Dr. Best,
I am a member of your website. I wrote you with a question on August 19th, I believe and have not received an answer. My understanding from your website is that I would have an answer by now. Are you on vacation or what?
Thank you for a response.
Actually, I received your email on August 22 and sent you a detailed response the same day. Perhaps it went to your spam box (for future reference, please add info@sciaticaselfcare.com to your address book / approved senders list). The short version of my response is that I requested you send me information regarding the findings of any imaging you’ve had done to allow me to better assess what’s happening with you and give you more specific advice. Please email me what information you have and we’ll go from there.
It depends on the underlying cause of your symptoms. In the event of a full disc rupture, a severe disc herniation, and/or severe narrowing of the bone canals from degenerative bone spurring, surgery may be needed. In most other cases without these severe underlying causes, surgery is not needed and the symptoms will gradually improve with the self-treatment methods on this website, with or without some additional help from spinal injections, medication, or physical therapy.
I am 63 and have had sciatica for the past two years. Usually flairs up in November as the Golf season is over. 7 months (March to October).
I have spoken to my Doctor and he has mentioned that injections can be beneficial. I do not want to have surgery if possible.
I have been doing the exercises you have recommended, improvements are very slow.
What do you think about Inversion tables? and can they make things worse?
Lastly, I had a hip replacement 7 years ago, All is ok with range of motion, and I have no pain, except that I have developed a problem where I can walk about a mile, then my hip starts to ache (have to sit down for 10 minutes or so). I read the surgeons report on my operation and it states that while operating the sciatic nerve was placed to one side ( I guess it means that they were careful) could this have anything to do with my walking ache? or even Sciatica.
You didn’t say what if any diagnostic procedures have been done to evaluate the cause of your sciatica. Since it comes on after golf season, rather than during, it may be primarily muscle referral pain from the piriformis and/or gluteus minimus muscles rather than true sciatic nerve irritation. Muscles tend to stay looser while you’re more active, so they may be knotting up after golf season because you’re not moving around as much. If that’s the case, stretching and massage will probably be helpful.
Inversion tables are usually helpful, but they can irritate symptoms when there is severe pain and inflammation present. If your symptoms are relatively tolrable, inversion is probably worth a try – just start slowly doing just a few minutes at a shallow downward angle at first.
The hip ache you described probably is muscular since the other common cause of that type of symptoms is arthritis, but that’s not an issue with a joint replacement. Since it is a little difficult to get a good stretch where it is needed with a replaced joint, massage from either a massage therapist, or simply finding sore spots and rubbing them with firm pressure yourself will probably help.
Thanks for letting me know that I had left off the link. I have added it now. Since you are already a member of my site, you’ve probably already seen the page that I was referring to, but in case you want to review it, it is at: http://www.sciaticaselfcare.com/advanced-sciatica-exercises-and-treatment/
Referring to my last note, If my problem is (muscle) and not (nerve) after Golf seasons ends would it be fair to say that exercises for muscle problems is the best solution? This past summer my problem did not effect my Golf swing only when the season was over (4 – 6 weeks later).
I do have serious pain that runs down my leg, is this not Sciatica? (especially just below my knee). There are times when I have a hard time walking, also does your body tilt to one side if the problem is muscle related?
I was a bit skeptical initially regarding the (mackenzie) exercise, I thought it was a waste of time to simply lay on the floor. Then I tried it I could stay on my elbows for about 10 – 15 seconds, then I had to lower myself to the floor. (there was serious pain) again would this happen if I had a muscle problem?
Golf would tend to really irritate a nerve compression problem such as from a herniated disc and it would cause increased symptoms while playing golf, not several weeks after you stopped playing. On the other hand, trigger points in the muscles will tend to be better with activitiy because they get more circulation. When you become less active, you don’t get as much circulation through the muscles and the trigger points will tend to become more active symptom generators.
The severity of the pain does not indicate the source of the problem. Muscle referral pain can be just as painful as nerve compression and can poduce symptoms that are essentially identical to sciatic nerve irritation (true sciatica). Tilting (bending to one side or having the appearance that one leg is longer than the other) needs to be distinguished from a sideways shift (where it looks like the upper body has been slid sideways on the lower body). Tilting can be caused by any kind of uneven muscle contraction. Sideways shifting is usually associated with a an acutely inflamed disc herniation.
When the McKenzie extension exercise immediately causes a lot of pain that is mostly in the low back, this is a sign of spinal arthritis as the exercise pushes joint surfaces closer together and arthritic joints are often inflamed. If it causes increased symptoms down the leg, this is a sign of degenerative arthritic changes at the back part of the spine (bone spurs, synovial cysts, ligament thickening, and/or associated swelling)narrowing the spinal canals. This type of problem has different reactions to activity in different people. In some cases, activity (like golf) improves symptoms and inactivity increases symptoms. In other cases, or even at other times for the same person, it is the other way around. Even when there are underlying issues with degenerative arthritis, muscles are often signficant symptom generators and things like stretching and massage are usually helpful even though they don’t alter the arthritic problems at all.
I couldn’t pass up the opportunity to express my gratitude for educating me on the subject of sciatica. I have either inflammation or herniation of the disk between my L4 and L5 vertebrae for which I am receiving treatment from a chiropractor, am performing the exercise to push the disk forward away from the sciatic nerve, and am applying ice packs to reduce the inflammation/herniation. Thanks to you, what was excruciating pain weeks ago has diminished to persistent but milder discomfort. I avoid all anti-inflammatory drugs and have firmer grounds on which to refuse unnecessary, expensive—and risky—surgery. I now understand that, as there is no “cure”, and even when I have completely recovered from my affliction, I will nevertheless perform the exercise as a preventative measure.
Hi Dr Best, and thanks again for getting back to me.
In you last note you mentioned diagnostic procedures (do you mean MRI or CT).
I seem to be in a position where I am not 100% sure as to wheather my problem is nerve or muscle.
I tried the sitting in a chair and lifting my leg (no pain) so I figure it has to be muscle.
I have also been given advice that an MRI is needed only if surgery is necessary do you agree?
Recently, I seem to have pain directly on my knee cap (nerve I guess) but it can be quite painfull.
I really want to get to the bottom of what it is I have. I am probably wasting my time if I don’t know. I may be headed in the wrong direction altogether. I will do whatever is necessary (exercise or whatever) Does this make sense to you.
Is there a foulproof way to determine if it really is Sciatica? or just a muscle spasm? or arthritis?
It is very frustrating not knowing what direction to go.
MRI is preferable to CT for image quality but if you’ve had any kind of metal implantation in your body (joint replacement, surgical staples, etc.), you have to do CT instead (because the magnetic field of an MRI machine is so powerful that it can literally rip metal implants out of the body and at the very least make having an MRI extremely painful). If someone is improving consistently, even if it is slowly, I don’t think an MRI or CT is necessary, but when someone is not improving, diagnostic imaging is an important tool to figure out why someone is not improving. To say that MRI is needed only if surgery is necessary misses the point – you don’t really know whether surgery is necessary (the definition of which can vary greatly) without taking steps to diagnose the problem, such as doing an MRI when a patient is not improving in a reasonable amount of time.
Now, don’t tell anyone I told you what I’m about to tell you because it’s the best-kept secret in health care and if anyone finds out I’m letting the cat out of the bag, my life could be in danger (just kidding – sort of!): Nothing in health care is really foolproof and while doctors would like you to believe that diagnosis is always scientific and definitive, that’s just not so. In fact, just because you find something on an MRI or other diagnostic test does not necessarily mean that is the cause of the symptoms. Diagnosis is really a best-guess that is based on all of the available information. In most instances there are multiple possible causes, and in some cases the symptoms may be a result of more than one thing. So, you start with treating the most obvious or most likely issues and modify treatment or run additional tests if needed, depending on the results. In the case of sciatica symptoms you can run neurodiagnostic tests to see if the nerve is involved. But even then that only narrows it down to a nerve issue – you have to look at other things to try to determine the cause of the nerve issue since nerves don’t just get inflamed for no reason. Xrays will tell you if there is arthritis, but in many cases arthritis (even severe arthritis) is asymptomatic, so just because there is arthritis present, it doesn’t mean it the cause of the symptoms (this is true of disc problems as well). In many cases treatment winds up being the ultimate diagnostic test – if you treat for arthritis and things get better, then the assumption is made that the problem was arthritis. If things don’t get better, you look for something else. And if all treatment measures fail and the doctors can’t figure out what’s wrong with you, then there is only one possible diagnosis – it’s all in your mind (because after all, doctors know everything and if they can’t figure out what’s wrong with you, there’s obviously nothing actually wrong with you and you must be imagining it)!
My purpose in telling you this is let you know what to expect and to encourage you to try to be patient with the process. You might very well go down the wrong path for a while and get delayed in finding a solution. The good news is that most of the things you might try won’t do any lasting harm, so even if they don’t do much to help you, they won’t do much to hurt you either. I know it is frustrating to have to take a trial and error approach, but unfortunately that’s just the way it is in a lot of cases.
What I can tell you is that in my 20 years or so of practice most of the cases I’ve seen appear to at least have a muscular component, even when there are other problems present, so you can’t go too far wrong addressing the muscle problems regardless of whatever other treatment you do.
Thank you for your recent, timely response. (Very Impressed)
This problem is much more complex than expected. I think that I now have a much better understanding of what is going on. I will try to be patient and do whatever is necessary.
When my situation is resolved, I’ll be in touch.
Dr. Best soy una persona que tengo 66 años y afortunadamente tengo buena salud y camino todos los días y hago una rutina de estiramientos durante 40 mins diariamente. Fui operada de mi columna hace 33 años de la 4ta y 5ta vertebra lumbar por un desgaste de disco en el cual se me implanto hueso de mi cadera. A partir de ese momento siempre he tenido que hacer ejercicio pues amanezco con dolores todos los días y el ejercicio me hace sentir bien, Tengo la pierna izquierda mas corta que la derecha desde que nací 3cms. Hace tres meses mi quiropractico me recomendo que me le pusiera a mi zapato izquierdo un aumento de dos centimetros para ayudarme a compensar el desgaste que mi columna puede seguir sufriendo por los años y me dijo que esto me iba a ayudar y que el cambio en mi estructura osea iba a a doler un poco pero con el tiempo me sentiría mejor. Desde entonces todos mis zapatos hasta mis tenis tienen, el aumento sin embargo me empezo a doler el ciatico de la pierna derecha y trato de hacer mas estiramiento y masajes y lo que me lo quita es el paracetamol pero lo tengo que tomar todos los días, eso no importa pues se que no tiene grandes efectos secundarios pero al leerlo a usted quiciera saber que más puedo hacer y si estoy en lo correcto. Mil gracias Lilia González
Lo siento, pero hablo solamente poquito Espanol. Recomiendo ejercicio de estiramiento para los musculos piriformis y gluteus minimus en los videos aqui:
I HAVE L4 PERTRUDING SLIGHTLY FORWARD AND TO THE RIGHT.ALSO A BONE SPUR AT SAME LOCATION.WHAT EXERCISES SHOULD I DO TO BRING VERTEBRAE BACK TO NORMAL.POSITION .
If the vertebra (not the disc) is shifted forward, this is a condition known as spondylolisthesis (which is Latin for “spine slippage”). There are two main underlying causes. One is a defect in the part of the vertebra between the neural arch and the vertebral body which produces a separation between the front and the back part of the vertebra. The other is degenerative arthritis in the spinal joints that causes thickening of the bone on the joint surfaces that displaces the vertebra forward. Neither cause can really be corrected by exercise, but further slippage in the first type can be minimized by keeping the abdominal muscles strong (with exercises like crunches). In the case of spondylolisthesis caused by degenerative arthritis, there is limited progression of the slippage, so exercises are primarily directed at stretching tight muscles for symptom control (knee to chest stretches and rolling face down across an exercise ball are two commonly-prescribed exercises for this purpose).
Well, Puerto Rico is actually a U.S. territory, but to my knowledge licensure for massage therapy for any state/territory is done through the state/territory board of health, or in some cases there may be a separate board of massage therapy. For Puerto Rico, I found the following information:
The Puerto Rico Department of Health (www.salud.gov.pr) handles the certification of all health professionals, including nurses, dentists, pharmacists, veterinarians, undertakers, etc. To obtain more information contact The Office of Regulation and Certification of Health Professionals at (787) 723-2885 or 725-7506, (787) 725-8161 or (787) 725-8121.
Dr. best,Hope you can help. I have grade 1 spondylolithesis, left ridiculopathy of L4-Ll5, and severe central canal stenosis .Also have disc bulges of L4-L5 flattening the thecal sacs on all. I had 1 ESI so far.Followed up with therapy and have started exercising at gym( limited). was great for about 2 months.Started getting pain again down back of both legs 1/2 way down.Continue doing stretching exercises, but have pain all day.would say pain level averages 5-6.No pain while sitting.What would you suggest.They tell me because of the severity of the stenosis, I will ultimately need surgery,not only to open up spinal canal, but to stabilize L4- L5. Should be absolutely fine after rehab of 3-6months.What are your thoughts? Thank you.Seen all of your related videos and gained a lot of knowledge.
Central canal stenosis can be caused by different things and the cause makes a big difference as to what the best treatment options are. If the stenosis is mostly due to disc bulging, exercises and anti-inflammatory measures (cold packs, medication, etc.) will often be sufficient to manage the issue, but surgery is sometimes needed. If it’s congenital (you were born with a narrower canal than normal) and/or due to degenerative bone and ligament thickening, symptoms can sometimes be controlled for a while with exercises and anti-inflammatory medication, but surgery is usually needed eventually to trim away the excess bone, ligament, and other tissue.
With regards to the spondylolisthesis, a grade 1 is usually quite stable, and when found in adults, it’s highly unlikely to progress to the point where it would need stabilization. It kind of sounds to me like the doctor may be trying to justify an “open” surgery when you would probably do just as well with a “minimally invasive” procedure. If you do wind up needing to consider surgery, I’d recommend at least getting an opinion from a surgeon who does minimally invasive (done through small incisions using a scope) to see if that is an option in your case. If you are a candidate for minimally invasive, the recovery is a lot faster and there are much fewer issues with post surgical scar-tissue.
One of my big pet peeves with spine surgeons is when they give unrealistic expectations to people to talk them into surgery. It’s very unusual for anyone to be “absolutely fine” after open spine surgery – EVER, let alone 3 to 6 months. Most are better than before the surgery (some are the same or worse), but almost everyone still has some residual symptoms to varying degrees that last for the rest of their lives. People who have minimally invasive surgery seem to fare considerably better overall, but it’s far from perfect. Surgery may be necessary in some cases to get lasting symptom improvement, but it rarely returns them back to completely normal. My rule of thumb for deciding whether to have surgery is to ask yourself whether or not you can tolerate the symptoms as they are. If the answer is yes, I would not go for the surgery. If the answer is no and you have exhausted the other potential treatment options, then it’s time to go forward with the surgery.
With regards to self-treatment, since you have no pain when sitting, my guess is that you would do best using the flexion (forward bending) position for the MxKenzie exercises, at least at first. I’d recommend investing in an exercise ball for doing the flexion exercise if you don’t already have one and use that position for a minute or so at a time several times per day. If you have some combination of disc bulging and degenerative bone stenosis, you may actually need to use both flexion and extension exercises, or start out with flexion and periodically add in some extension, so test the various positions on a regular basis and do whatever centralizes/relieves symptoms. Cold packs will help reduce inflammatory swelling, so as long as you are having symptoms, I suggest using them for 15 minutes or so at least a few times per day.
Dr. George,
There are at least 2 other injections I can think of that you didn’t mention:
Facet injects, of which I’ve had several for supposed facet
arthropathy but no relief; and Perispinal Etanercept (Enbrel) which
I’m trying to learn more about. Please share your thoughts as I’ll do just about
anything to avoid invasive procedures such as surgery.
Thanks
Facet injections my be helpful in some cases of low back pain, but they’re pretty useless for sciatica in most cases.
While perispinal etanercept is very effective in some cases, it is not yet widely available and studies on its overall effectiveness have had mixed results. It’s also currently “off-label” for the treatment of sciatica, meaning it is not yet FDA approved for this particular purpose, and therefore will probably not be covered by insurance. Despite the hype surrounding it, the way it works is supposedly by suppressing inflammation. While perispinal etanercept may or may not prove to be superior in effects and have fewer side-effects than cortisone injections in this regard, as with steroid injections, it probably will not help much in cases where there is significant direct nerve compression from protruding discs, degenerative bone and ligament thickening, etc., as opposed to symptoms coming primarily from the pressure of inflammatory swelling. One recent study has shown that the therapeutic effects of steroid injections are actually superior to perispinal etanercept (see: http://www.ncbi.nlm.nih.gov/pubmed/22508732), but more comparison studies may yield different results, so in my opinion, the jury is still out.
No No No..do not let them do surgery. I’ve had 2 failed spine surgeries my scar is 15 inches long. I’m worse now than I was before the surgery. I can only walk from point A to point B..very off balance and wobbly. The pain from my lower spine radiates down my left leg all the way to my toes..ive done physical therapy 6 times..accupuncture..at least 15 injections..tens machine..ice..exercising..and still can’t walk without severe pain..i could no way walk 1/2 block..im so sorry I ever went under the knife..i break down and cry at least 10 times a day..i have no life whatsoever..pain management makes you feel like an addict..if i don’t get some kind of break soon..its not looking good..im highly allergic to steroids.so maybe that’s why they don’t work..dr keeps wanting me to get them..i told him NO I’m done..if anyone knows of anything I can do to get some kind of releif.please email me..i know exactly what everyone is going through..this is no joke..and I CAN’T TAKE THIS PAIN NO MORE..PLEASE HELP ME SOMEONE..
Hi Dr. – do you have any information on something called Anti-TNF treatments for sciatica. There is a web sit for INR – Institute of Neurological Recovery. What does that injection do? Thank you
Anti-TNF is a relatively new means of treating inflammation. It works very well for some people, but is most likely to be effective in less severe cases of disc herniation in which inflammatory swelling is a significant symptom generator as opposed to more severe cases in which the protruding disc material itself is producing significant nerve compression. While it’s promoters claim it to be a superior new treatment for back pain and sciatica, the independent research so far has not supported that assertion. In fact, a recent study showed that the long-established treatment of steroid injections achieved statistically much better results overall than anti-TNF. Anti-TNF may have fewer side-effects than steroids, but it’s still a little soon to even say that with any certainty.
Dr wants me to get implanted spine stimulator..i said no.saw to many bad review’s..pain meds barely take the edge off..im never completely out of pain unless i lay with a pillow between my legs.
The only thing I got from injections was hair growing on my face and gained about 40 lbs. I had a severe reaction for about 3 weeks..i didn’t even know where i was..
Dry needling is a way of releasing trigger points and other soft tissue constrictions. It can be effective when the problem is primarily muscular or fascial (fascia is the tissue that covers and separates muscles and organs from each other). While some inidviduals get better results from dry needling than other soft tissue release methods (massage, stretching, foam rolling, etc.), in my opinion it is not a better method in general than other soft tissue techniques. The purpose and intent of dry needling is very different from spinal injections, which are used for delivering anti-inflammatory or pain blocking medication directly to the area of nerve irritation.
Dr wants me to get implanted spine stimulator..i said no.saw to many bad review’s..pain meds barely take the edge off..im never completely out of pain unless i lay with a pillow between my legs.
I have been suffering with pain in my groin/low back/down right leg, usually ending behind my knee for about 4 months now. MRI shows bulging S1/L5 disc pushing badly on nerve root. I have been in constant, terrible pain. I had epidural steroid injection last month, very little relief, and a month later my pain is the same. I’ve tried endless physical therapy, purchased a “low back trax” for spine decompression, and do stretches everyday (cobra, bridge, ect) it seems to me that right around my piriformis is where I hold most of my pain. Is it possible that even though my MRI shows bulging disc pushing on nerve, that some of my pain may be coming from my nerve running through the muscle? Would perispinal etanarcept be more effective? I’m coming close to losing my job at home, should I go ahead with the surgery they are offering? (Surgery claims to drill a piece of your spine away so disc has room to slide back in) please help!
In disc protrusion cases, symptoms are usually due to a combination of direct pressure on the nerve by the disc and pressure caused by inflammatory swelling. When it appears (from imaging like MRI) that there is substantial direct pressure from the disc, treatment directed at the inflammatory swelling component is typically not very effective. While perispinal etanercept works better in some cases than epidural steroid injection, both treatments address primarily the swelling aspect of the problem. In your case it sounds like direct pressure from the disc is by far the bigger problem, so I would not expect the perispinal etanercept to be significantly more effective than the ESI was.
It is certainly possible that the piriformis is involved, but since the MRI did show a significant issue with the disc, I think the piriformis is most likely to be a secondary issue. Because the piriformis is innervated by the lower lumbar nerves, the irritation of those nerves by the disc protrusion may be causing contraction and “trigger points” in the piriformis and thereby creating some piriformis symptoms mixed in with the true sciatica symptoms.
Your description of the proposed surgery is not familiar to me. My best guess is that the recommendation is for a laminectomy, which is a removal of part of the spinal bone to allow more space around the nerve even though the disc protrusion remains. That is a common procedure and gets reasonably good results in most cases. Even so, I suggest you look into a “minimally invasive” procedure where the surgeon goes in through small incisions using a view scope and trims away the protruding disc and/or other tissue that is compressing the nerve. While there are pros and cons to each type of procedure, the biggest benefit in a case like yours with a minimally invasive surgery is the quick recovery time. Most people are able to resume normal daily activities within a week or two with that type of procedure whereas a laminectomy typically takes at least a couple of months (surgeons often tell people 4 to 6 weeks, but most of the people I’ve seen who have had such procedures are still in a lot of pain for quite a bit longer than that). The primary disadvantage of minimally invasive is that the disc wall is left thinner after surgery and there is a potential for re-injury if one is not careful. In my experience most people do quite well with it if they understand that and continue to do preventive exercises and are diligent about bending and lifting properly.
In the meantime until you can get a consult for minimally invasive, assuming you choose to do so, my advice is to follow the intensive care regimen found in my free ebook. In my experience, doing the cobra or other extension exercises (such as the position propped up on the elbows in my ebook) frequently throughout the day (a minute or so at a time 5 or 6 times per hour is a good goal) is much more effective than doing them for even extended periods once or twice per day. Extension pushes the disc material forward and away from the nerve, but repetition seems to allow the disc wall to stabilize to hold the bulge in more effectively. This is of course assuming that extension is producing centralization (explained in detail in the ebook).
The other suggestion I have is to see a chiropractor if you have not already tried it. In many cases, altered biomechanics in the sacroiliac and/or lumbar spine place undue stress on the disc and other tissues and may interfere with healing. In addition, even slight changes in skeletal alignment can be sufficient to dramatically reduce symptoms as it only takes small changes in pressure on the nerves to change their firing patterns. If possible, I would recommend seeing a chiropractor with some years of experience and confidence with disc issues. If you do decide to see a chiropractor, there is a maneuver I have found that is particularly useful in disc cases (it’s not one of the usual methods chiropractors use, at least not in that part of the spine) and I’d be happy to walk your chiropractor through what I do. I don’t recommend it for anyone with an outright disc extrusion (rupture), but it works quite well for most other disc issues and in most cases using it with some soft tissue techniques can get the symptoms settled down by 50% or more right from the first treatment.
Thank you so much for your fast, detailed, and very helpful response.
I did see a chiropractor, but this was before I had my MRI and I feel she didn’t do much at all maybe because we didn’t know the exact problem. I am going to seek a chiro that is skilled with my specific problem, that way you can walk him through that process. I really appreciate your willingness! You are very much a blessing.
also, keep in mind I do work on an asphalt paving crew full time. I know this may affect some of your recommendations for me. (Most days, if I am able to make the drive and get moving, the work actually makes me feel better)
One other tip about chiropractic, the disc adjustment I use is very similar to a maneuver called an “anterior thoracic” adjustment from the Diversified technique. So, if you find a chiropractor who is familiar and comfortable doing that type of adjustment, it will be much easier to explain the modifications of that adjustment to him or her as opposed to someone who isn’t used to that maneuver.
It is a good sign that your work activity makes things better. It doesn’t really change anything from my prior suggestions, but usually when movement makes things better rather than worse, it is a favorable sign that things can be managed non-surgically in my experience.
Dr. Best
Jeffrey Coats
February 9, 2018
Dr Best,
I called around and found a Chiropractor that is familiar with that procedure and is willing to talk with you so you can walk him through the modification. I really appreciate this! My appointment is scheduled for Wed. Feb, 14th at 5PM. eastern time.
Dr. George Best
February 9, 2018
Hello Jeffrey,
Trying to get schedules to match up can be tricky, plus having a visual aid might be useful. What I suggest is having him email me at gbdc1@yahoo.com and I can send him a brief video showing how I do the adjustment and he can call me if he has any questions.
Hi doc,
Is walking good for sciatica and at my work they build a safety stairs would this affect my sciatica to flare up and when I use heat or ice I feel needles running down to my foot is that an indication of imflammation.
Walking at a comfortable pace is usually helpful. Climbing stairs sometimes aggravates the muscle reactions and inflammation associated with sciatica while things are already flared up. In and of itself though, climbing stairs probably won’t initiate sciatica symptoms unless there is a significant problem in the hip and/or sacroiliac joints. Getting a sensation of needles going down the leg while using ice or heat doesn’t necessarily indicate inflammation. While the nerves are irritated, almost anything, including ice or heat, can trigger a variety of sensations.
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43 Comments
Sylvia Wierick
August 26, 2011Dr. Best,
I am a member of your website. I wrote you with a question on August 19th, I believe and have not received an answer. My understanding from your website is that I would have an answer by now. Are you on vacation or what?
Thank you for a response.
Dr. George Best
August 26, 2011Hi Sylvia,
Actually, I received your email on August 22 and sent you a detailed response the same day. Perhaps it went to your spam box (for future reference, please add info@sciaticaselfcare.com to your address book / approved senders list). The short version of my response is that I requested you send me information regarding the findings of any imaging you’ve had done to allow me to better assess what’s happening with you and give you more specific advice. Please email me what information you have and we’ll go from there.
Dr. Best
mkraju
September 18, 2011i have a sciatica and numbness.is it advisable to have an steroid injection or to go to surgery?
Dr. George Best
September 19, 2011It depends on the underlying cause of your symptoms. In the event of a full disc rupture, a severe disc herniation, and/or severe narrowing of the bone canals from degenerative bone spurring, surgery may be needed. In most other cases without these severe underlying causes, surgery is not needed and the symptoms will gradually improve with the self-treatment methods on this website, with or without some additional help from spinal injections, medication, or physical therapy.
Dr. Best
Peter Adamack
January 12, 2012Hi Dr B
I am 63 and have had sciatica for the past two years. Usually flairs up in November as the Golf season is over. 7 months (March to October).
I have spoken to my Doctor and he has mentioned that injections can be beneficial. I do not want to have surgery if possible.
I have been doing the exercises you have recommended, improvements are very slow.
What do you think about Inversion tables? and can they make things worse?
Lastly, I had a hip replacement 7 years ago, All is ok with range of motion, and I have no pain, except that I have developed a problem where I can walk about a mile, then my hip starts to ache (have to sit down for 10 minutes or so). I read the surgeons report on my operation and it states that while operating the sciatic nerve was placed to one side ( I guess it means that they were careful) could this have anything to do with my walking ache? or even Sciatica.
Thank you in advance
Peter A
Dr. George Best
January 13, 2012Hello Peter,
You didn’t say what if any diagnostic procedures have been done to evaluate the cause of your sciatica. Since it comes on after golf season, rather than during, it may be primarily muscle referral pain from the piriformis and/or gluteus minimus muscles rather than true sciatic nerve irritation. Muscles tend to stay looser while you’re more active, so they may be knotting up after golf season because you’re not moving around as much. If that’s the case, stretching and massage will probably be helpful.
Inversion tables are usually helpful, but they can irritate symptoms when there is severe pain and inflammation present. If your symptoms are relatively tolrable, inversion is probably worth a try – just start slowly doing just a few minutes at a shallow downward angle at first.
The hip ache you described probably is muscular since the other common cause of that type of symptoms is arthritis, but that’s not an issue with a joint replacement. Since it is a little difficult to get a good stretch where it is needed with a replaced joint, massage from either a massage therapist, or simply finding sore spots and rubbing them with firm pressure yourself will probably help.
Good luck!
Dr. Best
peaarlina brown
January 14, 2012After viewing the video I did not see the website indicated to be shown at the bottom of the video. ow can it be located?
Dr. George Best
January 14, 2012Hello Pearlina,
Thanks for letting me know that I had left off the link. I have added it now. Since you are already a member of my site, you’ve probably already seen the page that I was referring to, but in case you want to review it, it is at:
http://www.sciaticaselfcare.com/advanced-sciatica-exercises-and-treatment/
Thanks!
Dr. Best
Peter A
January 15, 2012Dr Best, Thanks for the return information.
Referring to my last note, If my problem is (muscle) and not (nerve) after Golf seasons ends would it be fair to say that exercises for muscle problems is the best solution? This past summer my problem did not effect my Golf swing only when the season was over (4 – 6 weeks later).
I do have serious pain that runs down my leg, is this not Sciatica? (especially just below my knee). There are times when I have a hard time walking, also does your body tilt to one side if the problem is muscle related?
I was a bit skeptical initially regarding the (mackenzie) exercise, I thought it was a waste of time to simply lay on the floor. Then I tried it I could stay on my elbows for about 10 – 15 seconds, then I had to lower myself to the floor. (there was serious pain) again would this happen if I had a muscle problem?
Thank you again in advance for your help.
Peter A
Dr. George Best
January 16, 2012Hi Peter,
Golf would tend to really irritate a nerve compression problem such as from a herniated disc and it would cause increased symptoms while playing golf, not several weeks after you stopped playing. On the other hand, trigger points in the muscles will tend to be better with activitiy because they get more circulation. When you become less active, you don’t get as much circulation through the muscles and the trigger points will tend to become more active symptom generators.
The severity of the pain does not indicate the source of the problem. Muscle referral pain can be just as painful as nerve compression and can poduce symptoms that are essentially identical to sciatic nerve irritation (true sciatica). Tilting (bending to one side or having the appearance that one leg is longer than the other) needs to be distinguished from a sideways shift (where it looks like the upper body has been slid sideways on the lower body). Tilting can be caused by any kind of uneven muscle contraction. Sideways shifting is usually associated with a an acutely inflamed disc herniation.
When the McKenzie extension exercise immediately causes a lot of pain that is mostly in the low back, this is a sign of spinal arthritis as the exercise pushes joint surfaces closer together and arthritic joints are often inflamed. If it causes increased symptoms down the leg, this is a sign of degenerative arthritic changes at the back part of the spine (bone spurs, synovial cysts, ligament thickening, and/or associated swelling)narrowing the spinal canals. This type of problem has different reactions to activity in different people. In some cases, activity (like golf) improves symptoms and inactivity increases symptoms. In other cases, or even at other times for the same person, it is the other way around. Even when there are underlying issues with degenerative arthritis, muscles are often signficant symptom generators and things like stretching and massage are usually helpful even though they don’t alter the arthritic problems at all.
Dr. Best
Thomas W. Yale
January 18, 2012Dr. Best,
I couldn’t pass up the opportunity to express my gratitude for educating me on the subject of sciatica. I have either inflammation or herniation of the disk between my L4 and L5 vertebrae for which I am receiving treatment from a chiropractor, am performing the exercise to push the disk forward away from the sciatic nerve, and am applying ice packs to reduce the inflammation/herniation. Thanks to you, what was excruciating pain weeks ago has diminished to persistent but milder discomfort. I avoid all anti-inflammatory drugs and have firmer grounds on which to refuse unnecessary, expensive—and risky—surgery. I now understand that, as there is no “cure”, and even when I have completely recovered from my affliction, I will nevertheless perform the exercise as a preventative measure.
Thank you so much.
Sincerely,
Thomas W. Yale
Dr. George Best
January 19, 2012You’re welcome, Thomas. I’m glad that you’ve found my information helpful.
Good luck for continued recovery.
Dr. Best
Peter
January 19, 2012Hi Dr Best, and thanks again for getting back to me.
In you last note you mentioned diagnostic procedures (do you mean MRI or CT).
I seem to be in a position where I am not 100% sure as to wheather my problem is nerve or muscle.
I tried the sitting in a chair and lifting my leg (no pain) so I figure it has to be muscle.
I have also been given advice that an MRI is needed only if surgery is necessary do you agree?
Recently, I seem to have pain directly on my knee cap (nerve I guess) but it can be quite painfull.
I really want to get to the bottom of what it is I have. I am probably wasting my time if I don’t know. I may be headed in the wrong direction altogether. I will do whatever is necessary (exercise or whatever) Does this make sense to you.
Is there a foulproof way to determine if it really is Sciatica? or just a muscle spasm? or arthritis?
It is very frustrating not knowing what direction to go.
Once again, thanks for your help.
Peter A.
Dr. George Best
January 19, 2012Hello Peter,
MRI is preferable to CT for image quality but if you’ve had any kind of metal implantation in your body (joint replacement, surgical staples, etc.), you have to do CT instead (because the magnetic field of an MRI machine is so powerful that it can literally rip metal implants out of the body and at the very least make having an MRI extremely painful). If someone is improving consistently, even if it is slowly, I don’t think an MRI or CT is necessary, but when someone is not improving, diagnostic imaging is an important tool to figure out why someone is not improving. To say that MRI is needed only if surgery is necessary misses the point – you don’t really know whether surgery is necessary (the definition of which can vary greatly) without taking steps to diagnose the problem, such as doing an MRI when a patient is not improving in a reasonable amount of time.
Now, don’t tell anyone I told you what I’m about to tell you because it’s the best-kept secret in health care and if anyone finds out I’m letting the cat out of the bag, my life could be in danger (just kidding – sort of!): Nothing in health care is really foolproof and while doctors would like you to believe that diagnosis is always scientific and definitive, that’s just not so. In fact, just because you find something on an MRI or other diagnostic test does not necessarily mean that is the cause of the symptoms. Diagnosis is really a best-guess that is based on all of the available information. In most instances there are multiple possible causes, and in some cases the symptoms may be a result of more than one thing. So, you start with treating the most obvious or most likely issues and modify treatment or run additional tests if needed, depending on the results. In the case of sciatica symptoms you can run neurodiagnostic tests to see if the nerve is involved. But even then that only narrows it down to a nerve issue – you have to look at other things to try to determine the cause of the nerve issue since nerves don’t just get inflamed for no reason. Xrays will tell you if there is arthritis, but in many cases arthritis (even severe arthritis) is asymptomatic, so just because there is arthritis present, it doesn’t mean it the cause of the symptoms (this is true of disc problems as well). In many cases treatment winds up being the ultimate diagnostic test – if you treat for arthritis and things get better, then the assumption is made that the problem was arthritis. If things don’t get better, you look for something else. And if all treatment measures fail and the doctors can’t figure out what’s wrong with you, then there is only one possible diagnosis – it’s all in your mind (because after all, doctors know everything and if they can’t figure out what’s wrong with you, there’s obviously nothing actually wrong with you and you must be imagining it)!
My purpose in telling you this is let you know what to expect and to encourage you to try to be patient with the process. You might very well go down the wrong path for a while and get delayed in finding a solution. The good news is that most of the things you might try won’t do any lasting harm, so even if they don’t do much to help you, they won’t do much to hurt you either. I know it is frustrating to have to take a trial and error approach, but unfortunately that’s just the way it is in a lot of cases.
What I can tell you is that in my 20 years or so of practice most of the cases I’ve seen appear to at least have a muscular component, even when there are other problems present, so you can’t go too far wrong addressing the muscle problems regardless of whatever other treatment you do.
Good luck!
Dr. Best
Peter A
January 19, 2012Dr Best,
Thank you for your recent, timely response. (Very Impressed)
This problem is much more complex than expected. I think that I now have a much better understanding of what is going on. I will try to be patient and do whatever is necessary.
When my situation is resolved, I’ll be in touch.
Once again thank you for your help,
ps, I will keep your secret.
regards,
Peter A
Mike Ellis
February 2, 2012Succinct but informative videos, good job. Thanks.
Lilia González Burunat
February 25, 2012Dr. Best soy una persona que tengo 66 años y afortunadamente tengo buena salud y camino todos los días y hago una rutina de estiramientos durante 40 mins diariamente. Fui operada de mi columna hace 33 años de la 4ta y 5ta vertebra lumbar por un desgaste de disco en el cual se me implanto hueso de mi cadera. A partir de ese momento siempre he tenido que hacer ejercicio pues amanezco con dolores todos los días y el ejercicio me hace sentir bien, Tengo la pierna izquierda mas corta que la derecha desde que nací 3cms. Hace tres meses mi quiropractico me recomendo que me le pusiera a mi zapato izquierdo un aumento de dos centimetros para ayudarme a compensar el desgaste que mi columna puede seguir sufriendo por los años y me dijo que esto me iba a ayudar y que el cambio en mi estructura osea iba a a doler un poco pero con el tiempo me sentiría mejor. Desde entonces todos mis zapatos hasta mis tenis tienen, el aumento sin embargo me empezo a doler el ciatico de la pierna derecha y trato de hacer mas estiramiento y masajes y lo que me lo quita es el paracetamol pero lo tengo que tomar todos los días, eso no importa pues se que no tiene grandes efectos secundarios pero al leerlo a usted quiciera saber que más puedo hacer y si estoy en lo correcto. Mil gracias Lilia González
Dr. George Best
February 28, 2012Lilia,
Lo siento, pero hablo solamente poquito Espanol. Recomiendo ejercicio de estiramiento para los musculos piriformis y gluteus minimus en los videos aqui:
http://www.youtube.com/watch?v=EWc5tS2UIt4
http://www.youtube.com/watch?v=CQdTn2IjSKk
Si continúa la ciática, puede que necesite eliminar o reducir el ascensor en tu zapato.
Bueno suerte!
Dr. Best
Howard
August 28, 2012I HAVE L4 PERTRUDING SLIGHTLY FORWARD AND TO THE RIGHT.ALSO A BONE SPUR AT SAME LOCATION.WHAT EXERCISES SHOULD I DO TO BRING VERTEBRAE BACK TO NORMAL.POSITION .
Dr. George Best
August 28, 2012If the vertebra (not the disc) is shifted forward, this is a condition known as spondylolisthesis (which is Latin for “spine slippage”). There are two main underlying causes. One is a defect in the part of the vertebra between the neural arch and the vertebral body which produces a separation between the front and the back part of the vertebra. The other is degenerative arthritis in the spinal joints that causes thickening of the bone on the joint surfaces that displaces the vertebra forward. Neither cause can really be corrected by exercise, but further slippage in the first type can be minimized by keeping the abdominal muscles strong (with exercises like crunches). In the case of spondylolisthesis caused by degenerative arthritis, there is limited progression of the slippage, so exercises are primarily directed at stretching tight muscles for symptom control (knee to chest stretches and rolling face down across an exercise ball are two commonly-prescribed exercises for this purpose).
Dr. Best
Rosy
January 12, 2013I am a certified massage therapist in US. What is required to be a massage therapist in Puerto Rico?
Dr. George Best
January 12, 2013Well, Puerto Rico is actually a U.S. territory, but to my knowledge licensure for massage therapy for any state/territory is done through the state/territory board of health, or in some cases there may be a separate board of massage therapy. For Puerto Rico, I found the following information:
The Puerto Rico Department of Health (www.salud.gov.pr) handles the certification of all health professionals, including nurses, dentists, pharmacists, veterinarians, undertakers, etc. To obtain more information contact The Office of Regulation and Certification of Health Professionals at (787) 723-2885 or 725-7506, (787) 725-8161 or (787) 725-8121.
Good luck!
Howard
January 23, 2013Dr. best,Hope you can help. I have grade 1 spondylolithesis, left ridiculopathy of L4-Ll5, and severe central canal stenosis .Also have disc bulges of L4-L5 flattening the thecal sacs on all. I had 1 ESI so far.Followed up with therapy and have started exercising at gym( limited). was great for about 2 months.Started getting pain again down back of both legs 1/2 way down.Continue doing stretching exercises, but have pain all day.would say pain level averages 5-6.No pain while sitting.What would you suggest.They tell me because of the severity of the stenosis, I will ultimately need surgery,not only to open up spinal canal, but to stabilize L4- L5. Should be absolutely fine after rehab of 3-6months.What are your thoughts? Thank you.Seen all of your related videos and gained a lot of knowledge.
Dr. George Best
January 24, 2013Hello Howard,
Central canal stenosis can be caused by different things and the cause makes a big difference as to what the best treatment options are. If the stenosis is mostly due to disc bulging, exercises and anti-inflammatory measures (cold packs, medication, etc.) will often be sufficient to manage the issue, but surgery is sometimes needed. If it’s congenital (you were born with a narrower canal than normal) and/or due to degenerative bone and ligament thickening, symptoms can sometimes be controlled for a while with exercises and anti-inflammatory medication, but surgery is usually needed eventually to trim away the excess bone, ligament, and other tissue.
With regards to the spondylolisthesis, a grade 1 is usually quite stable, and when found in adults, it’s highly unlikely to progress to the point where it would need stabilization. It kind of sounds to me like the doctor may be trying to justify an “open” surgery when you would probably do just as well with a “minimally invasive” procedure. If you do wind up needing to consider surgery, I’d recommend at least getting an opinion from a surgeon who does minimally invasive (done through small incisions using a scope) to see if that is an option in your case. If you are a candidate for minimally invasive, the recovery is a lot faster and there are much fewer issues with post surgical scar-tissue.
One of my big pet peeves with spine surgeons is when they give unrealistic expectations to people to talk them into surgery. It’s very unusual for anyone to be “absolutely fine” after open spine surgery – EVER, let alone 3 to 6 months. Most are better than before the surgery (some are the same or worse), but almost everyone still has some residual symptoms to varying degrees that last for the rest of their lives. People who have minimally invasive surgery seem to fare considerably better overall, but it’s far from perfect. Surgery may be necessary in some cases to get lasting symptom improvement, but it rarely returns them back to completely normal. My rule of thumb for deciding whether to have surgery is to ask yourself whether or not you can tolerate the symptoms as they are. If the answer is yes, I would not go for the surgery. If the answer is no and you have exhausted the other potential treatment options, then it’s time to go forward with the surgery.
With regards to self-treatment, since you have no pain when sitting, my guess is that you would do best using the flexion (forward bending) position for the MxKenzie exercises, at least at first. I’d recommend investing in an exercise ball for doing the flexion exercise if you don’t already have one and use that position for a minute or so at a time several times per day. If you have some combination of disc bulging and degenerative bone stenosis, you may actually need to use both flexion and extension exercises, or start out with flexion and periodically add in some extension, so test the various positions on a regular basis and do whatever centralizes/relieves symptoms. Cold packs will help reduce inflammatory swelling, so as long as you are having symptoms, I suggest using them for 15 minutes or so at least a few times per day.
If you have further questions, let me know.
Good luck!
Dr. Best
Rich
March 26, 2013Dr. George,
There are at least 2 other injections I can think of that you didn’t mention:
Facet injects, of which I’ve had several for supposed facet
arthropathy but no relief; and Perispinal Etanercept (Enbrel) which
I’m trying to learn more about. Please share your thoughts as I’ll do just about
anything to avoid invasive procedures such as surgery.
Thanks
Dr. George Best
March 27, 2013Facet injections my be helpful in some cases of low back pain, but they’re pretty useless for sciatica in most cases.
While perispinal etanercept is very effective in some cases, it is not yet widely available and studies on its overall effectiveness have had mixed results. It’s also currently “off-label” for the treatment of sciatica, meaning it is not yet FDA approved for this particular purpose, and therefore will probably not be covered by insurance. Despite the hype surrounding it, the way it works is supposedly by suppressing inflammation. While perispinal etanercept may or may not prove to be superior in effects and have fewer side-effects than cortisone injections in this regard, as with steroid injections, it probably will not help much in cases where there is significant direct nerve compression from protruding discs, degenerative bone and ligament thickening, etc., as opposed to symptoms coming primarily from the pressure of inflammatory swelling. One recent study has shown that the therapeutic effects of steroid injections are actually superior to perispinal etanercept (see: http://www.ncbi.nlm.nih.gov/pubmed/22508732), but more comparison studies may yield different results, so in my opinion, the jury is still out.
Dr. Best
Lisa
December 6, 2017No No No..do not let them do surgery. I’ve had 2 failed spine surgeries my scar is 15 inches long. I’m worse now than I was before the surgery. I can only walk from point A to point B..very off balance and wobbly. The pain from my lower spine radiates down my left leg all the way to my toes..ive done physical therapy 6 times..accupuncture..at least 15 injections..tens machine..ice..exercising..and still can’t walk without severe pain..i could no way walk 1/2 block..im so sorry I ever went under the knife..i break down and cry at least 10 times a day..i have no life whatsoever..pain management makes you feel like an addict..if i don’t get some kind of break soon..its not looking good..im highly allergic to steroids.so maybe that’s why they don’t work..dr keeps wanting me to get them..i told him NO I’m done..if anyone knows of anything I can do to get some kind of releif.please email me..i know exactly what everyone is going through..this is no joke..and I CAN’T TAKE THIS PAIN NO MORE..PLEASE HELP ME SOMEONE..
Susan Gautsch
May 16, 2013Hi Dr. – do you have any information on something called Anti-TNF treatments for sciatica. There is a web sit for INR – Institute of Neurological Recovery. What does that injection do? Thank you
Dr. George Best
May 16, 2013Anti-TNF is a relatively new means of treating inflammation. It works very well for some people, but is most likely to be effective in less severe cases of disc herniation in which inflammatory swelling is a significant symptom generator as opposed to more severe cases in which the protruding disc material itself is producing significant nerve compression. While it’s promoters claim it to be a superior new treatment for back pain and sciatica, the independent research so far has not supported that assertion. In fact, a recent study showed that the long-established treatment of steroid injections achieved statistically much better results overall than anti-TNF. Anti-TNF may have fewer side-effects than steroids, but it’s still a little soon to even say that with any certainty.
Lisa
December 6, 2017Dr wants me to get implanted spine stimulator..i said no.saw to many bad review’s..pain meds barely take the edge off..im never completely out of pain unless i lay with a pillow between my legs.
Lisa
December 6, 2017The only thing I got from injections was hair growing on my face and gained about 40 lbs. I had a severe reaction for about 3 weeks..i didn’t even know where i was..
Ronna Sittig
November 27, 2017What do you think of “dry needling”?
Dr. George Best
November 27, 2017Dry needling is a way of releasing trigger points and other soft tissue constrictions. It can be effective when the problem is primarily muscular or fascial (fascia is the tissue that covers and separates muscles and organs from each other). While some inidviduals get better results from dry needling than other soft tissue release methods (massage, stretching, foam rolling, etc.), in my opinion it is not a better method in general than other soft tissue techniques. The purpose and intent of dry needling is very different from spinal injections, which are used for delivering anti-inflammatory or pain blocking medication directly to the area of nerve irritation.
Dr. Best
Lisa
December 6, 2017Dr wants me to get implanted spine stimulator..i said no.saw to many bad review’s..pain meds barely take the edge off..im never completely out of pain unless i lay with a pillow between my legs.
Jeffrey Coats
February 6, 2018Dr Best.
I have been suffering with pain in my groin/low back/down right leg, usually ending behind my knee for about 4 months now. MRI shows bulging S1/L5 disc pushing badly on nerve root. I have been in constant, terrible pain. I had epidural steroid injection last month, very little relief, and a month later my pain is the same. I’ve tried endless physical therapy, purchased a “low back trax” for spine decompression, and do stretches everyday (cobra, bridge, ect) it seems to me that right around my piriformis is where I hold most of my pain. Is it possible that even though my MRI shows bulging disc pushing on nerve, that some of my pain may be coming from my nerve running through the muscle? Would perispinal etanarcept be more effective? I’m coming close to losing my job at home, should I go ahead with the surgery they are offering? (Surgery claims to drill a piece of your spine away so disc has room to slide back in) please help!
Jeffrey Coats
February 6, 2018Job and* home.
Dr. George Best
February 6, 2018Hello Jeffrey,
In disc protrusion cases, symptoms are usually due to a combination of direct pressure on the nerve by the disc and pressure caused by inflammatory swelling. When it appears (from imaging like MRI) that there is substantial direct pressure from the disc, treatment directed at the inflammatory swelling component is typically not very effective. While perispinal etanercept works better in some cases than epidural steroid injection, both treatments address primarily the swelling aspect of the problem. In your case it sounds like direct pressure from the disc is by far the bigger problem, so I would not expect the perispinal etanercept to be significantly more effective than the ESI was.
It is certainly possible that the piriformis is involved, but since the MRI did show a significant issue with the disc, I think the piriformis is most likely to be a secondary issue. Because the piriformis is innervated by the lower lumbar nerves, the irritation of those nerves by the disc protrusion may be causing contraction and “trigger points” in the piriformis and thereby creating some piriformis symptoms mixed in with the true sciatica symptoms.
Your description of the proposed surgery is not familiar to me. My best guess is that the recommendation is for a laminectomy, which is a removal of part of the spinal bone to allow more space around the nerve even though the disc protrusion remains. That is a common procedure and gets reasonably good results in most cases. Even so, I suggest you look into a “minimally invasive” procedure where the surgeon goes in through small incisions using a view scope and trims away the protruding disc and/or other tissue that is compressing the nerve. While there are pros and cons to each type of procedure, the biggest benefit in a case like yours with a minimally invasive surgery is the quick recovery time. Most people are able to resume normal daily activities within a week or two with that type of procedure whereas a laminectomy typically takes at least a couple of months (surgeons often tell people 4 to 6 weeks, but most of the people I’ve seen who have had such procedures are still in a lot of pain for quite a bit longer than that). The primary disadvantage of minimally invasive is that the disc wall is left thinner after surgery and there is a potential for re-injury if one is not careful. In my experience most people do quite well with it if they understand that and continue to do preventive exercises and are diligent about bending and lifting properly.
In the meantime until you can get a consult for minimally invasive, assuming you choose to do so, my advice is to follow the intensive care regimen found in my free ebook. In my experience, doing the cobra or other extension exercises (such as the position propped up on the elbows in my ebook) frequently throughout the day (a minute or so at a time 5 or 6 times per hour is a good goal) is much more effective than doing them for even extended periods once or twice per day. Extension pushes the disc material forward and away from the nerve, but repetition seems to allow the disc wall to stabilize to hold the bulge in more effectively. This is of course assuming that extension is producing centralization (explained in detail in the ebook).
The other suggestion I have is to see a chiropractor if you have not already tried it. In many cases, altered biomechanics in the sacroiliac and/or lumbar spine place undue stress on the disc and other tissues and may interfere with healing. In addition, even slight changes in skeletal alignment can be sufficient to dramatically reduce symptoms as it only takes small changes in pressure on the nerves to change their firing patterns. If possible, I would recommend seeing a chiropractor with some years of experience and confidence with disc issues. If you do decide to see a chiropractor, there is a maneuver I have found that is particularly useful in disc cases (it’s not one of the usual methods chiropractors use, at least not in that part of the spine) and I’d be happy to walk your chiropractor through what I do. I don’t recommend it for anyone with an outright disc extrusion (rupture), but it works quite well for most other disc issues and in most cases using it with some soft tissue techniques can get the symptoms settled down by 50% or more right from the first treatment.
If you have further questions, let me know.
Dr. Best
Jeffrey Coats
February 8, 2018Dr Best.
Thank you so much for your fast, detailed, and very helpful response.
I did see a chiropractor, but this was before I had my MRI and I feel she didn’t do much at all maybe because we didn’t know the exact problem. I am going to seek a chiro that is skilled with my specific problem, that way you can walk him through that process. I really appreciate your willingness! You are very much a blessing.
also, keep in mind I do work on an asphalt paving crew full time. I know this may affect some of your recommendations for me. (Most days, if I am able to make the drive and get moving, the work actually makes me feel better)
Dr. George Best
February 8, 2018Hello Jeffrey,
One other tip about chiropractic, the disc adjustment I use is very similar to a maneuver called an “anterior thoracic” adjustment from the Diversified technique. So, if you find a chiropractor who is familiar and comfortable doing that type of adjustment, it will be much easier to explain the modifications of that adjustment to him or her as opposed to someone who isn’t used to that maneuver.
It is a good sign that your work activity makes things better. It doesn’t really change anything from my prior suggestions, but usually when movement makes things better rather than worse, it is a favorable sign that things can be managed non-surgically in my experience.
Dr. Best
Jeffrey Coats
February 9, 2018Dr Best,
I called around and found a Chiropractor that is familiar with that procedure and is willing to talk with you so you can walk him through the modification. I really appreciate this! My appointment is scheduled for Wed. Feb, 14th at 5PM. eastern time.
Dr. George Best
February 9, 2018Hello Jeffrey,
Trying to get schedules to match up can be tricky, plus having a visual aid might be useful. What I suggest is having him email me at gbdc1@yahoo.com and I can send him a brief video showing how I do the adjustment and he can call me if he has any questions.
Dr. Best
Cindy
March 29, 2018Hi doc,
Is walking good for sciatica and at my work they build a safety stairs would this affect my sciatica to flare up and when I use heat or ice I feel needles running down to my foot is that an indication of imflammation.
Dr. George Best
March 29, 2018Hello Cindy,
Walking at a comfortable pace is usually helpful. Climbing stairs sometimes aggravates the muscle reactions and inflammation associated with sciatica while things are already flared up. In and of itself though, climbing stairs probably won’t initiate sciatica symptoms unless there is a significant problem in the hip and/or sacroiliac joints. Getting a sensation of needles going down the leg while using ice or heat doesn’t necessarily indicate inflammation. While the nerves are irritated, almost anything, including ice or heat, can trigger a variety of sensations.
Dr. Best
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