Sciatica Treatment With Surgery

Click To Download Video

36 Comments

  • DINESH NARANG

    Reply Reply May 14, 2012

    please can you tell me what is perispinal etanercept treatment ?

    • Dr. George Best

      Reply Reply May 14, 2012

      Paraspinal etanercept therapy is new type of anti-inflammatory injection that has a different mechanism of inflammation suppression than other types of anti-inflammatories. It has been touted by its developers as a breakthrough in the treatment of sciatica and back pain as well as for other inflammatory conditions. It may very well be more effective for some patients than oral anti-inflammatories and steroid drug injections, but it is far from 100% effective and from what I have seen so far it is probably a marginal improvement over existing anti-inflammatory treatments, at best.

      It also should be kept in mind that this treatment is strictly an anti-inflammatory. In the case of large disc herniations or ruptures, or when there is some other cause for pain other than just inflammatory swelling, the results are not likely to be all that dramatic.

      It is still quite new and it may prove to live up to the manufacturer’s hype, but so far the independent reports on it I’ve seen have been less than exciting.

  • Rahul suryawanshi

    Reply Reply July 24, 2012

    dear sir there is posssible in sciatica can be cure by streaching & physicaly exercise ..& that is completely cure 100% please sir kindly replay me.

    • Dr. George Best

      Reply Reply July 24, 2012

      Hello Rahul,

      In most cases sciatica can be successfullly treated with exercises to the point where symptoms go away completely and can be kept away with ongoing preventive use of the exercises. But,there is no “cure” for sciatica in most cases in that no treatment, including surgery, can fully correct the common underlying causes of sciatica (such as herniated discs). Since the underlyng causes cannot be fully corrected, the symptoms will usually return if the individual does not manage the problem with long-term prevention strategies, such as the ones I present in my ebook and in the member’s area of my website.

      Dr. Best

  • Anthony Ahorttor

    Reply Reply March 26, 2013

    I do feel pain in the lower right back and in all of the right leg especially excruciating pain in calf and the back of the thigh. The sciatica affects only the right leg. MRI scan reveal herniated disc, ( according to Doctors). I watch your videos and most are very consistent with what I am suffering, however I am afraid of surgery.

    Anthony.

    • Dr. George Best

      Reply Reply March 27, 2013

      *I posted this response to your question on the physical therapy page, but I figured it was appropriate here as well for others who may be reading the comments:

      Hello Anthony,

      In my opinion, surgery should only be considered when the symptoms can not be managed to a point where they are tolerable using other treatments. The severity of symptoms during an acute episode is not a reliable indicator of the need for surgery. The only times symptoms alone would indicate the need for surgery without delay is when there is loss of bowel and/or bladder control and/or the presence of “saddle anaesthesia”, which is a loss of sensation in the inner thighs and lower buttocks (the area that would contact a saddle when riding a horse), and/or extreme weakness in the legs (which needs to be distinguished from “giving out” of the legs due to pain).

      The vast majority of cases can be effectively managed without surgery. If you have not already, I recommend you begin with the self-treatment methods in my free ebook, which can be downloaded at: http://www.sciaticatreatmentathome.com/sciatica-treatment-exercises/ . As it discusses in the ebook, an initial period of up to a week to ten days of intensive use of the McKenzie exercise and cold packs (see the ebook for details) will usually substantially reduce symptoms and then you can gradually reduce the frequency and use the exercises a few times a day for prevention. Management of the underlying causes of sciatica really should be considered as a lifelong thing – not something you only do when you have symptoms. Although sometimes presented as a once and for all “cure”, surgery rarely is a permanent fix, and often people who have surgery on one disc subsequently have to have surgeries on other discs down the line. Surgery may be the only option in a few cases, but it’s generally best to avoid it if possible.

      If you have further questions, let me know.

      Good luck!

      Dr. Best

  • Raquel

    Reply Reply April 8, 2013

    Hi Dr George Best

    I remember dancing and something went click in my inner thigh i went to the hospital and was diagnosed with sciatic nerve pain which none of them know how to get rid of so they just threw a pair of crutches at me.i had this for 2 years now. My leg hurts so much especially when i walk. I’m in my 3rd term of pregnancy and I’m struggling to walk and do normal house shores.Please tell me there is hope cause i have given up on all medication and exercise don’t seem to help.i tried acupuncture and heat as well as physiotherapy help me this pain has put my life on hold i really want to carry my baby around .

    • Dr. George Best

      Reply Reply April 8, 2013

      Hello Raquel,

      From the mechanism of injury, I’m not certain that what you have is actually sciatica. If you can give me more of a description as to what is going on in terms of where your symptoms are (specifically where in the leg and/or other areas), what makes them better or worse, and what diagnostic tests you’ve had (if any) and the results of those tests, I may be able to give you some recommendations.

      Dr. Best

  • Ed Samaniego

    Reply Reply June 13, 2013

    Can you please qualify for me “discoplasty” against other methods of easing nerve impingement. Is it effective, lasting and is there a potential problem both in short and long term.

    Thank you.

    • Dr. George Best

      Reply Reply June 13, 2013

      Discoplasty is one type of “minimally invasive” spine surgery that involves inserting a probe into a herniated disc and heating the disc tissue to cause shrinking and retraction of an area of disc bulging. When the only source of nerve impingement is disc bulging (there’s not also issues of bone spur formation, ligament thickening, synovail cysts, or other tissue encroachment on the nerve), discoplasty is a good option when conservative treatments have failed. As with any surgery, there are some risks, such as infection, reaction to anaesthesia, and rare surgical errors that can lead to nerve damage. As spine surgery goes though, it is relatively low risk compared to more aggressive surgical methods. In terms of long term effectiveness, it’s a relatively new technique, so it is hard to say how long it lasts and how the results compare to other methods. As with any spine surgery, it does not restore the disc to what is really a normal, healthy condition – it just reduces the bulging. Since the disc wall is constricted by the procedure, I would speculate that it may be somewhat stiffer and therefore somewhat prone to reinjury, especially if the patient does not make efforts to take good care of his or her back following surgery.

      I hope this is helpful for you.

      Dr. Best

  • Della Wofford

    Reply Reply July 6, 2013

    Hello Doctor Best,
    I have had sciatica for at least 3 years. I didn’t know what was wrong until just recently. I can only stand or walk for brief periods, I have no pain in my legs, just pain in my lower back with movement. I have been seeing a pain management doctor for the past 6 months. I had lumbar facet injections twice and an epidural steroid injection. These procedures did not work for me. I had a MRI about a week ago. I have the disk and am able to review the scan on my computer. I can see a growth in my vertebrae, it is growing and digging in the vertebrae below it. The growth is not connected to the vertebrae below but you can see where the bone has been worn. Also the disc space between the two vertebrae is smaller then the others. I have been doing spine stretching exercises and now I am able to stand and walk for longer periods of time. Do you think that removing the bone growth will benefit me? I am afraid to have surgery. I have another doctor appointment in about 2 weeks to review the MRI. Please share your thoughts with me.
    Thank You

    • Dr. George Best

      Reply Reply July 6, 2013

      Hello Della,

      Technically you don’t really have sciatica since the pain is only in the back and not in the legs, but most of the same underlying causes for sciatica can cause back pain as well.

      From your description of what you see on the MRI, it is hard to be sure whether you are seeing a bone spur/growth or a disc protrusion, or possibly something else. MRIs show a lot more detail than an X-ray, so unless you’ve had some training in reading them, you may not be drawing an accurate conclusion of what it shows. If we go on your analysis that it is a bone growth, the bigger issue is where is it located. A bone spur at the front of the spine may not produce any symptoms at all, whereas one projecting into one of the spinal nerve canals can produce major symptoms. So, with what I know so far, I can’t really say whether surgery is likely to be beneficial or not.

      What I can tell you is that if you are improving with the exercises, there’s a good chance that you will not need surgery, so keep at it and hopefully you’ll be much better still by the time you see your doctor.

      If you have further questions, let me know.

      Good luck!

      Dr. Best

  • Della Wofford

    Reply Reply July 6, 2013

    Thank You Doctor Best,
    I am no expert and I appreciate your input. I plan to continue with the exercises.

  • Len Griffiths

    Reply Reply August 29, 2013

    I am 70 yrs of age and have been weightlifting in the gym for many years; about 12 weeks ago I started having a sore ,aching hip,and assumed this was just old age so I rubbed in Volterol or sometimes Ibuleve to ease the pain; and I carried on with my bodybuilding.Then about 10 weeks ago I had pain in my back and when standing up,shooting pains down the buttocks and into both legs.
    I was prescribed antidepressent tabs,but no effect; I was then given Diclofenac and Tramadol; this eased my pain;three weeks later I told the doctor I needed to be checked out to find the source; and an MRI scan request was sent; I had that scan on 25th August; after a 4 week wait; I am still on Diclofenac but have dropped the tramadol for 60mg Dehydrocodeine; and I am waiting for the MRI report to go to my doctor. Since all this began I have strated doing stretches, Piniforus stretches, and McKenzie stretches; THE PAIN IN MY LEFT LEG HAS GONE; BUT THE RIGHT SIDED PAIN REMAINS; and my right lower leg is slightly swollen and hard with tingling in my toes; I expect to see my doctor for the report update in 7days; my question is,because the problem started with just an aching hip,could my hip have become arthritic,and the Sciatica problem is a seperate issue? Also I feel flat footed and as if I am walking on sponge which makes me uncertain on my legs as if they are made of lead; can this get better >=?

    • Dr. George Best

      Reply Reply August 29, 2013

      Hello Len,

      You posted a similar question on a different page of the site a couple of days ago, so in case you didn’t see my response, I’ve copied it below along with additional information regarding a couple of aspects that were not in your original post.

      There certainly could be a problem in the hip itself, but your symptoms may also be due to 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 or severe arthritis 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.

      Sciatic nerve issues can sometimes cause swelling in the legs and commonly cause tingling in the toes, but it is entirely possible that there is a separate issue. Be sure to ask your doctor about it so that he makes sure there’s not a circulation problem in your leg. The walking on sponge sensation could be due to either continued nerve compression effects or circulation problems, and while the sciatica is a likely cause, circulation issues can become quite serious if not attended to, so it’s definitely a good idea to rule them out.

      In most cases, the types of symptoms you’re having will get better, but depending on the underlying causes it may take some time.

      Good luck!

      Dr. Best

  • Marilyn B

    Reply Reply September 21, 2013

    I am not sure of what I should do, I really don’t understand, I have had surgery, the doctor put two metal bars in my back, it has been 2 years since the surgery took place, and I was down for 2 or 3 years before the surgery, I am now at the point that I can’t walk from my house to my car, which is less than 15 feet from my front door. Do you believe the exercises will work? This is about the only thing I haven’t tried,

    • Dr. George Best

      Reply Reply September 22, 2013

      Hello Marilyn,

      Since it sounds like they’ve fused your spine, the McKenzie exercises are unlikely to help much, although you may get some benefit from stretching the piriformis and gluteus minimus muscles. In your case, I suspect that a lot of your problems may be due to post-surgical scar tissue and possibly other soft tissue reactions. My suggestion would be to try deep tissue massage and possibly acupuncture to decrease the soft tissue restrictions. Hopefully that will be of some help to you.

      Good luck!

      Dr. Best

  • Marilyn B

    Reply Reply September 22, 2013

    Dr Best, Thank you, I will try.

    Marilyn

  • shaukat

    Reply Reply November 10, 2013

    Sir as I am following the exercise as described in your book but it suffer me too much pain while doing that.i need to ask you that should I continue with same exercise?. This is second mail as I have already given my pian decription which starts from my left hip and travel down to foot. Its realy unbearable now..plz need you advice ..

    • Dr. George Best

      Reply Reply November 11, 2013

      Hell Shaukat,

      First, it’s important to distinguish where the pain is while doing the exercise. As the directions in the ebook state, you’re not supposed to do all of the different positions, just the one position that best centralizes the symptoms. What this means is that if you start with pain all the way down the leg to the foot for example, if the exercise reduces the pain in the foot and lower leg, that’s a good sign, even if pain closer to the spine increases. If you cannot find any position that centralizes the symptoms, you should discontinue the exercise. You really should see a doctor if that’s the case, because it suggests that the problem may be too severe to be able to manage it with self-treatment methods. Whether or not you continue the exercise, I would suggest doing as much as possible to control inflammation. One of the best things you can do is use cold packs for about 10 to 15 minutes at a time as often as once every two hours you are awake. If you have anti-inflammatory medication, that should be used as directed on the maximum frequency schedule per the instructions that came with it.

      Good luck!

      Dr. Best

  • ARTHUR ROLA

    Reply Reply December 4, 2013

    WITH THE PROBLEM OF SCIATICA I CANT HAVE AN MRI IS IT NECESSARY OR I ST A PROBLEM TO

    • Dr. George Best

      Reply Reply December 4, 2013

      I don’t think I fully understand your question, but an MRI is simply a tool to diagnose the underlying cause of sciatica. I usually recommend waiting at least a couple of weeks to see if self-treatment and/or professional treatment relieves the symptoms. If there is no improvement with treatment within 2 week or so, then an MRI is recommended to further evaluate the problem.

      Dr. Best

  • anamitra

    Reply Reply February 2, 2014

    can lumber spondylosis leads to sciatica?

    • Dr. George Best

      Reply Reply February 2, 2014

      Spondylosis (which is just another term for degenerative changes in the spine such as bone and ligament thickening and disc thinning) can lead to sciatica, but by itself it would have to be relatively severe to cause significant symptoms. It is unlikely that the x-ray findings you described are the primary cause of your mother’s symptoms. I suggest she have an MRI (or CT scan if MRI is contraindicated due to something like a metal implant of some sort) to further evaluate the spine. This type of imaging will give a lot more information than an X-ray and will hopefully give a better indication on how to proceed with treatment.

      Dr. Best

  • Max

    Reply Reply March 17, 2014

    Dear Dr George Best
    Thank you so much for the intelligent, practical and useful information on your website. I believe that if i’d found your website six years ago I could have taken preventative measures and I wouldn’t be in the situation that I’m now in. It was by reading your website that I’ve been able to gain an insight into the mechanics of why I have been experiencing paralysing shooting pains down the right side, buttock, hip and thigh. This understanding of the mechanics has helped me go back over the images of a recent MRI scan and find the source of the pain. On a section view of the torso it is quite clear that there is a bulge to one of the discs ( RH side toward the back). It looks about the size of the end of my thumb and has what looks like a white blood vessel threading from the muscle, over the end of the bulge and then continues toward the front. I guess this could be the sciatic nerve. Incidentally, the MRI was reported as showing a healthy spine with no problems.
    My way of dealing with the problem(six times in the past 12 months) has been to rest for 5 – 6 days where standing or sitting exacerbates the pain.
    Severe episodes of pain can be triggered by leaning forward, bending over, walking uphill, lifting objects, airline seats etc etc. I work as a self employed furniture maker but the episodes of pain and immobility are destroying my business.
    I understand that I need to change how I work and am keen not to have surgery.
    Could you advise the best course of action regarding strengthening the body to help protect against further episodes, and will the bulging disc recover to its correct shape and strength over time.
    I have been reluctant to take up exercise in fear that I would exacerbate the problem, though I’m more confident now that I understand the core issues.
    I look forward to your reply.
    Best regards
    Max

    • Dr. George Best

      Reply Reply March 17, 2014

      Hello Max,

      I recommend you start with testing the positions for the McKenzie exercises (as discussed in detail in my free ebook. Assuming you can find a position that centralizes the symptoms (as explained in the ebook), doing a minute or so frequently throughout the day will usually not only help with the symptoms but gradually reduce the disc bulging. Using cold packs as directed in the ebook will reduce any inflammatory swelling that may be contributing to the symptoms. Continued use of the McKenzie exercise on a preventive basis a few times per day will allow the disc wall to become more stable and help prevent a recurrence. Strengthening the abdominal core and paraspinal muscles (some basic exercises are in the “Prevention and Rehabilitation” section of the members area of my website) is beneficial as well. Walking (on a flat surface) is also good. Once most or all of the symptoms are gone, it is also good to do some leg strengthening (quads, hams, glutes) and a simple way to do this is with low or just body weight resistance squats (don’t go lower than where your thighs are parallel to the floor).

      I did not understand your description of what you’re seeing on your MRI. If you’d like me to take a look at it before you start working with the exercises, let me know. If you have it in a digital form, you may attach the pertinent images to an email (send to info@sciaticaselfcare.com).

      In any event, I wish you good luck!

      Dr. Best

  • Yeo Kim Tek

    Reply Reply May 12, 2014

    Hi Dear Dr Best,

    Ref : Chronic Sciatica Paint

    Just joined your member’s page since found your articles precise and informative.

    I am 68 years old and suffering from chronic sciatica pain since 2008.

    In 2008 first diagnosied with sciatica pain down left leg. Did posterior
    decompression using facet argumentation ( percydyn system ) but failed. No
    relief of sciatica pain
    In 2010 did poterior & anterior L4/L5 fusing surgery but also no relief of the sciatica.
    Since then have tried all forms and type of treatment such as chiropractor, physio,
    accupuncture, hypnosis, inversion table , epidural injection, nerve block etc. But the
    sciatica pain remain.
    According to the doctors I am having ” failed back syndrome “.

    Currently having sciatica pain down left leg at ankle and calf area. Left toe felt numb. Less
    pain if I can get a good night sleep but pain still gradually build up from around 4/10 in the
    morning to 7/10 in the evening. But hard to get a good night sleep.
    When pain in my left leg around 6/10 my right foot also felt like burning.
    Pain is worst when standing or walking. Now not able to walk more than 70 metres.
    Slight osteoartitics also detected in my left hip joint.
    Pain is worst when I get exicited or in stressful situation.
    I am also a diabetic.

    Current medications:
    a) Before b’fast – 1 x glucosamine,500mg & chondroitin,400mg
    b) After b’fast – 1 x Lyrica, 75mg and 1 x Krill oil, 500mg
    c) After lunch – 1 x Apo amitriptylime,10mg
    d) Before dinner – 1 x glucosamine,500mg & chondroitin,400mg
    e) After dinner – 1 x Lyrica, 75mg and 1 x Krill oil, 500mg and 1 x Apo amitriptylime,10mg
    f) For sleep – 2 x stillnox, 10mg
    Despite the above medications no real relief and still having sciatica pain from around 4/10
    in morning and gradually built up to aroung 7/10 in the evening. Tried to stop above
    medication then the sciatica pain really bad ( 10/10 ).
    Currently doing some light stretching exercise in morning and afternoon.

    Tried to do the test to check whether I am having nerve or muscle compression. No
    problem in doing the test for nerve compression. For the muscle compression test no
    problem with right leg. But for left leg only able to raise left leg up the right leg knee level.
    Not able to cross left leg over right leg tigh.

    I wonder whether I can manage my chronic sciatica pain better if I follow your Mckenzie
    or I have to do something else.
    Your advise would be deeply appreciated.

    Thanks and Regd Yeo

    • Dr. George Best

      Reply Reply May 15, 2014

      Hello Yeo,

      It sounds to me like your current symptoms are probably due to muscle contraction issues in the piriformis, and probably other muscles in the buttock. The problem may have started as a nerve compression/irritation which caused the abnormal muscle contraction (which, after it begins, can be a residual issue once the nerve irritation is gone), but it sounds like any significant nerve compression that was present has probably been resolved. There could also be some contribution from your diabetes to the symptoms in the lower leg and foot.

      As to exercises, you may find one of the McKenzie positions helps, but I suspect that you will actually do better to focus on the piriformis and gluteus minimus stretching and self-massage. A few minutes of stretching and/or massage done several times throughout the day for the first few weeks will give you the best chance for a good result. If things go well, you can just do a few minutes each day as a preventive measure after that. You didn’t mention massage specifically as something you’d tried, but I think it would be worthwhile to find a massage therapist who does trigger point/ myofascial release, or some kind of deep tissue technique to help get things loosened up at least initially.

      As I mentioned, your diabetes could be involved as well, and in addition to managing your blood sugar as best you can, I’d suggest you try supplementing with alpha lipoic acid (600-1200 mg/day) for at least a month or so to see if it helps. If it does help, it will be good to continue it to help prevent neurological damage from the diabetes.

      If you have further questions, let me know.

      Good luck!

      Dr. Best

  • Peter

    Reply Reply May 16, 2014

    Hello Dr. Best,

    I’ve had sciatica symptoms for a few months now & have been going to the chiropractor for a few weeks, but the pain has quickly gotten unbearable the past 7-10 days. I’ve been bed-ridden & out of work for the past week. I cannot stand up straight at all without very sharp pains shooting down the right-side of my lower back, hip, buttocks, hamstring, all the way down to my calf. I find that if I lower my chin to my chest & walk very slowly & hunched over to the left, it seems to lessen the pain, but not completely. It’s extremely painful to get up after sitting for more than a few minutes & is painful lying down or turning in bed, unless I stay perfectly still. I’ve tried to do your recommended stretches, but could not get my body in the proper positions without very bad pain. I’ve tried ice, pain medication (cannot do NSAID’s because of a stomach problem) & massage therapy as well, but nothing seems to help. One day this week, I tried walking in place, hunched over & slowly began moving in an upright position. It took me about 30 minutes to begin walking with my head upright, but the process was excruciatingly painful, my hips/legs/thigh/calf muscles felt as though they were tearing apart. The pain made my right side numb & I felt dizzy. When I drove to my chiropractor and stepped out of my truck the pain shot through my lower back & I almost fell over. It’s been extremely painful trying to do everyday things like use the restroom or shower & I want to get back to work as soon as possible. I just turned 33 and my wife is 7 months pregnant with our first child, and I feel terrible not being able to help her. I want to believe I can get better without any injections or surgery, but the past 7-10 days have been really tough for me. Any help or advice would be tremendously appreciated.

    My chiropractor thinks I have a bulging disc at L5-S1, but said he can’t know for sure without an MRI. Is there a specific doctor I should see for this? Orthopedic Surgeon? Neurosurgeon? Spine Specialist? Is exercise better than bed-rest? Even if the exercise is very painful?

    It’s so hard to know what to do. Please help.

    Thank you.

    -Peter

    • Dr. George Best

      Reply Reply May 16, 2014

      Hello Peter,

      I agree with your chiropractor that it’s probably a disc herniation. In terms of how to proceed with professional care, the next step is an MRI to determine where/what the problem is and how severe it is in order to determine the best treatment options. Regardless of what type of doctor you see at this point, they’re going to want the MRI before they make any treatment recommendations, so I recommend getting your chiropractor to order it and get it done ASAP. Your chiropractor will probably have an opinion as to whether you should consider surgery and if so, can probably refer you to a good surgeon. If you would like my opinion once the results are in, let me know.

      What I suggest in the meantime since you can’t really do the exercises is to try lying on your stomach with a pillow under your chest for a few minutes at a time several times per hour interspersed with being in whatever position is most comfortable for you. If you reach a point where you can tolerate one pillow pretty well, try adding in a second and see how it goes. The goal is to gradually increase your tolerance to extension until you can do the propped on your elbows McKenzie exercise position. While it may be painful even with just one pillow, if the position centralizes the symptoms (explained in detail in the McKenzie exercise instructions) you can continue. Discontinue lying on the pillow if the symptoms in the lower leg increase or change to numbness/weakness. I suggest you continue applying ice – about 15 minutes at a time, up to every two hours you’re awake.

      In general, getting up and moving around at least a little bit every hour is better than total bed rest, but do what you can do. There’s no reason to force yourself to be active if the pain is increasing. I also do not recommend forcing yourself to stand straight if it causes increased pain down the leg, as this will only tend to increase inflammation around the nerve. I recommend you avoid sitting as much as possible. It’s better to be either lying down or being up moving around than sitting.

      Even with the severity of your symptoms, it is still quite possible that you will recover without needing to resort to injections or surgery, but I still recommend you proceed with getting the MRI without further delay so that if there is a change of treatment indicated, you can proceed with getting it sooner than later.

      If you have further questions, let me know.

      Good luck!

      Dr. Best

  • José

    Reply Reply August 4, 2014

    Dr. Best,
    I am 66, in excellent health and shape. I have never had sciatica problems before, but started having them about 2 weeks ago. Initially, just pain in my right buttock. A week later, the pain increased greatly and I started having tingling in my right leg and pain from my knee to my shin.
    Massages, magnets and acupuncture helped slightly. The pain was worse sitting. I would get tingling in my leg for a few seconds upon standing.
    The pain increased 3 days ago and I get relief only laying down.
    An MRI shows degenerative disc disease and spinal stenosis. Can you shed some light as to what I’m looking at?

    • Dr. George Best

      Reply Reply August 4, 2014

      Hello,

      I’m afraid I can’t tell you anything very specific because there’s a tremendous amount of variation in degenerative disc disease and spinal stenosis in terms of severity and cause, and therefore the treatment recommendations would vary greatly as well.

      Speaking in generalities, degenerative disc disease means that one or more discs is losing fluid and flexibility and is generally not as thick as normal. It may or may not be bulging, and the severity ranges from a slight reduction in disc height and hydration to a situation where the disc essentially is gone and the vertebral bones above and below it are fusing together. Spinal stenosis means that the central canal for the spinal cord is narrowed. It can be narrowed by disc protrusion, bone spur formation, ligament thickening/buckling (often associated with the loss of disc height in moderate to severe disc degeneration), tumors, synovial cysts, and/or congenital factors (some people are born with a narrower spinal canal than normal). There’s also foraminal stenosis (also called intervertebral stenosis) that often gets lumped in with spinal stenosis (although by strict definition they are different conditions), which refers to narrowing of the openings where the nerves branching off from the spinal cord exit the spinal column. This also can be due to a number of different causes and either type of stenosis ranges significantly in severity. It’s a huge pet peeve of mine that doctors tell patients they have spinal stenosis without making any mention of the cause or severity, because that information is absolutely essential to making appropriate treatment recommendations. Anyway, I would need to see the MRI or at least the radiologist’s report to be able to tell you anything specific about your situation.

      The fact that it’s worse when sitting suggests that the problem is most likely to be primarily from disc protrusion as opposed to bone spur, ligament thickening, etc.. In this case, one of the extension positions of the McKenzie exercises (as discussed in detail in my free ebook) will likely be helpful, as would using cold packs and other anti-inflammatory measures. It is still important to do the testing procedure for the McKenzie exercises though and it is possible that one of the flexion positions will actually test out to be the best.

      If you have further questions, or would like to get my opinion on the MRI report or images, let me know.

      Good luck!

      Dr. Best

  • azelectra@yahoo.com

    Reply Reply December 9, 2014

    Oh, I was not clear on this conception of decentralization. I have been attempting the McKenzie exercises. Now do I have this right? I have R sided sciatic pain-lumbar back to R outer toes. In the straight position the pain down my right leg– and especially the outside of the R calf–increases. If I move to the L the pain in my R leg is lessened. Trying the position to the R seems to lessen the pain also but moving to the L works best to lessen the leg pain. Which one do I do?

    I became a member last week and am much heartened by your knowledge.
    Elizabeth

    • Dr. George Best

      Reply Reply December 9, 2014

      Hello,

      You should do the position bent to the left as it provides the best centralization. Assuming you reach a point where you no longer have symptoms, you’ll probably do best to switch to the straight position for preventive purposes, but stick with the left bent position until it either gets rid of the symptoms altogether or you reach a plateau in your progress (at which point, you should re-test for the best position).

      Dr. Best

  • Ahmed Shabeen

    Reply Reply March 27, 2015

    I have being with this sciatica problem for 4 years now and i am holding with phisiotherapy and medicine ..My MRI shows i have mild bulging of L4 L5 and S1 discs. I started this due to heavy lifting. My question is does the epidural steroid injection work for sciatica and is it legal or risky?

    • Dr. George Best

      Reply Reply March 27, 2015

      Hello Ahmed,

      ESIs work by temporarily reducing inflammation around the involved nerves, so they can reduce or eliminate symptoms for a time. They don’t actually heal anything though, so the symptoms usually return within a few weeks to a few months. I’ve never heard of them being illegal anywhere, but local laws can vary. ESIs do carry risks, such as possible infections or nerve damage (from the needle accidentally hitting the nerve), but these are rare. ESIs do suppress immune function somewhat and repeated use is assoaciated with a risk of bone and soft tissue damage. In my opinion, they’re really only useful as a temporary means of reducing symptoms to allow people who would otherwise be in too much pain to undergo or wait for other treatment. You did not say what, if any home treatment you are doing, but if you would like some basic recommendations, I’d recommend you start with the methods in my free ebook. If you do not already have it, you may download it from this page: .

      Good luck!

Leave A Response

* Denotes Required Field