I have sciatic problems for 5 months now. If I walk or stand for long periods it hurts. I’ve done chiropractic, Vac D, did 2 injections and I have a teeter and use it 3 times per day. I also take 4000mgs of fish oil per day. I also do stretching also.Some days it does feel better. How long could my problem take?
What more can I do? Please tell me.
Sincerely
Joe Stites
The recovery from sciatica depends largely on the severity of the underlying cause. In your case, I am assuming that the cause is a disc protrusion – judging from the treatment you’ve had so far. Even large disc protrusions can get better eventually, but it can take a year or more. In my experience, most people who are going to get better with conservative treatment will do so within a few months. With the duration of your problem, I think it may be time to consider surgery if you’ve had an MRI or other imaging that suggests it may be needed, but I do have a suggestion for something to try first.
I suggest you use the basic McKenzie exercise as shown in my ebook and Part 2 video (assuming it produces any centralization of your symptoms) on a frequent basis – about a minute at a time, up to 4 or 5 times every hour you are awake. Do this for at least a few days in a row. Your back may get sore doing it that often, but if the symptoms are centralizing, you are on the right track. If you’re making progress, continue the frequent use of the exercise for at least a week and then you can begin reducing the frequency as the symptoms continue to improve. It may take several weeks to get maximum improvement, and it is possible that you’ll continue to have some intermittent symptoms for several months, but if you can get to the point where your symptoms are tolerable, I would recommend continued management with the exercise and use of the teeter and fish oil.
If you don’t get any improvement with the intensive use of the McKenzie exercise, then I’d recommend consulting with a surgeon who does “minimally invasive” spine surgery, which is discussed towards the end of the video on this page.
I’m not sure if I have sciatica or pyriformic syndrome. I’m a software engineering and have sat in front of a computer for the last 19 years. About 5 years ago I developed a very noticeable dull ache deep within my right buttock. Initially I thought it would go away but after 5 years it’s only become worse. The pain is 24×7 and unfortunately I am dependent on Ibuprofen in dealing with the pain where I take about 600-1000mg a day. I have had an MRI that showed nothing “unordinary”, have been to a pain Dr. where I got an injection in the right SI joint which did nothing. In the end I’ve found Ibuprofen to help the most. The pain is the worst while sitting. If I don’t take any medication I am hurting after only 30 minutes and find myself unable to focus on work, etc. The pain feels deep within my right buttock and extends to my right thigh but no further down. Many right buttock area usually feels tight and tender. I have watched numerous videos on the Internet, including yours (great by the way) and started stretching over the last few weeks which seems to help a little but the pain persists. I also find some relief rolling my right buttock on a baseball. I have about every back brace/contraption known to man and recently spent $1000 on two of the best/ergonomic office chairs available today (Herman Miller Aeron and a SteelCase Leap chair) of which while providing more comfort have not helped overall with the pain. I also have an electric shock device (TAMMS ?) which doesn’t help either. Sleeping or laying flat on the floor on my back seems to be the less painful position but often I wake up in the middle of the night in pain if I have rolled over on my side and twisted my legs, etc. I’m getting worried about being dependent on Ibuprofen and understand the side affects/risks of taking it for so long but I don’t know what else to do. This pain has taken over my life … I’m an avid motorcycle rider and used to ride every day …now with the pain I don’t even want to get on it or drive a car for very long. On a scale of 1-10 the pain is only like a 3-4 but because it’s there 24×7 it’s always there in the back of my mind. Any suggestions on what I should try next? What’s weird is I don’t remember doing anything to injure myself …just woke up one day and the pain was there and has never gone away.
Since the MRI was normal, chances are the direct symptoms are coming from the piriformis and/or gluteus minimus muscles. Occasionally a standard MRI (done lying down) will not show any problems whereas an upright MRI will show a significant disc bulge, so I would not rule out true sciatica entirely, but your history is more associated with the problem being muscular.
In many cases piriformis and gluteus minimus problems are secondary to SI joint dysfunction. The SI joint itself can cause symptoms (in which case the injection would likely have helped some), but is often asymptomatic and the mechanical dysfunction triggers abnormal muscle contraction. This can also occur with the other joint these muscles interact with – the hip joint. So, one possibility is that joint dysfunction in the SI and/or hip is the underlying issue, and this would not be unusual for someone who sits a lot. There are a few techniques for self-treating these joints, but in most cases the most efficient way of detecting and correcting the problem is to see a chiropractor or osteopath who does manipultion therapy, so that’s one thing I suggest you look into.
With the considerable amount of sitting you do, it is entirely possible that the problem is simply progressive tightening of the muscle(s). Since this may have been developing for several years, it may take a little time and frequent stretching and massage to start making some headway on correcting the problem. My suggestion is to work on the stretching and self-massage as frequently as possible for the next few weeks and see how it goes. Doing a minute or two of stretching / massage a few times every one to two hours will often get better results than trying to do one longer session per day.
Just saw this video today, and I am wondering about the “red flag” symptoms. My loss of sensation (numbness but not numb, very odd feeling) is in the back of my left thigh & heel of my foot, so not exactly the inner thigh…does this signal red flag? I am curious because if I require surgery I have no medical insurance, yet I don’t want to risk permanent nerve damage. My first visit with a chiropractor was today & he said we should know in 4-6 sessions if this will help or if I need a different route. Any advice? Thank-you.
No, the sensations you have in the back of the thigh and heel are not “red flag” indicators and are actually relatively common with sciatica. I think your chiropractor’s treatment plan is reasonable. As a general rule, if someone is not improving with treatment within about two weeks, further evaluation with an MRI or CT scan is advisable to determine the extent of the problem and suggest the best course of treatment. You may not be 100% within two weeks, but I would want to see some significant improvement in that time frame.
I had a fall in June of 2010 in which I broke my shoulder. A month later I experienced a severe case of sciatica, to the point that I could not even walk. The Dr put me on a round of predisone which relieved the symptoms for a few months. The pain began to return in June of 2011. I have been seeing an orthopedic Dr., who once again put me on a round of predisone,which helped very little this time. He then sent for an MRI, which showed a bulging disk in L5/L6 (I think). I asked about physical therapy, but he said he did not want me to do any therapy at that time as he was afraid it might make it worse. Then he sent me for an epidural, this is now August of 2011. I explained to him that my big concern is that I am scheduled for a trip to Thailand in Feb. 2012. At the same time I am dealing with the sciatica issue, my shoulder dislocated, and with further investigation it was revealed that there was a lot of soft tissue damage in the shoulder from the fall in 2010. So I was scheduled for surgery on my shoulder in November. In the mean time I have have had 2 more epidurals (3 total) and they have each helped about a month & 1/2. I am now dealing with the sciatica pain again, to the point that I am having to use pain meds everyday. I am limited in being able to do the McKenzie exercises, as my right arm is immobilized and will be for 2 more weeks. My question to you is it time to consider pursuing having a minimally invasive back surgery, done. I am getting very concerned, because I am leaving for a Thailand mission trip in 2 months.
You might be able to do a modified version of the McKenzie exercise by lying on your back with a pillow or rolled up towel placed in the small of your back. As with the regular version, frequent use typically gets the best results, so a minute or two at a time with the spine in extension done up to 4 or 5 times every hour you are awake might be sufficient to get rid of most of the pain within a few days. If you are able to get rid of the symptoms that way, chances are you can manage the problem without surgery.
If you can’t modify the exercise and/or get relief with it within a week or so, then I would suggest going forward with a minimally invasive surgery due to the pressing matter of the mission trip. I suggest scheduling a consult with the surgeon as soon as possible so that if you do need the surgery you can get it done as much in advance of your trip as possible so that you can be sufficiently healed and get in some rehab before you leave. Most people recover quite rapidly from minimally invasive surgery and can return to normal activities within a week or so, but that kind of a trip can be pretty taxing on the low back (just sitting on an airplane for that many hours takes a toll), so you’ll want to get your back as strong as possible in advance of the trip.
I have had back problems off an on for many years. I turned 65 in August and started walking, light jogging and exercising more than I had time for when I was working. I developed an ache in my right buttock and went down to the outside of my knee. I iced, stretched, took Advil (which didn’t really seem to help much) and if finally went away. Three weeks ago I developed the same symptoms on my left side but they are much more extreme. I can get into a sitting position and a laying position with minimal or no pain but if I am up on my feet for more than a minute or two the pain in my buttock and leg is excruciating. My chiropractor can’t seem to figure it out. He encouraged me to get an MRI which I did yesterday. My doctor had put me on steroids for six days and they did absolutely nothing for the pain. It is hard not to be on my feet a little bit as I am alone most of the week. I keep wondering if being on my feet is making it worse. Hopefully I will know something from the MRI next week. I quit taking pain pills because sitting with ice works better than they did although the results don’t last too long. Is it OK to keep stretching even if I don’t know what is causing my pain?
The MRI should be helpful in figuring out what’s wrong and what to do about it. As long as you are not forcing yourself to stretch through severe pain, you’re not likely to cause any significant harm, so I don’t think there’s a problem with stretching and using ice until the MRI results are in. If you have additional questions after you get the MRI results, let me know.
Five years ago I had butt/leg pain, had MRI and subsequent spinal shot. Recovery took over a year. I’m a Yoga teacher and began the practice of Bikram Yoga, which includes26 postures, some are backbends. After 5 and 1/2 years I again have issue with butt/leg. Again had spinal shot, some improvement for a week, but it’s been 3 weeks now and symptoms have returned. I always feel better after Bikram class, but several standing stretches I opt out because pain comes into the picture. This practice seems beneficial, but I may be doing more harm than good. Suggestion on how I can tell? My pain is not as severe as 5 years ago. Also I’ve been doing specific pyriformis stretches which help on temporary basis. My right calf muscle seems cramped to the point of extreme pain. After stretches ok for 3 to 5 steps then tight pain returns. Also 3 toes on my right foot are semi numb much of the time. With certain stretches the feeling sensation returns while in the stretch but semi numbness retunes when I release. Not sure if diet is a factor. I’ve been a vegan for 23 years.
Usually back bends are not a problem, but the forward bends of some yoga positions can definitely provoke a disc herniation. Spinal injections work by suppressing inflammation and reducing swelling around the nerve, but don’t do anything to resolve the disc bulging itself. Since the injection did provide short-term relief, it is likely that inflammation is playing a significant role. I suggest using cold packs along with anti-inflammatory medication or supplements to manage the inflammation and continue to avoid any yoga positions that increase symptoms. You may want to consider avoiding Bikram for the time being as the heated room may be increasing inflammation. The thing about heat is that it usually does feel good at the time because it sedates the nervous system, but the increase in inflammation it produces can delay recovery. What I suggest is to continue the back bends and poses you can do without pain, but do them in an unheated environment until such time as things are feeling better.
A vegan diet is usually fine, although high grain consumption (particularly wheat) can be pro-inflammatory. So, you may want to cut back on grains temporarily to help with the inflammation as well.
Frequent use of back bends and cold packs will usually get rid of most of the symptoms within a couple of weeks. If you’re not improving much in that time frame, I’d suggest getting checked by a doctor and probably getting some updated imaging to further evaluate the situation.
I’ve had back problems for 2 years now. I’ve had several MRI’s and they showed nothing. However, this last one showed (Mild) Facet Arthropathy at my L4/L5, L5/S1. I’ve had Sciatica for about 2 months now. The pain goes from my lower back down my buttock down the back of my leg under my foot and even to my toes. Sometimes the pain in my toes is so bad that I cannot get rest at night. I can’t seem to get any relief at night besides laying on my back and when I get up the pain is terrible. I also have terrible hip pain. I’ve tried the SI Injection and it seems to cause more pain than I had before. I have had PT and seen a Chiropractor. I am not getting any relief at all. The pain is getting unbearable. I sit down all day at work and I try to get up to move around. It seems to be getting worse. I’m really concerned about having a bulging disc as I have all the symptoms. My neurologist seems to think that it’s Piriformis Syndrome. However, does that cause pain down my leg and under my foot? I had an EMG and it showed some abnormalities with my S1. Any suggestions as to which way to go from this point? I’ve tried stretches and for some reason the pain is still getting worse. Is it possible that the disc bulge did not show on my MRI of which was lying down?
Piriformis syndrome can cause the symptoms you described; however, since you have low back pain as well as sciatica symptoms and because the EMG showed some S1 nerve root issues, my suspicion is that there may be a disc herniation that is not showing up on the lying down MRI. Since the only position that brings you relief is lying on your back (the same position standard MRIs are done in), it is quite possible that an upright MRI would show something very different. So, my recommendation is to see about having an upright MRI – they are not widely available yet, but most major metropolitan areas have at least one.
I was told I had severe sciatica after an MRI because I had severe arthritis in the spine. I was told surgery was NOT an option & the only thing was to try an inversion table. I feel quite upset as I feel that I will be like this for the rest of my life! am 80 yrs old (in good health apart from the arthritis) I am not very enthusiastic about using an inversion table. I do see a physio therapist & do some exercises. I use a walker & can walk 11 minutes at this time, then get very tired! I can only stand for a very few minutes & then more pain & the bottom of my left leg goes numb. Any suggestions or comments?
There are other options besides an inversion table. With severe arthritis that is causing nerve compression, it often helps to stretch the pine lengthwise such as with an inversion table, but use of such devices can be a little difficult. The same basic effects that can be achieved with inversion can also be obtained with home traction devices or even using the flexion position for the McKenzie exercises by simply lying face down on an exercise ball (they now even have “half therapy balls” which have a flat platform as the base so they don’t roll) or even just a stck of pillows. Any of these things can be used to stretch the spinal joints and ligaments and may significantly reduce pressure on the nerves. I suggest you discuss these options with your physio therapist and perhaps he or she can work with you to find the best option for you, as well as show you how to use whichever device you choose.
Another option that may help is incorporating massage into your treatment. In many cases, a lot of the symptoms that occur with spinal arthritis are actually produced by muscle reaction. Massage can help reduce the muscle tightness and directly ease pain produced by the muscles, but reducing the muscle tension can also reduce compression on the spine and ease the pressure and irritation of the nerves.
Low force chiropractic such as with an Activator or Arthrostim adjusting instrument is often helpful for people with spinal arthritis. Such techniques gently improve the mobility of the joints, which tends to reduce muscle and nerve irritation.
Finally, in many cases of spinal arthritis, swelling due to inflammation can play a major role in symptoms. Applying cold packs as directed in my ebook, using various natural anti-inflammatories and/or anti-inflammatory medication may help considerably. While not an ideal solution, steroid injections may provide enough inflammation control to dramatically reduce or eliminate symptoms for up to months at a time. One other option that works to varying degrees for reducing inflammation and pain is acupuncture, which can be done with the traditional needles, or with other forms of stimulation such as laser.
Different things work for different people, but hopefully one or more of these suggestions will be helpful for you.
Hi I had surgery 4 years ago for a bulging L5 S1 disc on the left hand side, which left me in severe pain for months. I had immediate relief and needed no pain killers after surgery as the pain was less than I had been in! A year ago, I forgot to be careful and lifted a 25 litre water bucket for my horse. My back exploded and pain shot into my right foot. I can only describe it as shooting electric pain. I was terrified and lay down in the field, very still for half an hour. Surprisingly I could get up and walk and, though in some pain, seemed ok. Chiropractic and excercises did not really relieve the pain, but I could live with it I guess. Two weeks ago it worsened and I lost feeling in part of my foot. I cannot raise my toes and sometimes my leg gets left behind. I can’t run, not because of the pain but I just can’t make my right leg move sufficently! Then I had an episode of excrutiating pain and even codeine and diazepam didn’t touch it.Thank God, my GP listened and sent me for an MRI which showed a large disc bulge causing ‘significant nerve compression’ on the L5 and S1 nerve roots on the right side. I saw the scan and there seemed no room at all for the nerve. I also had awful burning in my shin and foot and thought my foot was being deprived of blood and would fall off! – I’ve seen an orthopaedic registrar and they considered emergency surgery but decided to send me to the neurosurgeon for a consultation instead. I have no saddle anaesthesia. From the time when I had the excrutiating pain to having the MRI and seeing the orthopaedic guy was 7 days. I think surgery may be my only option and I don’t really WANT it but am more scared of what will happrn if they DON’T operate because I feel my back is going to ‘go’ again at the slightest opportunity.
Your website is great as is the book. It’s controlling my pain. Thanks and good luck to everyone else out there who is also suffering. I WILL NOT let this ruin my horse riding or the time I spend with my family. (Just hope this determination works….)
Jane
Sorry to hear of your troubles. With a bit of luck you may still be able to get things back to normal and manage the problem without surgery. Depending on how bad the disc is, surgery is sometimes the best option. In my experience, if the disc is just bulging but the inner gel is still contained by the outer cartilage wall of the disc, the chances are very good that it can be managed without surgery. If the disc appears to be extruded (ruptured) and the inner gel has breached the disc wall, chances are surgery is going to be needed to get lasting relief. In any event, I wish you the best of luck for a good, speedy recovery.
Hi George
Final question- does this mean the disc has ruptured or not?
MRI results
“L5-S1 large right lateral disc prolapse with cranial sequestra. The prolapse extends into the right neuroforamen and significantly compresses the right recess, right exiting L5 nerve root and right S1 nerve root.”
Can’t find anything of the internet about ‘cranial sequsetra’!
Jane
Sequestra/sequestrum/sequestration/sequestered fragment (either term may be used) indicates that the disc has most likely ruptured and a piece has separated from the main part of the disc. Cranial means that the piece has been displaced upward. Unfortunately, this is a situation that usually requires surgery. In some cases, the sequestered piece of disc will move to a spot where it does not create pressure on the nerve and therefore can become completely asymptomatic. The problem is that it can easily move at any time and suddenly become very symptomatic, so I suggest having it taken out.
I just signed up as a member and an very Impressed with your information available on Sciatica
I went for a 10km cycling just about 4 months ago and had a leg pain around the Outer Front Calf of my Right leg, sometimes extending to the lower outer part of the Right leg near the foor…its getting worst such that I cannot walk for more than 100 -200 ft and stand for 5 mins.before the pain comes
I saw an spinal specialist on it recently a week ago and the MRI reports…
a) Mild grade 1 spondylisthesis of L4 on L5…. Alignment of rest of spine is intact.
b) Degenerative changes with end plate osteopathy formation and lower facet atrophy.
c) Prominent disc space narrowing at L5/S1 level….Dr says there is Disc bulge in this area..
d) No compression fracture detected
My Questions are …
1) Why is the pain at the leg calf area and Not shooting from the lower back to the buttock…is this pain caused by the L4/L5 or L5/S1 nerve root.
2) Should I go for Surgery …for the L4/L5 or L5/S!,if needed be.
3) Whats is End plate Osteopathy formation and lower Facet Atropathy.
The Dr recommend Physio therapy first follows by Spine injection follows by Surgery if No improvements….I have Not start any treatment yet and I am Wits end and truly appreciate yr advise…Pls advise urgently…. Many Thanks
Jeffrey Koh
BTW..I cannot find yr e-book …Where Can i get it on the internet
Thanks.
As a 63 year old male with arthritis (here in Canada, arthritis is a catch-all term meaning that I experience pain and swelling in or near various joints for which they are not sure of the specific cause), in recent years I’ve been experiencing sciatica in both legs. The pain generally occurs in both legs at the same time and extends from the butt down to about calf level. Often the pain occurs in twinges rather than being constant. The twinges sometime cause my legs to buckle slightly with a short quick groan. I believe that I may be losing some of the strength in my legs (which may simply be because of entering ol’ geezer territory), most noticeable when doing exercises.
Fortunately (?) the pain generally goes away when I lie or sit down. It seems to bother me some days more than others, often after I’ve spent a period of time carrying something around (in front of me) or bending over for a period of time (washing my feet position).
X-Rays show a narrowing of the disks in the lumbar region (my doctor speaks in very generic terms apparently assuming that I’m not capable of understanding a more specific explanation).
Is there any means, based on this limited information, to zero in on specifically what’s causing the sciatic pain.
The only suggestion from my doctor was to visit a physiotherapist, which I did for a short period of time, without noticeable improvement. The physiotherapist seemed to focus mostly on piraformus exercises and stretching the quads.
I have begun doing inversions on my inversion machine (6 minute period of time) each day, which seems to help (placebo effect maybe?).
To my untrained mind, it seems somewhat like a bulging disk but have also considered a possible constriction (nerve impingement) caused by the narrowing gap in the vertebrae.
Thanks in advance for shedding any light you may be able on this situation.
With X-rays showing disc narrowing, chances are there’s some disc bulging (an MRI or CT scan would give more information about that) and probably some thickening of the bone and ligament structures (which occurs as a result of the increased mechanical stresses produced by the vertebrae being closer together) around the nerves. There’s usually also some variable contribution to symptoms from inflammatory swelling. Although in cases where there is just narrowing of the nerve canals from disc bulging extension exercises are usually helpful, extension can irritate symptoms when there is thickening of the bone and ligament structures at the back of the spine. The bone and ligament issues tend to improve with flexion exercises, although too much flexion can irritate the disc bulging (which is why the bending forward tends to increase the symptoms). So, sometimes none of the McKenzie exercises are effective and sometimes it takes some trial and error to find a balance of flexion and extension. One suggestion I have is to get an exercise ball and do the flexion exercises on it, as being supported on the ball minimizes the tendency for the disc bulging to increase.
Traction/decompression/inversion is usually helpful in such cases because it no only decompresses the disc, but also stretches the thickened ligaments, so I recommend you continue using your inversion machine and perhaps increase the frequency to do it a few times each day.
Controlling inflammation with ice packs during times of increased symptoms and with natural anti-inflammatories on a preventive basis will probably be helpful. One ant-inflammatory in particular that I’ve been seeing good results with is turmeric (If it’s available in Canada, I suggest the Himalaya Herbs brand 1 capsule 2 to 3 times per day).
Hopefully this is helpful to you. If you have further questions, let me know.
Thank you Dr Best for this Surgery For Sciatica video. Excellent as always.
This one has the greatest resonance for where I am now.
However the link and on screen button below, mentioned at the end, do not appear. If you recommend another browser that’s fine. If these are the exercises you have already published no problem, but if they are new could you please send me the links.
Regards
Richard
Good day Dr. Best. My symptoms dated back since 2012. Shooting pain on my left hip which would make me fall. Consultations with the Ortho at that time indicated Osteoathritis which was also shown on x-ray. Medications were given and therapies done which didn’t give relief. Repeat x-ray and an MRI showed severe Degenerative Osteoarthritis w/ subchondral cysts L hip and MRI showed disc bulging at L4-L5 with some stenosis and arthritic changes. A neuro consult at that time said that my pain is primarily due to the left hip Osteoarthritis.A THRA using cementless procedure was done on the left, however I didn’t get any relief and pain from the buttocks w/ radiation to the knee and lateral leg of the left persisted. Ortho doctor suggested pain is because of my low pain threshold and muscle spasms. He suggested continuous therapy and meds. 2013 left pain still persistent and noted with muscle weakness and size getting smaller. Went on pain management and given different drugs and continuous therapy. September of 2013 had same complaint on the right hip and x-ray showed Severe Degenerative Osteorthritis of the R hip. Underwent another THRA of the Right this time using cemented procedure. Recovery is better than the Left and later on noted dragging on my left foot which was due to a leg shortening on the right. I was advised to use insoles 2.5-3.0cm on the left foot. Because of the persistence of symptoms on the left, referred to a neurosurgeon which requested for another x-ray and MRI. Some translucencies were noted on the side of the left implant. MRI showed progression of previous findings. January 2014, Advised to go for Fusion surgery with metal instrumentation. Surgery set aside for travel to visit my kids in the US last March. While there pain persisted and by April there is already noted urinary incontinence so an immediate surgery was done when I went home. Revision of THRA on the left, this time using cemented procedure with leg stretching and laminectomy of the L4-L5 with metal instrumentation was done last April 30. On waking up noted burning sensation with numbness and foot drop on the left. I’ve been undergoing continuous therapy with pain meds, anti-inflammatories, Vit B supplement and Gabapentin. Up to the present I’m still having pain on the L buttock area and L lateral leg altho noted disappearance of the burning sensation, this time numbness and some shooting pain on the L foot and a foot drop. With these symptoms is there still a possibility of having a sciatica ? If no, how long ususally is the recovery and will my foot drop resolved? I’m using a Foot ankle orthosis on the left. Please help.. Thank you.
The foot drop indicates a neurological loss which is probably related to the disc bulge you had at L4/5, but it’s hard to say if that’s something that will improve over time or whether there is some degree of permanent nerve damage. Nerves recover slowly, so it could take several months to reach a point of maximum recovery and there’s not really a way to know in advance whether the foot drop will completely resolve.
Given the location and the history that includes hip degeneration, I think he pain in the buttock and on the outside of the leg is probably largely muscle referral pain from the gluteus minimus and/or piriformis rather than sciatica. Since you can’t really stretch the muscles fully when you have a hip replacement, your best bet for getting relief of those symptoms is probably going to be deep massage therapy (I’m assuming the surgical incisions are healed by now, but if not, you’ll need to wait until they are). While self-massage is helpful, I suggest seeing a professional massage therapist at least at first to get some in-depth work done and hopefully get some improvement pretty quickly. It is unusual for piriformis syndrome to be of such severity as to cause foot drop, but it is possible that the muscles are contributing to the nerve compression so even the foot drop may improve with the massage therapy.
DEAR SIR,
FOR THE TWO THREE WEEKS, DOING ST EXTENSION. MY RT FOOT(NUMBNESS)
HEAVINESS IS TILL THERE. SOME TIMES THE NUMBNESS FELT IN THE AREAS UNDER THE BUTTOCKS INCLUDING TESTICLE AREA. NOT FEELING ANY PAIN WHICH NEED MEDICATION. BUT FEELING WEAKNESS IN THE LEGS WHEN WALKING. PLEASE ADVISE AT THE EARLIEST. WHAT I HAVE TO DO? THANKS. ARUMUGHAM
The numbness in the area under the buttocks and in the testicle area is concerning as it may indicate pretty severe compression of the nerves. At this point, I strongly recommend you see a doctor and have an MRI to further evaluate the situation. Sorry I don’t have better news for you, but it is important to find out what’s going on and get the appropriate treatment to avoid permanent damage to the nerves.
amen to back surgery, use as last resort. i had complete lamesnectomy in 1996. the mri showed all circles for disks except L-2. which was flat not a circle. i never did know what exactly being flat meant on a mri. i truly believe that my real problems starting in 2003. by the way it took me about six months to get back to some normalcy. i have been thinking for years that caudification was causing my pains etc. i am now think it is spinal stenosis. i will know soon. thanks bond w.
I have pain behind leg and and but. Numbness down out side leg down to foot. Thought it was piriformis. Did stretches for piriformis. It aggravated the but pain when sitting. You suggested treatment of other other problems 1st.
Have been to chiropractor 3 times for spine stretching & side twist low back pop. Seen in videos. I believe my back is loosening up. I am starting to be able to walk a little more upright for longer periods of time. My problem is over a year old. The high leg pain was here far before the low back pain. Should I expect my pains to decreases in reverse order? What do you think?
Since you’ve had the problem for over a year, it may take a few months to get major lasting improvement. The pain may or may not decrease in reverse order to how they appeared. That pattern is consistent when it is a nerve compression issue, but it varies quite a bit when the symptoms are more muscle and joint related.
Hi Dr Best , Six weeks ago , I woke up with severe Sciatica and Foot Drop . I was in agony .
Went to my GP who took X Ray and even those showed a big problem . GP sent me to get MRI and to pain clinic ,where after results came in I received a Cocktail shot in my L5-S1. Yes the shot took me from a 9.5 to a 4 Whew .I also received a referral to a neurosurgeon .
Was told my disc had ruptured like a V so it was protruding in Two places . Surgeon said they only see one like mine every 4 years or so ,and because it was also causing foot drop . I would need to remove disc and have titanium screws and rods put in for fusion . OK its now been ,like stated six weeks and while I understand I am feeling the benefits of spinal shot .I believe my Sciatica and Foot Drop are getting better . Here in is the dilemma. My Insurance has denied my Surgery as of today 1/29/17 . My surgery is in two days the 31st . The office manager ,said quote: In your case because of the unique and seriousness of your condition . The Surgeon will bring you though the ER and do the surgery anyways FREE,if we don’t get the approval in time . end quote . Ok time for the rhubarb . My pain is now at a low level of maybe a 2 and it ‘seems ‘ like my foot drop is improving . So I am of course wondering if maybe (i hate to say this ) I don’t need the surgery . You can see my predicament . I truly trust my surgeon ,and at the same time would like to forgo a surgery if not necessary. But am told the longer I wait the more nerve damage is being done to my leg and foot .ugggg . I have one day to decide ,so I hope you see this soon LOL . Would love your opinion ,that is if can . Otherwise ,being 60 and with arthritis in the area and with the opinion of this very humanitarian Dr’s gesture . I feel I should trust his judgement and go forward with it . Thank You for your time and valuable advice . I can see from previous post ,your a caring thoughtful man yourself .
In most cases, an actual rupture of the disc will usually require surgery and there is definitely some urgency when “motor” symptoms like foot drop are present. In most cases, there is a combination of nerve compressioncoming directly from the disc and other structural issues and some coming from inflammatory swelling. The purpose of the injection was to bring down the inflammation, and you’ve had a pretty good result from it – for now. Assuming that what the surgeon told you about the MRI findings is true, you probably still have some significant nerve impingement coming directly from the disc protrusion which. If the disc is actually ruptured, not just bulging, it’s not likely to improve significantly without surgery. In addition, at some point the effects of the injection will likely wear off and the inflammatory swelling will return and start to increase the nerve compression and the associated symptoms. For this reason, based on what you’ve said, I think proceeding with the surgery is probably your best course of action. I would recommend getting the doctor’s offer to do the surgery at no cost if the insurance doesn’t approve it in writing. I’d also suggest calling your insurance company yourself to find out why they are denying coverage. Many times such denials are due to simple coding errors or miscommunication between the doctor and whoever is handling the claim, but sometimes there’s a legitimate clinical reason for the denial and that might be cause for you to reconsider the surgery yourself. In any event, I wish you the best of luck for a good recovery.
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38 Comments
Joe Stites
August 12, 2011I have sciatic problems for 5 months now. If I walk or stand for long periods it hurts. I’ve done chiropractic, Vac D, did 2 injections and I have a teeter and use it 3 times per day. I also take 4000mgs of fish oil per day. I also do stretching also.Some days it does feel better. How long could my problem take?
What more can I do? Please tell me.
Sincerely
Joe Stites
Dr. George Best
August 12, 2011The recovery from sciatica depends largely on the severity of the underlying cause. In your case, I am assuming that the cause is a disc protrusion – judging from the treatment you’ve had so far. Even large disc protrusions can get better eventually, but it can take a year or more. In my experience, most people who are going to get better with conservative treatment will do so within a few months. With the duration of your problem, I think it may be time to consider surgery if you’ve had an MRI or other imaging that suggests it may be needed, but I do have a suggestion for something to try first.
I suggest you use the basic McKenzie exercise as shown in my ebook and Part 2 video (assuming it produces any centralization of your symptoms) on a frequent basis – about a minute at a time, up to 4 or 5 times every hour you are awake. Do this for at least a few days in a row. Your back may get sore doing it that often, but if the symptoms are centralizing, you are on the right track. If you’re making progress, continue the frequent use of the exercise for at least a week and then you can begin reducing the frequency as the symptoms continue to improve. It may take several weeks to get maximum improvement, and it is possible that you’ll continue to have some intermittent symptoms for several months, but if you can get to the point where your symptoms are tolerable, I would recommend continued management with the exercise and use of the teeter and fish oil.
If you don’t get any improvement with the intensive use of the McKenzie exercise, then I’d recommend consulting with a surgeon who does “minimally invasive” spine surgery, which is discussed towards the end of the video on this page.
If you have further questions, let me know.
Good luck!
Dr. Best
Jeff L.
August 26, 2011I’m not sure if I have sciatica or pyriformic syndrome. I’m a software engineering and have sat in front of a computer for the last 19 years. About 5 years ago I developed a very noticeable dull ache deep within my right buttock. Initially I thought it would go away but after 5 years it’s only become worse. The pain is 24×7 and unfortunately I am dependent on Ibuprofen in dealing with the pain where I take about 600-1000mg a day. I have had an MRI that showed nothing “unordinary”, have been to a pain Dr. where I got an injection in the right SI joint which did nothing. In the end I’ve found Ibuprofen to help the most. The pain is the worst while sitting. If I don’t take any medication I am hurting after only 30 minutes and find myself unable to focus on work, etc. The pain feels deep within my right buttock and extends to my right thigh but no further down. Many right buttock area usually feels tight and tender. I have watched numerous videos on the Internet, including yours (great by the way) and started stretching over the last few weeks which seems to help a little but the pain persists. I also find some relief rolling my right buttock on a baseball. I have about every back brace/contraption known to man and recently spent $1000 on two of the best/ergonomic office chairs available today (Herman Miller Aeron and a SteelCase Leap chair) of which while providing more comfort have not helped overall with the pain. I also have an electric shock device (TAMMS ?) which doesn’t help either. Sleeping or laying flat on the floor on my back seems to be the less painful position but often I wake up in the middle of the night in pain if I have rolled over on my side and twisted my legs, etc. I’m getting worried about being dependent on Ibuprofen and understand the side affects/risks of taking it for so long but I don’t know what else to do. This pain has taken over my life … I’m an avid motorcycle rider and used to ride every day …now with the pain I don’t even want to get on it or drive a car for very long. On a scale of 1-10 the pain is only like a 3-4 but because it’s there 24×7 it’s always there in the back of my mind. Any suggestions on what I should try next? What’s weird is I don’t remember doing anything to injure myself …just woke up one day and the pain was there and has never gone away.
Thanks – Jeff
Dr. George Best
August 26, 2011Hi Jeff,
Since the MRI was normal, chances are the direct symptoms are coming from the piriformis and/or gluteus minimus muscles. Occasionally a standard MRI (done lying down) will not show any problems whereas an upright MRI will show a significant disc bulge, so I would not rule out true sciatica entirely, but your history is more associated with the problem being muscular.
In many cases piriformis and gluteus minimus problems are secondary to SI joint dysfunction. The SI joint itself can cause symptoms (in which case the injection would likely have helped some), but is often asymptomatic and the mechanical dysfunction triggers abnormal muscle contraction. This can also occur with the other joint these muscles interact with – the hip joint. So, one possibility is that joint dysfunction in the SI and/or hip is the underlying issue, and this would not be unusual for someone who sits a lot. There are a few techniques for self-treating these joints, but in most cases the most efficient way of detecting and correcting the problem is to see a chiropractor or osteopath who does manipultion therapy, so that’s one thing I suggest you look into.
With the considerable amount of sitting you do, it is entirely possible that the problem is simply progressive tightening of the muscle(s). Since this may have been developing for several years, it may take a little time and frequent stretching and massage to start making some headway on correcting the problem. My suggestion is to work on the stretching and self-massage as frequently as possible for the next few weeks and see how it goes. Doing a minute or two of stretching / massage a few times every one to two hours will often get better results than trying to do one longer session per day.
If you have further questions, let me know.
Good luck!
Dr. Best
Megan
November 17, 2011Just saw this video today, and I am wondering about the “red flag” symptoms. My loss of sensation (numbness but not numb, very odd feeling) is in the back of my left thigh & heel of my foot, so not exactly the inner thigh…does this signal red flag? I am curious because if I require surgery I have no medical insurance, yet I don’t want to risk permanent nerve damage. My first visit with a chiropractor was today & he said we should know in 4-6 sessions if this will help or if I need a different route. Any advice? Thank-you.
Dr. George Best
November 17, 2011No, the sensations you have in the back of the thigh and heel are not “red flag” indicators and are actually relatively common with sciatica. I think your chiropractor’s treatment plan is reasonable. As a general rule, if someone is not improving with treatment within about two weeks, further evaluation with an MRI or CT scan is advisable to determine the extent of the problem and suggest the best course of treatment. You may not be 100% within two weeks, but I would want to see some significant improvement in that time frame.
If you have further questions, let me know.
Good luck!
Dr. Best
Mary Miler
December 27, 2011I had a fall in June of 2010 in which I broke my shoulder. A month later I experienced a severe case of sciatica, to the point that I could not even walk. The Dr put me on a round of predisone which relieved the symptoms for a few months. The pain began to return in June of 2011. I have been seeing an orthopedic Dr., who once again put me on a round of predisone,which helped very little this time. He then sent for an MRI, which showed a bulging disk in L5/L6 (I think). I asked about physical therapy, but he said he did not want me to do any therapy at that time as he was afraid it might make it worse. Then he sent me for an epidural, this is now August of 2011. I explained to him that my big concern is that I am scheduled for a trip to Thailand in Feb. 2012. At the same time I am dealing with the sciatica issue, my shoulder dislocated, and with further investigation it was revealed that there was a lot of soft tissue damage in the shoulder from the fall in 2010. So I was scheduled for surgery on my shoulder in November. In the mean time I have have had 2 more epidurals (3 total) and they have each helped about a month & 1/2. I am now dealing with the sciatica pain again, to the point that I am having to use pain meds everyday. I am limited in being able to do the McKenzie exercises, as my right arm is immobilized and will be for 2 more weeks. My question to you is it time to consider pursuing having a minimally invasive back surgery, done. I am getting very concerned, because I am leaving for a Thailand mission trip in 2 months.
Dr. George Best
December 27, 2011Hi Mary,
You might be able to do a modified version of the McKenzie exercise by lying on your back with a pillow or rolled up towel placed in the small of your back. As with the regular version, frequent use typically gets the best results, so a minute or two at a time with the spine in extension done up to 4 or 5 times every hour you are awake might be sufficient to get rid of most of the pain within a few days. If you are able to get rid of the symptoms that way, chances are you can manage the problem without surgery.
If you can’t modify the exercise and/or get relief with it within a week or so, then I would suggest going forward with a minimally invasive surgery due to the pressing matter of the mission trip. I suggest scheduling a consult with the surgeon as soon as possible so that if you do need the surgery you can get it done as much in advance of your trip as possible so that you can be sufficiently healed and get in some rehab before you leave. Most people recover quite rapidly from minimally invasive surgery and can return to normal activities within a week or so, but that kind of a trip can be pretty taxing on the low back (just sitting on an airplane for that many hours takes a toll), so you’ll want to get your back as strong as possible in advance of the trip.
Good luck!
Dr. Best
Dawn Reisig
January 13, 2012I have had back problems off an on for many years. I turned 65 in August and started walking, light jogging and exercising more than I had time for when I was working. I developed an ache in my right buttock and went down to the outside of my knee. I iced, stretched, took Advil (which didn’t really seem to help much) and if finally went away. Three weeks ago I developed the same symptoms on my left side but they are much more extreme. I can get into a sitting position and a laying position with minimal or no pain but if I am up on my feet for more than a minute or two the pain in my buttock and leg is excruciating. My chiropractor can’t seem to figure it out. He encouraged me to get an MRI which I did yesterday. My doctor had put me on steroids for six days and they did absolutely nothing for the pain. It is hard not to be on my feet a little bit as I am alone most of the week. I keep wondering if being on my feet is making it worse. Hopefully I will know something from the MRI next week. I quit taking pain pills because sitting with ice works better than they did although the results don’t last too long. Is it OK to keep stretching even if I don’t know what is causing my pain?
Dr. George Best
January 13, 2012The MRI should be helpful in figuring out what’s wrong and what to do about it. As long as you are not forcing yourself to stretch through severe pain, you’re not likely to cause any significant harm, so I don’t think there’s a problem with stretching and using ice until the MRI results are in. If you have additional questions after you get the MRI results, let me know.
Dr. Best
myron
September 28, 2012Five years ago I had butt/leg pain, had MRI and subsequent spinal shot. Recovery took over a year. I’m a Yoga teacher and began the practice of Bikram Yoga, which includes26 postures, some are backbends. After 5 and 1/2 years I again have issue with butt/leg. Again had spinal shot, some improvement for a week, but it’s been 3 weeks now and symptoms have returned. I always feel better after Bikram class, but several standing stretches I opt out because pain comes into the picture. This practice seems beneficial, but I may be doing more harm than good. Suggestion on how I can tell? My pain is not as severe as 5 years ago. Also I’ve been doing specific pyriformis stretches which help on temporary basis. My right calf muscle seems cramped to the point of extreme pain. After stretches ok for 3 to 5 steps then tight pain returns. Also 3 toes on my right foot are semi numb much of the time. With certain stretches the feeling sensation returns while in the stretch but semi numbness retunes when I release. Not sure if diet is a factor. I’ve been a vegan for 23 years.
Best regards,
Myron
Dr. George Best
September 29, 2012Hi Myron,
Usually back bends are not a problem, but the forward bends of some yoga positions can definitely provoke a disc herniation. Spinal injections work by suppressing inflammation and reducing swelling around the nerve, but don’t do anything to resolve the disc bulging itself. Since the injection did provide short-term relief, it is likely that inflammation is playing a significant role. I suggest using cold packs along with anti-inflammatory medication or supplements to manage the inflammation and continue to avoid any yoga positions that increase symptoms. You may want to consider avoiding Bikram for the time being as the heated room may be increasing inflammation. The thing about heat is that it usually does feel good at the time because it sedates the nervous system, but the increase in inflammation it produces can delay recovery. What I suggest is to continue the back bends and poses you can do without pain, but do them in an unheated environment until such time as things are feeling better.
A vegan diet is usually fine, although high grain consumption (particularly wheat) can be pro-inflammatory. So, you may want to cut back on grains temporarily to help with the inflammation as well.
Frequent use of back bends and cold packs will usually get rid of most of the symptoms within a couple of weeks. If you’re not improving much in that time frame, I’d suggest getting checked by a doctor and probably getting some updated imaging to further evaluate the situation.
Good luck!
Dr. Best
Dee Dee
March 7, 2013I’ve had back problems for 2 years now. I’ve had several MRI’s and they showed nothing. However, this last one showed (Mild) Facet Arthropathy at my L4/L5, L5/S1. I’ve had Sciatica for about 2 months now. The pain goes from my lower back down my buttock down the back of my leg under my foot and even to my toes. Sometimes the pain in my toes is so bad that I cannot get rest at night. I can’t seem to get any relief at night besides laying on my back and when I get up the pain is terrible. I also have terrible hip pain. I’ve tried the SI Injection and it seems to cause more pain than I had before. I have had PT and seen a Chiropractor. I am not getting any relief at all. The pain is getting unbearable. I sit down all day at work and I try to get up to move around. It seems to be getting worse. I’m really concerned about having a bulging disc as I have all the symptoms. My neurologist seems to think that it’s Piriformis Syndrome. However, does that cause pain down my leg and under my foot? I had an EMG and it showed some abnormalities with my S1. Any suggestions as to which way to go from this point? I’ve tried stretches and for some reason the pain is still getting worse. Is it possible that the disc bulge did not show on my MRI of which was lying down?
Dr. George Best
March 7, 2013Piriformis syndrome can cause the symptoms you described; however, since you have low back pain as well as sciatica symptoms and because the EMG showed some S1 nerve root issues, my suspicion is that there may be a disc herniation that is not showing up on the lying down MRI. Since the only position that brings you relief is lying on your back (the same position standard MRIs are done in), it is quite possible that an upright MRI would show something very different. So, my recommendation is to see about having an upright MRI – they are not widely available yet, but most major metropolitan areas have at least one.
Good luck!
Dr. Best
Bunny H Waterworth
July 15, 2013I was told I had severe sciatica after an MRI because I had severe arthritis in the spine. I was told surgery was NOT an option & the only thing was to try an inversion table. I feel quite upset as I feel that I will be like this for the rest of my life! am 80 yrs old (in good health apart from the arthritis) I am not very enthusiastic about using an inversion table. I do see a physio therapist & do some exercises. I use a walker & can walk 11 minutes at this time, then get very tired! I can only stand for a very few minutes & then more pain & the bottom of my left leg goes numb. Any suggestions or comments?
Bunny H Waterworth
Dr. George Best
July 16, 2013Hello Bunny,
There are other options besides an inversion table. With severe arthritis that is causing nerve compression, it often helps to stretch the pine lengthwise such as with an inversion table, but use of such devices can be a little difficult. The same basic effects that can be achieved with inversion can also be obtained with home traction devices or even using the flexion position for the McKenzie exercises by simply lying face down on an exercise ball (they now even have “half therapy balls” which have a flat platform as the base so they don’t roll) or even just a stck of pillows. Any of these things can be used to stretch the spinal joints and ligaments and may significantly reduce pressure on the nerves. I suggest you discuss these options with your physio therapist and perhaps he or she can work with you to find the best option for you, as well as show you how to use whichever device you choose.
Another option that may help is incorporating massage into your treatment. In many cases, a lot of the symptoms that occur with spinal arthritis are actually produced by muscle reaction. Massage can help reduce the muscle tightness and directly ease pain produced by the muscles, but reducing the muscle tension can also reduce compression on the spine and ease the pressure and irritation of the nerves.
Low force chiropractic such as with an Activator or Arthrostim adjusting instrument is often helpful for people with spinal arthritis. Such techniques gently improve the mobility of the joints, which tends to reduce muscle and nerve irritation.
Finally, in many cases of spinal arthritis, swelling due to inflammation can play a major role in symptoms. Applying cold packs as directed in my ebook, using various natural anti-inflammatories and/or anti-inflammatory medication may help considerably. While not an ideal solution, steroid injections may provide enough inflammation control to dramatically reduce or eliminate symptoms for up to months at a time. One other option that works to varying degrees for reducing inflammation and pain is acupuncture, which can be done with the traditional needles, or with other forms of stimulation such as laser.
Different things work for different people, but hopefully one or more of these suggestions will be helpful for you.
Good luck!
Dr. Best
Jane
September 8, 2013Hi I had surgery 4 years ago for a bulging L5 S1 disc on the left hand side, which left me in severe pain for months. I had immediate relief and needed no pain killers after surgery as the pain was less than I had been in! A year ago, I forgot to be careful and lifted a 25 litre water bucket for my horse. My back exploded and pain shot into my right foot. I can only describe it as shooting electric pain. I was terrified and lay down in the field, very still for half an hour. Surprisingly I could get up and walk and, though in some pain, seemed ok. Chiropractic and excercises did not really relieve the pain, but I could live with it I guess. Two weeks ago it worsened and I lost feeling in part of my foot. I cannot raise my toes and sometimes my leg gets left behind. I can’t run, not because of the pain but I just can’t make my right leg move sufficently! Then I had an episode of excrutiating pain and even codeine and diazepam didn’t touch it.Thank God, my GP listened and sent me for an MRI which showed a large disc bulge causing ‘significant nerve compression’ on the L5 and S1 nerve roots on the right side. I saw the scan and there seemed no room at all for the nerve. I also had awful burning in my shin and foot and thought my foot was being deprived of blood and would fall off! – I’ve seen an orthopaedic registrar and they considered emergency surgery but decided to send me to the neurosurgeon for a consultation instead. I have no saddle anaesthesia. From the time when I had the excrutiating pain to having the MRI and seeing the orthopaedic guy was 7 days. I think surgery may be my only option and I don’t really WANT it but am more scared of what will happrn if they DON’T operate because I feel my back is going to ‘go’ again at the slightest opportunity.
Your website is great as is the book. It’s controlling my pain. Thanks and good luck to everyone else out there who is also suffering. I WILL NOT let this ruin my horse riding or the time I spend with my family. (Just hope this determination works….)
Jane
Dr. George Best
September 8, 2013Hello Jane,
Sorry to hear of your troubles. With a bit of luck you may still be able to get things back to normal and manage the problem without surgery. Depending on how bad the disc is, surgery is sometimes the best option. In my experience, if the disc is just bulging but the inner gel is still contained by the outer cartilage wall of the disc, the chances are very good that it can be managed without surgery. If the disc appears to be extruded (ruptured) and the inner gel has breached the disc wall, chances are surgery is going to be needed to get lasting relief. In any event, I wish you the best of luck for a good, speedy recovery.
Dr. Best
Jane
September 10, 2013Hi George
Final question- does this mean the disc has ruptured or not?
MRI results
“L5-S1 large right lateral disc prolapse with cranial sequestra. The prolapse extends into the right neuroforamen and significantly compresses the right recess, right exiting L5 nerve root and right S1 nerve root.”
Can’t find anything of the internet about ‘cranial sequsetra’!
Jane
Dr. George Best
September 11, 2013Hello Jane,
Sequestra/sequestrum/sequestration/sequestered fragment (either term may be used) indicates that the disc has most likely ruptured and a piece has separated from the main part of the disc. Cranial means that the piece has been displaced upward. Unfortunately, this is a situation that usually requires surgery. In some cases, the sequestered piece of disc will move to a spot where it does not create pressure on the nerve and therefore can become completely asymptomatic. The problem is that it can easily move at any time and suddenly become very symptomatic, so I suggest having it taken out.
Dr. Best
Jane
September 11, 2013Thank you, you are worth your weight in gold! It is very difficult to get straightforward explanations.
Jane
Dr. George Best
September 11, 2013You’re welcome. Glad to be of help, but sorry the news wasn’t better.
Dr. Best
jeffreykoh
November 11, 2013Hi Dr Best
I just signed up as a member and an very Impressed with your information available on Sciatica
I went for a 10km cycling just about 4 months ago and had a leg pain around the Outer Front Calf of my Right leg, sometimes extending to the lower outer part of the Right leg near the foor…its getting worst such that I cannot walk for more than 100 -200 ft and stand for 5 mins.before the pain comes
I saw an spinal specialist on it recently a week ago and the MRI reports…
a) Mild grade 1 spondylisthesis of L4 on L5…. Alignment of rest of spine is intact.
b) Degenerative changes with end plate osteopathy formation and lower facet atrophy.
c) Prominent disc space narrowing at L5/S1 level….Dr says there is Disc bulge in this area..
d) No compression fracture detected
My Questions are …
1) Why is the pain at the leg calf area and Not shooting from the lower back to the buttock…is this pain caused by the L4/L5 or L5/S1 nerve root.
2) Should I go for Surgery …for the L4/L5 or L5/S!,if needed be.
3) Whats is End plate Osteopathy formation and lower Facet Atropathy.
The Dr recommend Physio therapy first follows by Spine injection follows by Surgery if No improvements….I have Not start any treatment yet and I am Wits end and truly appreciate yr advise…Pls advise urgently…. Many Thanks
Jeffrey Koh
BTW..I cannot find yr e-book …Where Can i get it on the internet
Thanks.
Dr. George Best
November 11, 2013I’ve sent a detailed response via email. For the benefit of others looking for the ebook, there’s a link to it on the right sidebar of:
http://www.sciaticaselfcare.com/basic-sciatica-exercises/
Dr. Best
Dale Mullen
January 22, 2014Hello Dr. Best:
As a 63 year old male with arthritis (here in Canada, arthritis is a catch-all term meaning that I experience pain and swelling in or near various joints for which they are not sure of the specific cause), in recent years I’ve been experiencing sciatica in both legs. The pain generally occurs in both legs at the same time and extends from the butt down to about calf level. Often the pain occurs in twinges rather than being constant. The twinges sometime cause my legs to buckle slightly with a short quick groan. I believe that I may be losing some of the strength in my legs (which may simply be because of entering ol’ geezer territory), most noticeable when doing exercises.
Fortunately (?) the pain generally goes away when I lie or sit down. It seems to bother me some days more than others, often after I’ve spent a period of time carrying something around (in front of me) or bending over for a period of time (washing my feet position).
X-Rays show a narrowing of the disks in the lumbar region (my doctor speaks in very generic terms apparently assuming that I’m not capable of understanding a more specific explanation).
Is there any means, based on this limited information, to zero in on specifically what’s causing the sciatic pain.
The only suggestion from my doctor was to visit a physiotherapist, which I did for a short period of time, without noticeable improvement. The physiotherapist seemed to focus mostly on piraformus exercises and stretching the quads.
I have begun doing inversions on my inversion machine (6 minute period of time) each day, which seems to help (placebo effect maybe?).
To my untrained mind, it seems somewhat like a bulging disk but have also considered a possible constriction (nerve impingement) caused by the narrowing gap in the vertebrae.
Thanks in advance for shedding any light you may be able on this situation.
Dr. George Best
January 22, 2014With X-rays showing disc narrowing, chances are there’s some disc bulging (an MRI or CT scan would give more information about that) and probably some thickening of the bone and ligament structures (which occurs as a result of the increased mechanical stresses produced by the vertebrae being closer together) around the nerves. There’s usually also some variable contribution to symptoms from inflammatory swelling. Although in cases where there is just narrowing of the nerve canals from disc bulging extension exercises are usually helpful, extension can irritate symptoms when there is thickening of the bone and ligament structures at the back of the spine. The bone and ligament issues tend to improve with flexion exercises, although too much flexion can irritate the disc bulging (which is why the bending forward tends to increase the symptoms). So, sometimes none of the McKenzie exercises are effective and sometimes it takes some trial and error to find a balance of flexion and extension. One suggestion I have is to get an exercise ball and do the flexion exercises on it, as being supported on the ball minimizes the tendency for the disc bulging to increase.
Traction/decompression/inversion is usually helpful in such cases because it no only decompresses the disc, but also stretches the thickened ligaments, so I recommend you continue using your inversion machine and perhaps increase the frequency to do it a few times each day.
Controlling inflammation with ice packs during times of increased symptoms and with natural anti-inflammatories on a preventive basis will probably be helpful. One ant-inflammatory in particular that I’ve been seeing good results with is turmeric (If it’s available in Canada, I suggest the Himalaya Herbs brand 1 capsule 2 to 3 times per day).
Hopefully this is helpful to you. If you have further questions, let me know.
Good luck!
Dr. Best
Richard Campbell
January 23, 2014Thank you Dr Best for this Surgery For Sciatica video. Excellent as always.
This one has the greatest resonance for where I am now.
However the link and on screen button below, mentioned at the end, do not appear. If you recommend another browser that’s fine. If these are the exercises you have already published no problem, but if they are new could you please send me the links.
Regards
Richard
Dr. George Best
January 23, 2014It’s the same exercises, Richard.
Monina Santos
June 26, 2014Good day Dr. Best. My symptoms dated back since 2012. Shooting pain on my left hip which would make me fall. Consultations with the Ortho at that time indicated Osteoathritis which was also shown on x-ray. Medications were given and therapies done which didn’t give relief. Repeat x-ray and an MRI showed severe Degenerative Osteoarthritis w/ subchondral cysts L hip and MRI showed disc bulging at L4-L5 with some stenosis and arthritic changes. A neuro consult at that time said that my pain is primarily due to the left hip Osteoarthritis.A THRA using cementless procedure was done on the left, however I didn’t get any relief and pain from the buttocks w/ radiation to the knee and lateral leg of the left persisted. Ortho doctor suggested pain is because of my low pain threshold and muscle spasms. He suggested continuous therapy and meds. 2013 left pain still persistent and noted with muscle weakness and size getting smaller. Went on pain management and given different drugs and continuous therapy. September of 2013 had same complaint on the right hip and x-ray showed Severe Degenerative Osteorthritis of the R hip. Underwent another THRA of the Right this time using cemented procedure. Recovery is better than the Left and later on noted dragging on my left foot which was due to a leg shortening on the right. I was advised to use insoles 2.5-3.0cm on the left foot. Because of the persistence of symptoms on the left, referred to a neurosurgeon which requested for another x-ray and MRI. Some translucencies were noted on the side of the left implant. MRI showed progression of previous findings. January 2014, Advised to go for Fusion surgery with metal instrumentation. Surgery set aside for travel to visit my kids in the US last March. While there pain persisted and by April there is already noted urinary incontinence so an immediate surgery was done when I went home. Revision of THRA on the left, this time using cemented procedure with leg stretching and laminectomy of the L4-L5 with metal instrumentation was done last April 30. On waking up noted burning sensation with numbness and foot drop on the left. I’ve been undergoing continuous therapy with pain meds, anti-inflammatories, Vit B supplement and Gabapentin. Up to the present I’m still having pain on the L buttock area and L lateral leg altho noted disappearance of the burning sensation, this time numbness and some shooting pain on the L foot and a foot drop. With these symptoms is there still a possibility of having a sciatica ? If no, how long ususally is the recovery and will my foot drop resolved? I’m using a Foot ankle orthosis on the left. Please help.. Thank you.
Dr. George Best
June 26, 2014Hello Monina,
The foot drop indicates a neurological loss which is probably related to the disc bulge you had at L4/5, but it’s hard to say if that’s something that will improve over time or whether there is some degree of permanent nerve damage. Nerves recover slowly, so it could take several months to reach a point of maximum recovery and there’s not really a way to know in advance whether the foot drop will completely resolve.
Given the location and the history that includes hip degeneration, I think he pain in the buttock and on the outside of the leg is probably largely muscle referral pain from the gluteus minimus and/or piriformis rather than sciatica. Since you can’t really stretch the muscles fully when you have a hip replacement, your best bet for getting relief of those symptoms is probably going to be deep massage therapy (I’m assuming the surgical incisions are healed by now, but if not, you’ll need to wait until they are). While self-massage is helpful, I suggest seeing a professional massage therapist at least at first to get some in-depth work done and hopefully get some improvement pretty quickly. It is unusual for piriformis syndrome to be of such severity as to cause foot drop, but it is possible that the muscles are contributing to the nerve compression so even the foot drop may improve with the massage therapy.
If you have further questions, let me know.
Good luck!
Dr. Best
arumugham
June 29, 2015DEAR SIR,
FOR THE TWO THREE WEEKS, DOING ST EXTENSION. MY RT FOOT(NUMBNESS)
HEAVINESS IS TILL THERE. SOME TIMES THE NUMBNESS FELT IN THE AREAS UNDER THE BUTTOCKS INCLUDING TESTICLE AREA. NOT FEELING ANY PAIN WHICH NEED MEDICATION. BUT FEELING WEAKNESS IN THE LEGS WHEN WALKING. PLEASE ADVISE AT THE EARLIEST. WHAT I HAVE TO DO? THANKS. ARUMUGHAM
Dr. George Best
June 29, 2015The numbness in the area under the buttocks and in the testicle area is concerning as it may indicate pretty severe compression of the nerves. At this point, I strongly recommend you see a doctor and have an MRI to further evaluate the situation. Sorry I don’t have better news for you, but it is important to find out what’s going on and get the appropriate treatment to avoid permanent damage to the nerves.
Good luck!
Dr. Best
bond
October 1, 2015amen to back surgery, use as last resort. i had complete lamesnectomy in 1996. the mri showed all circles for disks except L-2. which was flat not a circle. i never did know what exactly being flat meant on a mri. i truly believe that my real problems starting in 2003. by the way it took me about six months to get back to some normalcy. i have been thinking for years that caudification was causing my pains etc. i am now think it is spinal stenosis. i will know soon. thanks bond w.
Dr. George Best
October 3, 2015You’re welcome. Good luck to you.
Dr.Best
Manuel
January 15, 2017I have pain behind leg and and but. Numbness down out side leg down to foot. Thought it was piriformis. Did stretches for piriformis. It aggravated the but pain when sitting. You suggested treatment of other other problems 1st.
Have been to chiropractor 3 times for spine stretching & side twist low back pop. Seen in videos. I believe my back is loosening up. I am starting to be able to walk a little more upright for longer periods of time. My problem is over a year old. The high leg pain was here far before the low back pain. Should I expect my pains to decreases in reverse order? What do you think?
Dr. George Best
January 16, 2017Hello Manuel,
Since you’ve had the problem for over a year, it may take a few months to get major lasting improvement. The pain may or may not decrease in reverse order to how they appeared. That pattern is consistent when it is a nerve compression issue, but it varies quite a bit when the symptoms are more muscle and joint related.
Dr. Best
Casey
January 30, 2017Hi Dr Best , Six weeks ago , I woke up with severe Sciatica and Foot Drop . I was in agony .
Went to my GP who took X Ray and even those showed a big problem . GP sent me to get MRI and to pain clinic ,where after results came in I received a Cocktail shot in my L5-S1. Yes the shot took me from a 9.5 to a 4 Whew .I also received a referral to a neurosurgeon .
Was told my disc had ruptured like a V so it was protruding in Two places . Surgeon said they only see one like mine every 4 years or so ,and because it was also causing foot drop . I would need to remove disc and have titanium screws and rods put in for fusion . OK its now been ,like stated six weeks and while I understand I am feeling the benefits of spinal shot .I believe my Sciatica and Foot Drop are getting better . Here in is the dilemma. My Insurance has denied my Surgery as of today 1/29/17 . My surgery is in two days the 31st . The office manager ,said quote: In your case because of the unique and seriousness of your condition . The Surgeon will bring you though the ER and do the surgery anyways FREE,if we don’t get the approval in time . end quote . Ok time for the rhubarb . My pain is now at a low level of maybe a 2 and it ‘seems ‘ like my foot drop is improving . So I am of course wondering if maybe (i hate to say this ) I don’t need the surgery . You can see my predicament . I truly trust my surgeon ,and at the same time would like to forgo a surgery if not necessary. But am told the longer I wait the more nerve damage is being done to my leg and foot .ugggg . I have one day to decide ,so I hope you see this soon LOL . Would love your opinion ,that is if can . Otherwise ,being 60 and with arthritis in the area and with the opinion of this very humanitarian Dr’s gesture . I feel I should trust his judgement and go forward with it . Thank You for your time and valuable advice . I can see from previous post ,your a caring thoughtful man yourself .
Dr. George Best
January 30, 2017Hello Casey,
In most cases, an actual rupture of the disc will usually require surgery and there is definitely some urgency when “motor” symptoms like foot drop are present. In most cases, there is a combination of nerve compressioncoming directly from the disc and other structural issues and some coming from inflammatory swelling. The purpose of the injection was to bring down the inflammation, and you’ve had a pretty good result from it – for now. Assuming that what the surgeon told you about the MRI findings is true, you probably still have some significant nerve impingement coming directly from the disc protrusion which. If the disc is actually ruptured, not just bulging, it’s not likely to improve significantly without surgery. In addition, at some point the effects of the injection will likely wear off and the inflammatory swelling will return and start to increase the nerve compression and the associated symptoms. For this reason, based on what you’ve said, I think proceeding with the surgery is probably your best course of action. I would recommend getting the doctor’s offer to do the surgery at no cost if the insurance doesn’t approve it in writing. I’d also suggest calling your insurance company yourself to find out why they are denying coverage. Many times such denials are due to simple coding errors or miscommunication between the doctor and whoever is handling the claim, but sometimes there’s a legitimate clinical reason for the denial and that might be cause for you to reconsider the surgery yourself. In any event, I wish you the best of luck for a good recovery.
Dr. Best
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