. The remaining neural foraminae and exiting nerve roots are normal. The para vertebral soft tissues and the posterior elements are unremarkable.
IMPRESSION: Disc degenerative disease with mild to moderate posterior disc bulges at L4-L5 and L5-S1 impinging the preexiting right S1 nerve root.
Dr. George Best
March 27, 2018Hello Cindy,
In my experience, most cases with MRI findings like yours can be resolved without surgery. Therapy and exercises usually work, although I have found that frequent at-home treatment usually is necessary to get reasonably fast improvement (within a few weeks) – as opposed to just doing daily or every other day treatment in a professional setting (which often takes a few months).
Regarding what McKenzie position to use, that’s not something that can be determined from an MRI. That requires using the testing procedure discussed in detail in the instructions in my ebook.
Dr. Best
Annette
April 4, 2018Hi Dr. Best!
I found your site very helpful, I would really appreciate it if you could make my MRI findings (one year apart) easier for me to understand as I have no medical background or anything, and all I understood was the word “progression” in it. The 2nd MRI came about because I was having physiotherapy and my therapist asked me to do planks and leg raises (lying down). I was in a 3/10 pain scale and now I am at 9, I have pain now up to my calf area whereas before it was only up to my bum. I was given one Voltaren injection and it did not do anything for me at all. Will I be needing surgery soon? Below are my MRI findings.
Thank you for any help Dr. Best!
2017 MRI OF THE LUMBAR SPINE WITHOUT CONTRAST:
CLINICAL INDICATION:
Lower back pain.
FINDINGS:
There is straightening of the normal alignment with minimal positional scoliosis. The vertebral body heights and bone marrow signal are unremarkable. No suspicious focal bony lesions identified. The cord, conus, and cauda equina roots are unremarkable. The disc spaces and signal are preserved with the exception of L5/S1 disc. The L1/L2, L2/L3, L3/L4, and L4/L5 show no disc herniation, spinal canal, or foraminal stenosis.
L5/S1: There is a mild diffuse disc bulge with a superimposed right subarticular annular tear and focal protrusion noted. This is causing mass effect on the right subarticular recess and compression of the traversing right S1 nerve root. Minimal facet joint arthropathy and thickened ligamentum flavum noted at this level. No spinal canal or foraminal stenosis seen.
The imaged soft tissues are unremarkable. The paraspinal muscle volume is preserved.
IMPRESSION:
Focal disc herniation at L5/S1 with compression on the S1 nerve root as described.
2018 MRI OF THE LUMBAR SPINE WITHOUT CONTRAST:
CLINICAL INDICATION:
Lower back pain.
FINDINGS:
There is straightening of the normal alignment. The vertebral body heights and marrow signal are preserved. The cord, conus, and cauda equina roots are unremarkable. The intervertebral discs from L1/L2 to L4/L5 level are intact.
There is mild interval progression of the previously described right L5/S1 subarticular disc protrusion with increasing mass effects on the traversing right S1 nerve root. There is persistent changes of facet joint arthropathy and thickening of the ligamentum flavum. No spinal canal or foraminal stenosis noted at this level.
The imaged soft tissues are intact. The paraspinal muscle volume is preserved.
Dr. George Best
April 4, 2018Hello Annette,
The simplified version is that the last disc in your spine has a mild generalized bulge/protrusion with a more focal bulge/protrusion on top of that which is putting pressure on the nerve. To use an analogy, it would be kind of like a road that had a gradually sloped bump on it and then someone set a parking curb on top of that – if you drove over the bump by itself, you probably wouldn’t notice it that much, but if you drive over it with the parking curb there, you’re definitely going to feel it! You also have some thickening of the bone surfaces and ligaments at the back of the spine, which may or may not be contributing to your symptoms by means of slightly narrowing the back side of the opening that the nerve passes through (the disc protrusion narrows the front side of the opening). The disc protrusion has increaed slightly when comparing the second MRI to the first. That might have happened to some degree over time, but I suspect that the leg raises were probably the culprit. Leg raises require you to strongly contract the iliopsoas (hip flexor) muscles. These muscles attach to the front of the lumbar vertebrae and the hip joints, and when you contract them, they produce compression of the lumbar spine which is generall well-tolerated by most people, but can potentially irritate an existing disc protrusion.
The good news is that your case can probably still be managed non-surgically. Even a tiny reduction in the amount of disc protrusion can dramatically reduce the symptoms. First, I suggest you try the McKenzie method per the instructions in my free ebook (if you have not already downloaded it, you may do so from the link on the right side of this page). Make sure to go through all the instructions thoroughly about finding the one position that best centralizes the symptoms and then use that position frequently as discussed in the ebook. Using cold packs as discussed in the ebook may help to some degree, but since the Voltaren didn’t do much, inflammation is probably a relatively minor factor as compared to direct nerve contact by the disc protrusion, so I’d focus more on the McKenzie method. In most cases, there will be a significant reduction in symptoms within 1 to 2 weeks (often 1 to 2 days) if it’s going to work.
In the meantime, I suggest looking into spinal decompression therapy as a possible treatment. It is usually not covered by insurance (still too new for most carriers to cover), so the downside is that there may be a significant out of pocket cost. I prefer the more advanced decompression machines like the DRX9000 or Vax-D, but lower-end units like the Triton DTS work well for some and may allow for lower-cost treatment. Basically the idea of decompression is to use traction to produce a suction force within the disc and “suck” the disc protrusion back in. It doesn’t work in every case, but in my experience it does work most of the time in cases like yours where the disc hasn’t ruptured and the protrusion is not too extreme. In many cases, such treatment is offered by chiropractors, and you might benefit from some chiropractic treatment as well. Getting everything in proper alignment helps minimize the mechanical stresses on the damaged disc. Since you’re in severe pain right now, a low-force method such as Activator, Arthrostim, or Sacro-Occipital technique might be necessary at first.
In my experience, most cases like yours can be managed non-surgically, but if conservative treatments fail, then I recommend looking into “minimally-invasive” surgery in a case like yours. That type of procedure is done using small incisions and a view scope trim away the protruding disc and other tissue (such as the thickened bone and ligament in your case) pressing on the nerve. In most cases, the symptoms are much-improved almost immediately and people are able to return to normal activities within a week or so, as compared to several months of recovery that are typical with more aggressive surgical approaches.
If you have further questions, let me know.
Good luck!
Dr. Best
Annette
April 5, 2018Thank you Dr. Best! Now I fully understand what I have. I will try and do the McKenzie exercises and hopefully I won’t be needing surgery any time soon. I really appreciate your thorough explanation of my findings. Thank you again doc!
Dr. George Best
April 5, 2018You’re welcome and good luck!
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