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2007-03-28 11:47 AM

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Subject: Lower back Sciatic Nerve
My lower back was sore and tight after last weekends race 3/18. Monday I was lifting light weights and my lower back just got tighter so I stopped lifting and did some lower back stretching. Tuesday morning (3/20) I was putting on my pants and got whacked hard in the back with sharp pain. Went to the doc Monday 3/26 and all he did was give me Motrin and Tylenol and Flexeral. I now have pain going from my lower back down my left leg. The pills do very little to suppress the pain and I don't think I am any better at all. I have not exercised at all and I can bearly put my own shoes and socks on. I can do it but only with extreme pain. The doc took no xrays and in fact did not even touch me. He thinks my injury is sports related and with get better with time. I am starting to think I slipped a disk or something, b/c this bad.


2007-03-28 12:09 PM
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Subject: RE: Lower back Sciatic Nerve
Good luck with your back. I was having a sciatic nerve problem that I mistakenly thought was a strained hamstring. My physical therapist had me focus on core strengthening. After struggling with this for better part of a year, I was pain free after about three weeks of the new excercises... Might be helpful for you to work with a good PT.
2007-03-28 12:36 PM
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Subject: RE: Lower back Sciatic Nerve
Hmm, I'm surprised he didn't offer up Vicodin too. Go see a chiropractor and see if he can get that thing to release. It will still be sore for a couple days after, but you should be up and running in no time. A chiro will also X-ray your back before he/she does anything in case it is something major. Oh BTW don't ask your docs' opinion on seeing a chiro either. From my experience 90% turn their noses up at the mere mention of the C word......
2007-03-28 12:51 PM
in reply to: #740294

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Subject: RE: Lower back Sciatic Nerve

Yeah.  It's much better to take the word of a random anonymous person on the internet.

mdg2003 - 2007-03-28 12:36 PM Hmm, I'm surprised he didn't offer up Vicodin too. Go see a chiropractor and see if he can get that thing to release. It will still be sore for a couple days after, but you should be up and running in no time. A chiro will also X-ray your back before he/she does anything in case it is something major. Oh BTW don't ask your docs' opinion on seeing a chiro either. From my experience 90% turn their noses up at the mere mention of the C word......

2007-03-28 2:53 PM
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Subject: RE: Lower back Sciatic Nerve

Nerve pain can be fairly excruciating so hopefully the meds will take some of the edge off of it.

When you have an acute injury, R.I.C.E. is a good acronym to remember (rest, ice compression, elevation)

Stuff you can do to get relief:

REST: If you have that much pain then you should avoid lifting anything over 10lbs, bending or twisting at the waist, prolonged standing (greater than 30 minutes) or prolonged sitting (greater than 20 minutes). Sometimes calling off of work really does a world of good. A lot of people don't think of back pain the same way they think of the flu. However, if you are at work in a lot of pain, how much work are you really doing? Also, if sitting (or whatever you do for a living) is aggravating your back, then you can turn an acute injury into a chronic problem in no time flat. It isn't worth it, trust me.

ICE: Ice is your friend, not heat. Don't take a hot shower, sit in a hot tub or put a heating pad on it. If it is inflamed, then the ice will help it. Don't leave ice on for longer than 10 minutes at a time.

COMPRESSION: In order to get some pain relief, sometimes a lumbar belt (which can usually be purchased at WalMart for like $20) will help provide support/compression while you are in an acute phase of injury.

ELEVATION (sorta): Lying flat on your back with something substantial (like a couch cushion) under your knees can take some of the pressure off of your lower back. Sometimes even a pillow under your head can cause enough traction in your lower back to irritate it. When I say flat on your back, I mean flat.

FYI:

Physical problems often respond to physical treatment, i.e. physical therapy or chiropractic. I have found that a combination of both is usually the best. In my experience it can take 4-16 weeks for a sprain/strain soft tissue injury to heal, and that means once it starts healing. If you re-injure it then you can start the clock over again. Also, while a lot of MDs don't like chiropractors, a lot really do. Our office has medical referrals all the time. And we refer to MDs all the time as well. Definitely keep your MD in the loop with what is going on with you.

Good luck with your back pain.



Edited by dr_evil_0818 2007-03-28 2:54 PM
2007-03-28 4:01 PM
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Subject: RE: Lower back Sciatic Nerve
DerekL - 2007-03-28 12:51 PM

Yeah.  It's much better to take the word of a random anonymous person on the internet.


I rest my case, it is kind of like an exposed nerve for some people. BTW it is just my opinion, not the official word.......



2007-03-28 4:24 PM
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Subject: RE: Lower back Sciatic Nerve

Geez, can't even joke around with some folks.

No nerves touched here.  Do whatever floats your boat.  The previous poster (who is a DC, gasp) gave out some pretty good advice.

2007-03-28 6:03 PM
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Subject: RE: Lower back Sciatic Nerve
Just a little friendly banter Derek !! No offense taken and hopefully none delivered..
2007-03-29 9:21 AM
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Subject: RE: Lower back Sciatic Nerve
I'm having the same problem right now. I HATE the way your whole leg tingles and aches. What I have researched and talked about with my PT friends is that in all likelihood what's happening is this.
Your/My piriformis (a muscle in your upper butt) has gotten tight and is pressing against your sciatic nerve. Combine that with tight hamstrings and we've got ourselves a nasty situation.
2007-03-29 11:51 AM
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Subject: RE: Lower back Sciatic Nerve
1) Xrays will not show you what your problem is, and are not needed in teh vast majority of back pain cases, especially in a young active adult. Who wants to have their gonads radiated if they can avoid it?

2) Your doctor SHOULD have touched you to evaluate for nerve function (strength, sensation, reflexes, sphincter tone or at least peri-rectal sensation)

3) about 90% of all back pain goes away, on its own, regardless of treatment provided within 6-8 weeks. So even if you did nothing but each chips & watch videos, most likely your pain would go away all by itself regardless of what your MD or DC or PT did.

That doesn't mean that you can't and shouldn't take measures to rest, sort out the underlying issue and try to prevent it form happening again by including appropriate core strengthing measures.

Red flags for back pain with sciatica include the inability to urinate, inability to hold your stool and numbness around your rectum. Anything else can be treated rather conservatively.

Ultimately, the only way to diagnose a herniated/ruptured disk is with an MRI which shows the soft tissues, but even after personally having had back problems for over 15 years, I never had an MRI until 2 days before surgery. I knew I needed surgery for an acute nerve injury so I had the test done. IT basically shows the surgeon where to cut.

ACtually, I did have x-rays when I was 23 by my PCP, and after learning about back pain and the idications for xrays I was really pissed that he took them, they were unnecessary and exposed my poor eggs to radiation. I fired him immediately, went to a doc that took me seriously and began PT whcih was extremely helpful.

Sorry for the rambling...sadly I'm a back pain expert from both sides of the doctor/patient relationship.

Edited by AdventureBear 2007-03-29 11:52 AM
2007-03-29 12:42 PM
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Subject: RE: Lower back Sciatic Nerve

AdventureBear - 2007-03-29 12:51 PM 3) about 90% of all back pain goes away, on its own, regardless of treatment provided within 6-8 weeks. So even if you did nothing but each chips & watch videos, most likely your pain would go away all by itself regardless of what your MD or DC or PT did.

The good doctor knows exactly of what she speaks.

End of last season, marathon training, my back "went out" on me. I had a microdiscectomy (L5-S1) in Aug 2001 so I knew the pain and was weary. Bumped into my orthopedist who said "if it's not better in 6 weeks come see me." Six weeks to the day it stopped hurting. I'm back training full bore.

Heed the good doc's words!



2007-03-30 8:01 AM
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Subject: RE: Lower back Sciatic Nerve
Does this mean I have to wait six weeks for it to get better? Is there any way to speed that process up?
2007-03-30 8:07 AM
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Subject: RE: Lower back Sciatic Nerve

The time that it takes for the tissue to heal is not really negotiable.  It just takes that long.  However things like chiropractic and PT help with the remodeling of scar tissue, joint stability, neuromuscular re-education, strength, stability and range of motion.  Modifying your activities of daily living and training so you don't re-injure it while you are healing also help.

 

 

2007-03-30 9:00 AM
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Subject: RE: Lower back Sciatic Nerve
dr_evil_0818 - 2007-03-30 8:07 AM

The time that it takes for the tissue to heal is not really negotiable. It just takes that long. However things like chiropractic and PT help with the remodeling of scar tissue, joint stability, neuromuscular re-education, strength, stability and range of motion. Modifying your activities of daily living and training so you don't re-injure it while you are healing also help.



What, as specifically as possible, does "modifying my daily training" mean? I don't have any races for 10wks, but I need to be training pretty consistently: @ least 6-10hrs/wk, ideally more.
2007-03-30 9:18 AM
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Subject: RE: Lower back Sciatic Nerve

Since I haven't done an exam on you, I can't specifically tell you.

If you want to PM me with more details regarding your injury I can perhaps give you a better idea of my opinion.  But you probably won't like it.

 

 

2007-03-30 9:44 AM
in reply to: #743023

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Subject: RE: Lower back Sciatic Nerve
dr_evil_0818 - 2007-03-30 10:18 AM

Since I haven't done an exam on you, I can't specifically tell you.

If you want to PM me with more details regarding your injury I can perhaps give you a better idea of my opinion. But you probably won't like it.

 

Great response. Again spot on. Another wise doc Wink

I stretched and used my inversion table but every time I tried to run the sciatica was too intense.  Everyone is different but for me there was no speeding it up. Hope you have better luck.



2007-03-30 11:31 AM
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Subject: RE: Lower back Sciatic Nerve

Rhino, I am sorry you are experiencing this. Before I post, let me say that I have no agenda or medical credentials, just my own experience. I started experiencing sciatica last year. At first, it was just in my glute and wasn't debilitating, it just concerned me. I saw a chiropractor and she prescribed 42 visits and wanted me to pay in full up-front to get a discount. What?! So I decided to see a non-surgical orthopoedist (sports doc) instead. He did an MRI, which (to his suprise) showed a herniated disk. He told me to stop all exercise, and he gave me anti-inflammatories and Vicodin and sent me to PT 2-3 days a week for 6 weeks. I tried exercises and they put me in traction. The pain got worse and started radiating down my leg (the Vicodin didn't help at all). I decided to try another route and went to a chirpractor. The DC told me I could exercise, but I couldn't tolerate it because the pain had gotten so bad. After 3 weeks and 9 visits, I was completely messed up. Not only was the pain radiating down my leg, my back muscles started pulling me in contorted ways so that my shoulders were not squarely over my hips. I subsequently found out that this is referred to as "splinting"... the body trying to protect itself from further pain. Next I went to an occupational therapist who did some soft tissue work to alleviate the muscle spasms. She referred me to a different DC. I was hesitant, but nothing else had worked, so I reluctantly went.  Well, it turns out that the 3rd chiropractor I saw was the person who was able to help me through this. It took 2 months of twice a week visits with her before the pain was reduced significantly (the technique that really seemed to help was called distraction. It's more specific than traction). I lost my whole season and am now, nearly a year later, just beginning to run again.

Here is my .02:

  • If you are having nerve pain, be careful; even if you are up to it, you may want to consider not exercising until it is resolved (I know that right now, you aren't even up to it).
  • I am shocked your doctor didn't even touch you. Find a new doctor.
  • If you are open to it, see a chiropractor.
  • Whether it's a physical therapist, doctor, chiropractor or other care provider, ask WHEN you should start feeling better, and if you don't start feeling better within his/her timeframe, consider moving on to someone else.
  • DON'T LOSE HOPE. It took me 3 chiropractors, an MD, a PT and an OT to finally find relief. The back is frustrating and everyone's experience is different. I really feel for you.
2007-03-30 4:13 PM
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Subject: RE: Lower back Sciatic Nerve
Thanks KellyJ, mdg2003, adventurebear, and dr evil. I did go see a chiropactor and she did x-rays and an exam. I have had one adjustment which has helped "some" and I go today for another adjustment. What is so frustrating is that I just finished a year long battle with plantar fiiciatcis! That was a long and tough battle and now I have back problems. What gives!!! Maybe this sport is not for me!!! Maybe I am just too old to start this in this sport!!! Who knows? I am using R.I.C.E. for now and I will see how things go.
2007-03-30 4:25 PM
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Subject: RE: Lower back Sciatic Nerve

Rhino42 - 2007-03-30 4:13 PM ...What is so frustrating is that I just finished a year long battle with plantar fiiciatcis! That was a long and tough battle and now I have back problems. What gives!!! Maybe this sport is not for me!!! Maybe I am just too old to start this in this sport!!! Who knows? I am using R.I.C.E. for now and I will see how things go.

I can imagine how frustrated you must be. I am glad you have experienced some relief from your adjustment. Keep your chin up, it will get better!  

 p.s. I don't know how old you are, but I don't care - you aren't too old...

2007-03-30 6:17 PM
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Subject: RE: Lower back Sciatic Nerve
AdventureBear - 2007-03-29 11:51 AM

"and exposed my poor eggs to radiation."


I found this quote amusing, but AB is right on. I'm also a back pain "expert" from the patient side. X-rays are indeed useless because they don't show soft tissue; to see the discs, you need an MRI.

I think the standard "wait" time is about 4 weeks. If you have a ruptured or bulging disc (and it sounds like you do, based on my experience as a non-medical person who is currently suffering from a ruptured disc), it may heal on its own in 4 weeks and you'll be done with it. If you still have pain after that, then you'll need to specialist (I'm seeing a neurosurgeon right now, but orthopedic surgeons who specialize in spinal surgery are also good) who will tell you about the next level of conservative treatment.

Chiropractors? There is nothing here that needs "releasing." The best analogy I've read to explain a ruptured disc is that the discs are like little jelly donuts between your vertebrae. When one ruptures, the jelly squirts out. Sometimes a disc can rupture and you'll feel no symptoms at all. Sometimes, the "jelly" well press against a nerve causing pain. The way to stop the pain is for the "jelly" to get reabsorbed back into the disc. Manipulating and "releasing" will not do a d*mn thing to speed this along. In fact, aggressive chiropractic manipulation and actually make things worse by causing more of the jelly to squeeze out. This is according to the Mayo Clinic's Web site that discusses treatments for ruptured discs. I hear that the Mayo Clinic is pretty good at what they do, so they can afford to turn up their noses a bit. If you don't like it, take it up with them.

BTW - The term "slipped disc" is a bit inaccurate. Discs aren't like little hockey pucks that can slip in and out. They are attached to your verterbrae. The term "squished disc" is more accurate, which is what happened.
2007-03-30 11:31 PM
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Subject: RE: Lower back Sciatic Nerve
haygosl - 2007-03-29 9:21 AM

I'm having the same problem right now. I HATE the way your whole leg tingles and aches. What I have researched and talked about with my PT friends is that in all likelihood what's happening is this.
Your/My piriformis (a muscle in your upper butt) has gotten tight and is pressing against your sciatic nerve. Combine that with tight hamstrings and we've got ourselves a nasty situation.


In my extensive readings on this topic, I too have read about this. It's called piriformis syndrome. However, piriformis syndrome is not that common and is a diagnosis of last resort after a disc injury or something else has been ruled out.


2007-03-30 11:39 PM
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Subject: RE: Lower back Sciatic Nerve
Yeah, squished disk is a better term!

I'm not saying that any single modality is better or worse than another. In my back pain quest over the past >horror< 15 years, I have seen chiropractors, osteopaths, physical therapists, MDs and massage therapists and finally, an orthopedic spine surgeon. Since the surgery I have returned to the chriopractor and done home PT, and had massage.

They all help in their own way. I trust my chiropractor. Back in teh day he used to do occasional high-velocity adjustments, but no longer given my specific injury. He does help me, and so do my exercises and so does the massage therapist. In fact, the therapist has helped the most, next ot the surgeon of course.

i wouldn't be walking if I hadn't had surgery, Well, OK, I'd be walking, but with a pretty significant limp and I wouldnt' be running at all.

I know my body well after 15 years. Don't underestimate the value and necessity of rest. 6 weeks is infinitismally small when compared to a lifetime of back pain, trust me.

Listen to your body. Give up a race if it means saving yoru back from further injury and pain. A pain free life is pretty priceless and something many of us will never have.

But we all find ways to cope and distract ourselves.
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