Sciatica – Management Versus Cure

Thanks for your comment, Elmarie. If the stretches don’t provide lasting relief, there may be some other problem causing the muscles to stay tight. The two most common issues are sacroiliac joint dysfunction and disc herniation.

Sacroiliac dysfunction is something a chiropractor or osteopath can evaluate for and probably correct (depending on the nature of the problem).

You were probably checked for a disc problem by now, but if not, an MRI of the lumbar spine would be a good idea. In some cases there is a disc bulge that is deemed to mild to be the cause of direct nerve compression, yet it can still be enough to trigger some nerve irritation that in turn causes the piriformis and/or other muscles to remain overly contracted.

Hope this helps you.

Good luck!

Dr. Best

With the mechanism of injury, it could be a disc protrusion or the symptoms could be due to jamming of the sacroiliac joint and/or lumbar spinal joints with associated reaction in the piriformis and/or gluteus minimus muscles. If the pain is more to the outside of the leg rather than down the back of the leg, that suggests the gluteus minimus muscle is involved. My suggestion is to try the basic McKenzie exercise from my Ebook on a frequent basis (use the position that best centralizes symptoms – as explained in the ebook – for about a minute at a time up to 3 to 4 times every hour you are awake) for a few days and see how it goes. If there’s no significant improvement, then I would suspect the sacroiliac to be more the problem and for that I’d suggest seeing a chiropractor or osteopath who does spinal manipulation to get the joint working again.

Good luck!

Dr. Best

Hello Valiant,

I think you’ve somewhat misinterpreted the concept of centralization with the McKenzie exercises. It is not a matter of returning the pain to where it first occurred, but of reducing irritation of the nerve caused by a bulging disc. As nerve irritation decreases, the typical pattern is for the symptoms to ease beginning with the point of pain furthest from the spine. In some cases, the pain closer to the spine may temporarily increase somewhat as the pain furthest from the spine decreases, but this is a normal sign of nerve recovery and is unfortunately a necessary part of healing.

Most people find the exercises helpful, so my suggestion is to give them a try and see how it goes. You might also benefit from massage therapy at this point, because oftentimes there are residual knots of contraction in the muscles that can continue to cause pain for quite some time.

If you have further questions, let me know.

Good luck!

Dr. Best

Hello Len,

Unfortunately I don’t know anyone to recommend in your area. At this point regardless of who you go to, I think it’s time to get an MRI to evaluate the situation. Your primary care doctor (if you have one) can order it. If you don’t, a chiropractor or other doctor will likely be willing to order it just based on your history. If you don’t have insurance, before you schedule the MRI be sure to check around with different MRI facilities as to what their “cash” (payment at time of service) price is. In most cases, this will be 50 to 70% less than their regular (insurance) price.

In cases where the pain is worst in the morning, the problem is often inflammatory swelling that builds up while you’re lying in bed and not moving much. While I’m not a big fan of steroid injections as a long-term management strategy, they can be helpful in these situations to break the cycle of inflammation. While some doctors will do steroid injections without an MRI, the chances for success are much better when they know specifically where the problem is. If cost is not an issue, imaging guided injections (the injection is actually done with live-action imaging to guide the positioning) has the best chance for success.

Given the severity and duration of the problem, my guess is that the problem is inflammatory swelling related to a disc herniation, but the other situation where pain is worst in the morning is with piriformis syndrome and/or gluteus minimus trigger points. Trigger points are knots of contraction in the muscles that tend to be very sensitive to circulation. When you are sleeping, the circulation through the muscles decreases due to the lack of movement, and this sets off the trigger points. The piriformis and gluteus minimus stretches an/or application of a hot pack to the buttock area for about 15 minutes done just before bed usually help reduce the morning pain in this situation. The other thing I would suggest is finding a good massage therapist and try a few sessions to see if that helps.

If you have further questions, let me know.

Good luck!

Dr. Best

You’re welcome, Mariano. Thanks for your comments!

Dr. Best

Hello Chris,

Even with advanced degeneration, you’re not necessarily stuck with being in pain. Some cases of moderate to severe degeneration can even be managed effectively with exercises (usually flexion works better than extension) cold packs (when needed for inflammation) and perhaps traction/inversion/decompression. I suggest you at least give the flexion position of the McKenzie exercises and cold packs a try (see the ebook or members area for full instructions). If you can find a place that will allow you to try a traction or inversion unit before you buy, that would probably be a good thing to try as well.

If those methods fail, you may be a candidate for “minimally invasive” surgery. There are different methods but all are done through smalll incisions using a view scope and they trim away the disc, bone, and other tissue that is impinging on the nerve(s). Compared to the more aggressive “open” spine surgeries, the recovery time for minimally invasive is much shorter (most people are able to resume normal activities within a week or so) and there are fewer post-surgical complications such as excessive scar tissue formation.

If you have further questions, let me know.

Good luck!

Dr. Best

Hello,

The back pain could be due to a mild disc protrusion in which case the exercises in my free ebook should help. If the pain is only in the feet and not running down the back of the legs to the feet, the problem could be from the low back (and again, the exercises should help if that’s the case), but there could be some direct problem in the feet, such as poor circulation. If you do not get any improvement with the exercises within a week or two, I’d recommend seeing a doctor to have things checked out. Good luck!

Dr. Best

You’re welcome.

Good luck to you,

Dr. Best

You’re welcome, Phillip and thank you for your nice message. By the way, I happen to also have a book on plantar fasciitis, which you’ve probably found in your research is closely associated with heel spurs. I would be happy to gift you a copy of the ebook version and perhaps if you find it useful you might consider posting a review on Amazon for it. I’m out of town and using my tablet and I don’t have the book file with me, but when I get back tomorrow I can send it to you. Let me know if you prefer a pdf or word document and your preferred email to send it to if you would like me to send it.

God bless you as well,

Dr. Best

Hello Cindy,

First of all, since the main symptoms are in the front of the thigh, you do not have sciatica. The sciatic nerve produces symptoms in the back of the leg. Front of the thigh symptoms can be caused by femoral neuritis, which is a condition similar in nature and cause to sciatica, but involving nerves that arise higher up in the lumbar spine, but I think it is more likely that your symptoms are due to tightening/contraction of various muscles in the back, hips, and/or legs. The piriformis stretch from my site may help with the buttock and some of the leg symptoms. With symptoms in the front of the thigh and given the fact that you sit a lot, you probably need to stretch a muscle called the iliopsoas as well. One safe and effective stretch for the iliopsos can be found at: https://www.youtube.com/watch?v=x0j9kHFUZyQ. As you may have guessed, taking breaks from sitting is a very good idea in these situations as well. Even just standing up and walking or stretching for 30 seconds to a minute every 20 to 30 minutes can make a big difference.

In some cases, dysfunction of the sacroiliac and/or hip joint can be associated with tightness in the piriformis and iliopsoas, so it may be helpful to get that possibility checked out by a chiropractor if stretching and taking breaks from sitting fails to resolve the problem relatively quickly.

While any machine that induces movement and helps promote circulation is helpful to an extent, no machine that I know of by itself will effectively fix these types of problems for most people. The Chi machine and others can be relaxing and helpful in reducing symptoms and can be a beneficial addition to other self-treatments, but they are no more effective (and in most cases, probably less effective) than appropriate stretching and regular movement to break up the periods of sitting. On the other hand, I have known some people for whom having a gadget of some sort sitting out in their home or office is a good visible reminder to stretch/walk/use the gadget, etc., and that can make it quite worthwhile to have such a device around.

Dr. Best

Most likely you have a relatively mild disc protrusion. X-rays are not a very good means of diagnosing the discs since they only show the space the discs occupy and not the discs themselves. X-rays will show disc thinning (degeneration), but are usually not helpful at all with regards to assessing disc protrusions. Since things have improved significantly over the 5 days, things will probably resolve pretty well within the next couple of weeks. Tingling and numbness sensations usually take longer than pain to go away. I would suggest trying the McKenzie method from my free ebook to try to speed up the process. Since your symptoms are relatively mild at this point, it may be difficult to determine the one position that best centralizes your symptoms (as explained in the ebook), and if so, I’d suggest just using the straight extension position. Because disc protrusions have a tendency to flare up periodically, it would be a good idea to use the extension exercise a few minutes per day for prevention, as well as to avoid as much as possible the types of activities that tend to cause problems (which are also discussed in the ebook).

Good luck!

Dr. Best

Hello Ivy,

My best guess is that you have a disc protrusion and it probably started when you fell. I can’t say for sure why the leg symptoms didn’t start until the tailbone pain resolved, but I have a theory. The brain and spinal cord are covered by tough protective layers of tissue known collectively as the meninges. The spinal nerves branch off from the spinal cord through “sleeves” in the meninges and the meninges are held in place at the bottom of the spine at the coccyx. My theory is that the coccyx was misaligned and somehow corrected itself and when it did, it altered the pull of the meninges on the nerve and this altered the pressure on the nerve from a disc protrusion enough to provoke nerve symptoms.

Regarding nortriptyline, I am not a medical doctor and pharmaceuticals are outside my scope of practice, but in my experience, anti-inflammatory medications typically work much better with this type of problem. Nortriptyline is approved as an anti-depressant, but because it acts to elevate serotonin levels, it often helps with chronic pain, which is why your doctor most likely prescribed it. The fact that the prednisone helped confirms that you’d probably do better on an anti-inflammatory. Besides medication, I strongly recommend using cold packs per the instructions in my free ebook.

Chances are your child care activities are keeping things aggravated and will probably delay your recovery, so the more you are able to reduce those activities, the better for the time being. \

Unfortunately, there is no good way to cough in these situations. Coughing increases pressure in the spinal canal and that’s going to hurt when there’s a disc protrusion present.

You didn’t say what exercises you are trying to do. I strongly recommend sticking to just the ones in my free ebook for now. If you cannot test the positions for the McKenzie exercises, I recommend starting with extension and if you can’t tolerate going all the way onto your elbows, use the modified method of lying with your arms folded under your chest or with a pillow under your chest. Applying a cold pack before and/or during the exercise will usually help too. If you can’t tolerate even the modified extension exercise, stick with using cold packs for a few days before attempting the exercise again. As discussed in the ebook, frequent use of the exercise throughout the day will get the best results and hopefully things will subside substantially within a few days and you can then begin transitioning to more of a preventive program.

If you don’t get significant improvement within a week or two, I’d strongly recommend getting an MRI to evaluate the situation further.

Good luck!

Dr. Best

From what you’ve said, it sounds like you have not been professionally evaluated. Given the duration and severity of the problem, I would strongly advise getting checked by a chiropractor or other physician who specializes in musculoskeletal problems. While you probably do have a disc protrusion, it sounds like there’s probably some joint misalignment/dysfunction that is contributing to your symptoms, and that is something that would best be assessed and treated by a chiropractor.

The exercises and other self-treatment methods in my free ebook (available here)are a worthwhile place to start, I think in your case a thorough professional evaluation of the problem is in order. If you do not get significant improvement within a few weeks using the methods in the ebook and/or any initial professional treatment, then I’d definitely recommend having an MRI to assess the situation so that you can get the appropriate treatment.

Good luck!

Dr. Best

Of the things you listed, the main problem is most likely the L4/5 disc bulge, although I would take issue with the description of it as being “minimal”, yet was bad enough to indent the thecal sac and narrow both nerve canals (to paraphrase the radiology jargon). I think sometimes radiologists use pre-written reports to save time and sometimes forget to edit some of the wording that doesn’t apply. Basically what’s happening is that the disc is protruding into both the main spinal canal where the spinal cord would be (at the L4/5 level it is no longer a cord, per se, but a bundle of individual nerves) as well as into both of the canals where the nerves exit the spine on the left and right. This creates pressure and irritation of the nerves. In addition to the direct pressure on the nerves caused by the disc protrusion, there is usually also some contribution from inflammatory swelling adding to the pressure on the nerves.

The methods in the free ebook here on my site are usually quite effective at treating issues such as yours. If you have not already downloaded the ebook, you may do so here:
http://www.sciaticaselfcare.com/basic-sciatica-exercises/

Be sure to read and carefully follow the instructions for using cold packs and the McKenzie method. In addition, avoiding prolonged sitting is usually also helpful. If you must sit for long periods for work or other reasons, it is best to try to take brief breaks to do the McKenzie exercise in the position that best centralizes symptoms (as explained in detail in the ebook) or simply get up and walk for a minute or so every 15 to 20 minutes, or as often as you can.

With regards to the other findings from your MRI, none are particularly significant and although they may be complicating the issue, they are not likely to be primary causes of your symptoms in my opinion. In fact,the straightened lumbar lordosis may actually be due to muscle spasm and may be an effect rather than a cause of the underlying problem.

If you do not get significant improvement using the methods in the ebook within 1 to 2 weeks, I would recommend you ask your doctor for a referral to a chiropractor and/or a physical therapist to work with the structural issues that are present. One other option would be a steroid injection to reduce inflammation around the spine, but that tends to be a temporary treatment and unless you also directly address the disc protrusion with the McKenzie method and/or chiropractic/physical therapy, symptoms typicall return at some point.

Good luck!

Dr. Best

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