Medication For Back Pain and Sciatica Treatment

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54 Comments

  • Vinod. Shah

    Reply Reply July 26, 2012

    I got much relief from exercise. Which I show in the video for the sciatica pain. Thank you very much

    • Dr. George Best

      Reply Reply July 26, 2012

      You’re welcome!

      Dr. Best

  • Tim

    Reply Reply August 31, 2012

    Any thoughts on Gabapentin? That is what my doc has prescribed to me. I can not tell if they do anything or not.

    • Dr. George Best

      Reply Reply September 1, 2012

      Hi Tim,

      Gabapentin is an effective pain medication for some people with symptoms related to nerve damage/injury, although the overall effectiveness is relatively low (about 30 to 40%). As with any medication prescribed for sciatica, even when it does work, it is not fixing anything, but merely suppressing symptoms. For short-term relief of symptoms in combination with other more corrective therapies it can be helpful, but it really cannot be considered a stand-alone means of long-term management for sciatica.

      Dr. Best

  • Tim

    Reply Reply September 2, 2012

    Thanks for the quick response. I just completed my 3rd epidural. I have done the PT, that only seemed to make it worse. I found your website and have been doing the extension exercises, walking and a little swimming. I am trying to do as much as I can like walking and swimming while I have this little bit of relief from the injections. I really am scared to have the surgery. I cant get any more injections for a year. So hopefully these stretches and staying active will prolong the relief. Surgery is a last resort, but I feel like that is my next and only option. I have had severe sciatica pain all the way to my foot for about 16 months. I gave up surfing which is a huge passion of mine. I hope one day I can surf again without having the surgery. I know having the surgery is no guaranty that I will surf again. I have the typical bulging discs at L4 -L5-S1 some borderline central canal stenosis and facet hypertrophy. When I look in the mirror I can see that my hips are all out of whack, right higher than the left. Also my right leg is much smaller than my left leg now, lots of muscle loss. I am 36 and 6’2″ and down to 140lbs, I have always been at 160lbs since high school. Seems like no matter what I eat I am stuck at 140 now. Doc am I on the right track with the makenzie excercises and the walking, swimming? I still take the gabapentin but like I said I cant tell a difference. Thank you for your website I find it very informative. Thanks again, Tim

    • Dr. George Best

      Reply Reply September 3, 2012

      Hello Tim,

      The McKenzie exercises along with walking and swimming are probably your best chance of avoiding the surgery. With the duration and severity of the symptoms, it minght take a few weeks of intensive use of the exercises to make significant progress. If you don’t get much change within 3 to 4 weeks, then I think surgery is probably going to be necessary.

      The fact that your hips are unleveled makes me suspect that you probably have a sacroiliac joint issue along with the disc problems. In many cases, sacroiliac dysfunction can create substantial biomechanical stress on the lumbar spine, and might be at least part of the reason that you are not recovering. I suggest you consult with a chiropractor to see if the sacroiliac is indeed a problem. While you may have some concerns about seeing a chiropractor when in such pain, there are numerous treatment methods that can be used. If you are worried about the treatment being painful, I suggest you look for a chiropractor who uses a low-force technique such as Activator (or other instrument adjusting) or Sacro-Occipital Technique, as these methods are gentle and easy to tolerate even by people in a lot of pain.

      If you are not able to get relief with the exercises and/or chiropractic within the next 3 to 4 weeks, my suggestion would be to consult with a surgeon who does “minimally-invasive” spine surgery. This type of surgery is done through small incisions using a scope and generally is much easier to recover from and has much fewer post-surgical complications than other methods. In a case like yours, there is a potential downside of the disc wall being left thinner and therefore susceptible to reinjury, so surfing after surgery would really not be recommended. But with any kind of surgery, I would imagine the surgeon would recommend against surfing. If you gave it several months for the disc to heal as much as possible and used the McKenzie exercises preventively on a daily basis, you probably could get away with doing some surfing as long as you didn’t get too extreme with it to where you were having a lot of major wipeouts.

      If you have further questions, let me know.

      Good luck!

      Dr. Best

  • Tim

    Reply Reply September 4, 2012

    Thank you very much. I will keep at it and talk to a chiro, You are right about the fear of seeing a chiropractor when being in such pain. I appreciate you responding so quickly once again. Tim

  • tim

    Reply Reply November 19, 2012

    Hi George,
    Well i had the surgery. I had it done 3 weeks ago. The Dr. told me to stay in bed for 3 weeks and then I go to see him. I still have a little pain in my leg but not like it was before. When I look at my hips they are still uneven, right higher than the left. Is there any thing that I could do to help that or is that something only a chiro can fix? What are your thoughts about seeing a chiro post surgery? I am a little nervous now that a lot of my disc has been removed between l-4 and l-5. Thanks for your time. Tim

    • Dr. George Best

      Reply Reply November 19, 2012

      The uneven hips may be a factor of ongoing nerve irritation and may correct on its own as the nerve recovers. If not, it probably is something that a chiropractor can correct. It would probably be best to stick to a chiropractor who uses a low-force method such as Activator, Arthrstim, or SOT at first (once the surgeon releases you to normal activity). Depending on your recovery, after 4 to 6 months, almost any technique is fine to use, but early on things can be a little sensitive, so the low-force methods are a good option.

      Good luck!

      Dr. Best

  • johnbreemen@gmail.com

    Reply Reply November 25, 2012

    I have been investigating an anti tnf injection near the spine. Has any one had any experience with this treatment ?

    • Dr. George Best

      Reply Reply November 26, 2012

      Hello,

      Anti-TNF injections get mixed results with disc protrusions and other conditions that narrow the spinal canals. Anti-TNF is a new type of anti-inflammatory, so it works by reducing inflammatory swelling, which contributes to nerve compression and irritation to varying degrees. Anti-TNF seems to provide superior anti-inflammatory effects for some people than conventional medications and steroid injections. In cases where the disc protrusion is relatively mild, Anti-TNF tends to work better because the nerve irritation is presumably more from swelling than due to direct nerve compression by the protruding disc itself. With more severe disc protrusions or extrusions (ruptures), the disc itself plays a much greater role in nerve compression, so no anti-inflammatory treatment works all that well, including Anti-TNF.

      Dr. Best

  • John Kos

    Reply Reply December 26, 2012

    I have 4 ruptured discs L1,2,3,5 and degenerative disc disease. I have been dealing with these problems since I was 38 yrs. old and am now 50. I have been on pain management for those 12 years and now have Sciatica down right leg and numbness in foot. Pain management Doctor just prescribed Methylprednosolone 4 mg dose pk on Christmas Eve and I have been exercising but still no relief. Do u have any suggestions?

    • Dr. George Best

      Reply Reply December 26, 2012

      Hello John,

      My suggestion is to use the McKenzie exercise in the position that best centralizes symptoms (see my ebook for an explanation if don’t know what I mean by that) for about a minute at a time up to 4 or 5 times every hour you are awake. If there is no clear “winner” in terms of position, use the straight extension position unless it seems to increase the symptoms furthest from the spine. In addition, apply cold packs to the lower back as directed in the ebook for 10 to 15 minutes about every 1-2 hours you are awake. You can discontinue the cold packs and start decreasing the frequency of the exercises if and when the symptoms are at least 50% better.

      As a point of clarification, chances are your discs are bulging/protruding and not actually ruptured (even a lot of doctors use the term “ruptured” to describe a disc that is simply bulging). Having one fully ruptured disc is unusual and extremely debilitating. Having 4 fully ruptured discs would be very rare and you’d likely be completely disabled due to pain as well as loss of muscle function. Even 4 protruding discs is pretty bad and with the span of time they’ve been present, it may take some time for things to improve much. If you’re not getting significant improvement within a couple of weeks using the exercises, cold packs, and medication, it would be advisable to have an updated MRI or CT evaluation to re-evaluate the situation.

      Good luck!

      Dr. Best

  • John Kos

    Reply Reply December 26, 2012

    Back in 1991 I was planning to have disc replacement surgery for L5 and prior to surgery a discography was done and surgery was cancelled as 4 discs came up positive. I was told nothing could be done and was sent to pain management were I am on Oxycodone (15 mg) / 4 per day, Fentanyl (150 mcg/hr) every other day and Tizanidine.

    • Dr. George Best

      Reply Reply December 27, 2012

      Hello John,

      A lot has changed with regards to back surgery since 1991. They’re still trying to develop more reliable materials for disc replacement, but overall that approach has not been particularly successful in the long run so far. I don’t know if you’ve had any imaging done since the discography, but if you have not, I would suggest getting an MRI (or CT if you have a contraindication for MRI) to get a more up to date evaluation of what’s going on. There may be some viable options available now that were not available when you were first diagnosed.

      Dr. Best

  • Helen

    Reply Reply February 3, 2013

    Thank you. Most informative

    • Dr. George Best

      Reply Reply February 3, 2013

      You’re welcome!

  • John

    Reply Reply February 28, 2013

    I have severe pain in the the front of my left leg which has been diagnosed as sciatica, a friend says it is not sciatica if it iis at the front, Is this true?
    My main question is how do you rate a tens machine for pain relief?

    • Dr. George Best

      Reply Reply February 28, 2013

      Your friend is correct that it is not sciatica if it is in the front of the leg; however, you could have femoral neuritis which is similar to sciatica (both tend to be caused by disc protrusions and other nerve-compression issues), but effecting a different nerve. The same exercises for sciatica usually work well for femoral neuritis as well.

      TENS machines range considerably in effectiveness for pain relief from case to case. Some people get very good results with one right out of the box, while others may be able to play with the settings to get good relief, and others still may get no relief from a TENS no matter what settings they use.

      Dr. Best

  • Brenda

    Reply Reply March 25, 2013

    Hello , I hurt my back over 20 yrs ago , I had a lot of pain for over a year , I reached a stage eventually where it was ok most of the time , if I was reasonably careful , although I would sometimes get muscle spasms . I twinged it 2 yrs ago pulling a door mat , again months of pain , and just as it was recovering i hurt it again using a wii fit . I found it difficult to sit and after 12 months i went to a chiropractor , she diagnosed a SI joint injury , she adjusted this for me but no relief . I have had 5 appointments and far from improving it is worse , I have more pain and I have sensations down the front of my legs and at times in my feet , these are like nettle stings , although I don’t always have them when standing , they always come when trying to sit . Sitting has been painful for the last two years . I don’t know what to do , if I should continue to see the chiropractor , which seems to be making things worse , or leave things alone and hope they settle down to what they were before I saw her , I am very worried .

    • Dr. George Best

      Reply Reply March 25, 2013

      Hello Brenda,

      I suspect that there’s more going on than an SI joint injury, probably a disc herniation. While chiropractic treatment can and often does help with disc-related problems as well, since you are not improving / getting worse after 5 visits, my recommendation is to have an MRI to evaluate the situation more fully and hold off on further chiropractic treatment until the MRI results are in.

      In the meantime, although symptoms in the front of the legs is technically not sciatica (which effects the back of the legs), almost any symptoms of lumbar bulging discs may respond to the same treatments used for sciatica. I suggest you get the free ebook at:

      http://www.sciaticatreatmentathome.com/sciatica-treatment-exercises/

      and focus on the McKenzie exercises and use of cold packs and see if that helps you.

      Good luck!

      Dr. Best

  • Denis

    Reply Reply June 24, 2013

    Please can you advise whether using an inversion table is beneficial in helping sciatica?
    I have read that used daily inversion relieves pressure on the discs and gives them a chance to heal.

    Many thanks
    Denis White

    • Dr. George Best

      Reply Reply June 25, 2013

      Hello Denis,

      Inversion is helpful in some cases, but can make symptoms worse during the acute inflammatory stage. For this reason, I recommend inversion more as a preventive measure once symptoms are gone. As I said, some people find it helpful for relieving symptoms, so if you want to try it, I suggest proceeding very slowly and just do 30 seconds to a minute on a shallow inversion angle. If things go well, you can then gradually increase time or angle (don’t increase both in the same session). One last tip – many people find that they actually get the best results at a 45 to 60 degree angle rather than full inversion.

      Good luck!

      Dr. Best

  • Len Griffiths

    Reply Reply August 27, 2013

    I am 70 years old,but have lifted weights for over 20 years, in a controlled environmnet; however 9 weeks ago I developed a diull ache in my right hip; and simply rubbed in Volterol anti inflammatory gel; after three weeks I developed hard core sciatica whilst on holiday; I could hardly stand or walk,pain was down both legs but more acute in right leg;had to call on doctor in Greece where I was on holiday,and he gave me injections in my buttocks for seven days,then three intravenence injections in arm; and also gave me two sticks to allow walking. I flew home and went to see my doctor who gave me Diclofenic and de hydrocodiene; whilst I waited for a scan; had scan 25th August and now await results;
    By doing the excersizes that are designed to help reduce sciatica (for last 3 weeks) I am a lot better in as much as left leg is free of sciatic pain; and right leg is just painful a little in lower leg; however the hip is aching nonstop; could I have arthritis or stress fracture or injury to hip?
    I have another week to get MRI scan results,but need as much advice and help as I can; do you have any advice/observations;

    • Dr. George Best

      Reply Reply August 27, 2013

      Hello Len,

      There certainly could be a problem in the hip itself, but it may also be residual muscle reaction. Oftentimes the initial nerve irritation causes the muscles to spasm and contract and while they are in this state they may develop focal areas of contraction. As the nerve irritation decreases, the contraction of the main part of the muscle relaxes, but these focal areas remain and can continue to cause symptoms. Usually some stretching and massage will work these out, but because the possibility of a more serious issue in the hip exists, I’d want to at least have some X-rays of the hip to make sure there’s not a fracture present before doing too much with the muscles, particularly with stretching. You can try applying pressure with your fingers or knuckles to any sore points you find and hold firm pressure for about 10 to 15 seconds and then release the pressure for several seconds before repeating the pressure. This will often help to release any knots of muscle contraction and ease symptoms. Once you have the MRI results they will hopefully shed a bit more light on the situation and if you have additional questions, feel free to contact me.

      Good luck!

      Dr. Best

  • helen dempsey

    Reply Reply September 21, 2013

    I would like to know if ibuprohen is better than nsaids?

    Thanks
    Helen

    • Dr. George Best

      Reply Reply September 22, 2013

      Helen,

      Ibuprofen is an NSAID. NSAIDS (Non-Steroidal Anti-Inflammatory Drugs) include several different medications, including aspirin, ibuprofen, naproxen, diclofenac, celecoxib, and others, as well as several different brand names for each.

      Dr. Best

  • helen dempsey

    Reply Reply September 25, 2013

    Dr. Best,
    I keep getting advice from so many people, about which is better to use, such as ice or heat for my sciatica. I remember you saying that ice is better, If there is inflamation, heat would be crazy to use. Am I doing the right thing?
    Thanks Helen

    • Dr. George Best

      Reply Reply September 26, 2013

      Yes, definitely stick with ice. Heat may feel good while it is on because it sedates the nerves (which is why a lot of people like to use it), but it increases inflammation and will prolong recovery.

      Dr. Best

  • Tom Bodensick

    Reply Reply September 30, 2013

    Hello, My mother recently was hit with her first attack of sciatica. The first 24 hours were hell for her the pain was so intense. I read your on-line booklet and went to a health food store for pills that you recommended and she has started taking these. Hopefully these pills (omega 3 fatty acids, glucosimine, valarian root, and something else I can’t remember. These pills are all packaged together in a daily routine. Are pills as good as liquid? Will the active ingrediants go into the blood stream or are pills less digestible? She has also started using the ice therapy on her leg and backside to relieve the pain. It took about a week before the pain completely subsided and she’s feeling better now. It hurts me when my mother is in such pain. Thank you for your guidance and help. Tom

    • Dr. George Best

      Reply Reply September 30, 2013

      Hello Tom,

      While there are some who insist that liquid supplements are superior to pills, there has been no evidence for this as a blanket statement. The digestive tract is quite capable of absorbing nutrients in solid form from pills just as it is from food in most cases, provided that the pills are of good quality and they dissolve properly.

      I’m glad to hear that your mother is feeling better.

      Dr. Best

  • marlene

    Reply Reply November 6, 2013

    Any opinion on taking Ultram for scialtica leg pain? The doctor scared me with the list of side effects, so I declined it. But I may request it , as I still deal with the pain,especially when trying to walk a longer distance. Also, thoughts on the t.e.n.s. machine for pain relief?

    • Dr. George Best

      Reply Reply November 6, 2013

      Ultram is much like any other strong pain-killer. It may help with the pain, but many people find that they can’t really function very well on this type of medication, so it may not lend itself well to you being able to carry out your normal daily activities. Generally, anti-inflammatory medications are a better choice for relieving symptoms without causing mental impairment.

      TENS units work very well for some and not at all for others. If you have a doctor or therapist who is experienced with using them, your chances of getting decent results are improved because the doctor/therapist can work with you to figure out the best settings as opposed to handing you a box and hoping the pre-sets work for you.

      Dr. Best

  • Azhar

    Reply Reply December 25, 2013

    Dear Sir, My Mother is suffering from Sciatica problem where she is having pain from Spine(Lower Back) to down the leg via buttock, thigh till foot and having numbness for a period of time in Leg. She is Suffering Very high pain in Night hours she can not sleep in straight position also. Before 2 years we took MRI she got report as Sacralization of L5 Vertebra, Diffuse Annular Disc Bulge at L3-L4, L4-L5 levels causing Thecal Sac Compression. When we consult Nerve doctor he given medicine and referred for surgery but after using medicines pain has gone. Now after 2 years pain started again highly from 1 Month. So, when i consult doctor Once again he referred for surgery.
    Then i preferred Homeopathy Treatment regarding the pain she is using medicine for last 20 days but there is no effect in it till now. Can you please suggest me what to prefer & do. She is having very much pain. Please Help.

    • Dr. George Best

      Reply Reply December 26, 2013

      I suggest she try the self treatment methods in the free ebook. If you don’t already have it, you may download it from the link on the right sidebar of:
      http://www.sciaticatreatmentathome.com/sciatica-treatment-exercises/.

      If she does not see any improvement within one to two weeks, I’d suggest getting a follow-up MRI, as much can change in 2 years and if surgery is to be considered it is best to have up to date information.

      Good luck to her.

      Dr. Best

  • Mike shewan

    Reply Reply January 19, 2014

    I find a mixture initially NSAIDs and lerica with heat cold massage and chiro therapy with a hot tub walking stretching 3-6 times a day is beginning to releave the pain. However numbness continues I do find oxcyotin is only useful first 1-3 days till pain is controlled then work on flexibility

    Great video on medication..don’t over compensate with meds go to the source stretch walk through the pain

    • Dr. George Best

      Reply Reply January 20, 2014

      Thanks for your comment Mike. It can take some trial and error to find medication that helps keep symptoms at bay while you go through the process of working on the underlying problems.

  • Jacqueline

    Reply Reply February 6, 2014

    Could you recommend something for immflamation? Is there one type of supplement that helps or is it several. Different types of herbs..etc…it’s very confusing searching over the Internet. I’m also reading more about herbs for helping in immflamation is this true? I would appreciate any help you can give and your videos have been very helpful…so thank you

    • Dr. George Best

      Reply Reply February 7, 2014

      I make suggestions for inflammation control in my free ebook (click here to download it). In addition to the recommendations in the ebook, recently I’ve been seeing very good results using a high-quality turmeric supplement. I use the Himalaya Herbs brand, 1 capsule 2 to 3 times per day.

      Dr. Best

  • Christena

    Reply Reply February 19, 2014

    Nice blog here! Also your website loads up very fast!
    What host are you using? Can I get your affiliate link to your host?
    I wish my web site loaded up as fast as yours lol

    My personal blogging site regarding modern technology: webslideapp.com; Christena,

    • Dr. George Best

      Reply Reply February 19, 2014

      I use Bluehost.

  • Patty B.

    Reply Reply April 11, 2014

    Good morning , I hope you will offer your thoughts on my situation. I have been having pain on my left back side that travels down the side of the leg and at times to my knee.
    This has been going on for aprox. 5 years. I was sent to a specialist who xrayed my hip and then sent me to have an MRI. long story short the doctor said the ligament in the hip was shredding and I had surgery. I got pain relief for a few short weeks due to cold packs because the pain came once I stopped the cold pack. I saw a chiropractor and after 11 visits I had the same pain. Its now been a year sense I saw the chiropractor and for the past month the pain on the left side is also mirrored on my right side. I really don’t know wha t to due next.
    Can you offer any advice.
    Thanks

    • Dr. George Best

      Reply Reply April 11, 2014

      Hello Patty,

      With the pain being on the side of the leg (rather than the back), it’s most likely a muscle issue, specifically the gluteus minimus and/or the TFL/ITB. Depending on what type of hip surgery was done, you may or may not be able to get in the position to stretch these muscles effectively. My suggestion is to see a massage therapist who does some sort of deep tissue technique. Hopefully releasing the muscles will alleviate the symptoms. You may get more sore temporarily after the first session or two, so I suggest you stick with it for a few sessions and see how it goes. If you don’t get much improvement, it would probably be a good idea to have a follow-up MRI to evaluate the situation further.

      Good luck!

      Dr. Best

  • Dena

    Reply Reply July 31, 2014

    I have the l4-5 s1 problems. Ive been fighting this for about 25 years now. Up until recently I have just had bouts of it that were manageable with NSAIDs. 5 years ago I had gastric bypass surgery which makes it impossible to use NSAIDs anymore so Im currently taking Norco and Requip. I have developed restless leg that drives me nuts. I have been seeing a chiropractor for years who used a Cox table for traction. Ive been through my 3 epidural injections. They all quit on me at about 4 weeks. I have trochanteric bursitis. Ive had injections there but they didn’t last long either. Im confused about the Cox method of stretching and then McKenzie says bend the opposite way. I have also done acupuncture with no relief. Ive bee an avid yogi for years. I just wonder what is next.I also walk, swim, get therapeudic massage. I hurt at my hips and can not walk upstairs even 1 or 2, down the side of my legs, on the outside of the knees and then below the knees it curves around the front mid calf. I just want direction.

    • Dr. George Best

      Reply Reply July 31, 2014

      Hello Dena,

      To start with the question of Cox versus McKenzie, McKenzie is not strictly extension and in fact uses a testing procedure to determine what position (extension, flexion, extension with left or right side bending or flexion with left or right side bending) is most appropriate for a given individual. While in most disc protrusion cases the McKenzie protocol does indicate one of the extension positions, other conditions like degenerative stenosis will usually have an indication for a flexion position. Even when McKenzie does indicate extension for a given case, it’s not mutually exclusive from Cox, because the treatments do very different things. Cox is a type of flexion distraction, which is similar in effects to traction. The distraction/traction force reduces pressure in the discs and may reduce disc bulging by essentially “sucking” the protruding disc material back in. By contrast, the concept in McKenzie is that the extension positioning is used to squeeze the protruding disc material forward and away from the nerve roots. Both Cox and McKenzie do often reduce disc bulging, they just do it in different ways. Cox also stretches various soft tissues around the spine and can relieve symptoms caused by contracted areas in those tissues. In my experience, at least half of the people who come to me pre-diagnosed with a “slipped” or bulging disc have symptoms that are primarily related to things besides the disc, and those conditions typically respond well to treatments that reduce contraction of the tissues, including treatments like flexion distraction. In any event, while on the surface it may seem like Cox and McKenzie are doing the opposite of each other, that’s really not the case.

      With having trochanteric bursitis in addition to the spine issues, it can be difficult to distinguish which symptoms are coming from which problem. With the pain being mainly on the sides of the legs, it suggests that your symptoms are more from muscle referral from the piriformis and gluteus minimus rather than actual sciatic nerve irritation. That plus the chronic and treatment resistant trochanteric bursitis suggests to me that there’s an unresolved mechanical issue in the hip and/or sacroiliac joint. That could be something like a joint misalignment that either hasn’t been identified by your chiropractor or one that has some other underlying issue that causes it to recur frequently (such as unstable arches in the feet). It could also be a more advanced problem such as arthritis in the hip joint that is preventing normal mechanics (and might be advanced enough that a hip replacement might need to be considered). My suggestion is to consider getting an opinion from another chiropractor. The one you’ve seen for years may be excellent, but sometimes a new approach is needed. Likewise, a different style of massage might be worth a try (perhaps trigger point therapy or myofascial release if you have not had it yet). If you haven’t had any imaging done on the hip joint recently, I’d also suggest at least having some X-rays to evaluate that area further.

      I hope this is helpful for you.

      Good luck!

      Dr. Best

  • james r

    Reply Reply October 22, 2014

    Hi. I had a microdiscectomy 4 weeks ago.the pain is relentless . With pain meds it is barely manageable. I had alot of pressure on my sciatic nerve. I’m not concerned about the medicine. I have no issues with them not even constipation. My concern is that I will Need a fusion. It’s L4-L5 plus stenosis. As people like me are 8 weeks in with no improvement. I exercise, walk use ice and heat plus meds. I’m following protocol. My question is could my sacroiliac be mimicking my other symptoms. I am in healthcare as a rehab assistant and massage therapist so I am informed but very worried. Thx for listening to me whine. Lol

    • Dr. George Best

      Reply Reply October 22, 2014

      Hello James,

      If the disc that you had the microdiscectomy on was the primary issue, I’d expect things to be getting better by now,so I’d say there’s a good chance that there is some other problem. One possibility as you mentioned is the sacroiliac joint. In my experience, the lumbosacral joints can also be culprits. In fact, I have seen more than one patient with symptoms unresponsive to various disc treatments respond dramatically and immediately to chiropractic adjustments of SI and/or lumbosacral dysfunctions. In some cases, muscle reactions are a big factor as well, as the quadratus lumborum may go into reactive spasm after surgery and of course the piriformis and gluteus minimus contraction issues can persist long after any disc issues are resolved. So, the first suggestion I have would be to get the joint and soft tissues checked out by a chiropractor and/or massage therapist who does deep tissue techniques (or poke around on the muscles yourself to see if they appear to be involved).

      Another possibility is that the stenosis at L4-5 involves bone spurring/thickening and/or ligament thickening that was not addressed by the microdiscectomy and is causing continued nerve irritation, either by itself or in combination with inflammatory swelling. For that matter, swelling alone could be the primary issue, although 4 weeks is a long time for that to persist with the treatments you are using.

      Finally, there could potentially be a different level of the spine causing problems that did not show up on the imaging you had. Sometimes rather substantial disc protrusions do not show up on MRI done lying down, but become visible when the spine is in an upright position or a loading harness is used. If your symptoms are mainly when you are sitting or standing, that becomes a more likely scenario. Another possibility is that the symptoms are actually coming from a different part of the spine altogether. Since you have stenosis in the lumbar spine, it would not be surprising if you had it in the cervical spine as well. Cervical stenosis can sometimes cause symptoms primarily in the legs, most commonly on both sides, but I have heard of cases that were one-sided.

      As far as fusion goes, in my opinion it is only appropriate when there is demonstrable instability in the spine (per motion imaging studies). While I would not rule out further surgery of some kind at this point, there are other options besides fusion, such as a different minimally invasive procedure or perhaps a laminectomy, depending on what follow-up imaging shows (I would not recommend making any surgical decisions until having a new MRI).

      I hope this is helpful for you. If you have further questions, let me know.

      Good luck!

      Dr. Best

  • James r

    Reply Reply October 22, 2014

    Thanks for getting back to me.I just want to clarify something . The pain is still originating in the same spot. Distal of l4 l5. It is a constant throbbed on with jolts of pain. It’s like I’m back at square one. The pain is 24/7 med just make it borderline tolerable . Could my nerve still be in shock. It did take a long time to get this way.maybe I need more time. There was exceptional pressure on the nerve.there are people 8 weeks in still stuck where I am.I value your opinion . I do have a pinch in my upper spine T1 area .stiff lower neck.but not near the type of pain as l4 l5. The for listening .

    • Dr. George Best

      Reply Reply October 22, 2014

      In the more severe cases of nerve compression, it can take up to several months for the nerve to maximally recover; however, in those cases the symptoms usually start as numbness and weakness more than pain and you then move into pain as the nerve recovers. Even so, it is certainly possible that you simply need more time. In case it is a question of nerve recovery, I’d suggest supplementing with some B-complex vitamins, as they are important in nerve repair. The other possibilities previously discussed are still all on the table, including cervical stenosis. In some cases, the leg symptoms can be considerably worse than the symptoms localized in the cervical area. I would put cervical stenosis as probably the least likely problem of the ones mentioned before, but if all else fails, it’s worth looking into.

      Dr. Best

  • James r

    Reply Reply October 23, 2014

    Thank you.I’m seeing my surgeon next week . If I have any revelations or find out if it’s something new.I will let you know . I know we are all busy and I don’t want to waste our time . Hopefully I’ll b fine if not I’ll drop a line

  • Kristine

    Reply Reply December 4, 2016

    Hi. Hope this is still an active site and forum. I have spindylolisthesis with a bi-lateral pats fracture, apparently since I was a kid (gymnast for years). I found out I had this about 6 years ago when I slipped on an icy patch while walking. My back ached the next day and was really tight. I went to the dr. And x-ray revealed my spondylolisthesis. It was a grade 1, they gave me some muscle relaxers and I was fine in a few days. 3 years later I had a terrible bout with sciatica. It lasted about 2 months. It was annoying but not debilitating. I did not connect the two, but did start doing a lot more stretching. I work out regularly and often and I’m really diligent about stretching and foam rolling daily and have been since the sciatica 3 years ago. It went away and all was well until about 3 months ago. The sciatica started acting up again. It runs down my right leg and into my big toe which often goes numb, especially when I stand or walk. It was getting progressively worse and I went back to the doctor. They put me on gabapentin, Mobic and flexiril. Not crazy about taking all the meds but they help a little bit. It took a month to get into the Spine specialist office. I had an MRI and my spondylolisthesis has progressed to a grade 2-3 (just over 50% he says). It is my L-5/S-1. I can’t walk or stand for more than a few minutes at a time and it seems to be getting worse day by day. I had an ESI 5 days ago. The day after I felt pretty good. About 50-60% better, but by 2 days after I was right back to where I started or worse. I am SO discouraged! I keep hoping the ESI is going to kick in and I’ll feel better, but so far it has not. What do I do now? I am 51 years old but really fit and active, and now I have to rush through my grocery shopping so I don’t have to squat in the aisles. (Squatting and sitting alleviate my pain). I can deal with the burning in my lower back, but the leg and foot pain is unbearable. HELP!

    • Dr. George Best

      Reply Reply December 5, 2016

      Hello Kristine,

      I think part of the story may be missing for you and/or for me. It would be very unusual at your age for a spondylolisthesis that started when you were a kid to suddenly progress to a 2-3 in a period of 6 years without some significant trauma to cause the progression. In addition, even a Grade 2 or 3 spondylo in and of itself usually doesn’t produce sciatica (back pain, yes, but not sciatica), so I have to guess that there’s a disc protrusion, bone spurring, or some other factor that’s also contributing to your symptoms. So, before I can give you any treatment suggestions, I’d need to see the MRI findings (you can email me the report and/or mail me a CD with the actual images if that’s available to you).

      What I can tell you is that most likely you’ve had what relief you’re going to get from the first ESI. The sole purpose of the ESI is to reduce inflammatory swelling that may be contributing to a person’s nerve compression and resultant symptoms. In some cases, inflammatory swelling is a significant symptom generator in itself, while in other cases, the vast majority of symptoms are due to actual structural compression of the nerve(s) and therefore reducing swelling has little effect on symptoms. In most cases, the steroid is mixed with an anaesthetic of some kind, and the early symptom relief from the injection is actually due to the anaesthetic, then the steroid starts to take effect as the anaesthetic wears off. It sounds like your symptom relief was probably due mostly to the anaesthetic or possibly even the process of inserting the needle (in some cases, “dry neeedling” is effective for pain relief and is presumed to work as a kind of unskilled acupuncture). If the steroid was going to do much, it would have started doing it within a few days. In some cases, additional steroid injections will get better results due to various factors (location of the injection, additional suppression of inflammation, etc.), but in any case will not usually provide long-term relief when significant structural causes for the symptoms are present.

      As I said, I’d like to see the MRI results before giving any treatment suggestions. If you wish to email me your MRI report, you may send it to info@sciaticaselfcare.com. If you want to send me a CD with the actual images, let me know and I’ll give you my mailing address.

      Dr. Best

  • Dr. George Best

    Reply Reply May 11, 2015

    You’re welcome!

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