Newbie, Very Confused About Diagnosis

[parisa film]

Hello,

I'm Sara and I'm new here. I currently have back and leg pain, but I am uncertain about the diagnosis of sciatica caused by a disc protrusion. I'm hoping for some help in understanding whether this is correct, and some suggestions as to lifestyle changes and treatments which may help me.

My current issue began on Monday, when I woke with severe lumbar pain and was unable to bend. I had to make a train journey, so I put on a heat wrap, threw co-codamol in my bag and left, but sitting on the train was excruciating in my right buttock and lower back. I became so hot I had to throw my coat on the floor, could feel sweat streaming down my body, my vision was a blur of grey. I swear I'd have passed out had I not focussed on breathing steadily. I struggled through the rest of the day with the aid of much co-codamol.

Next morning it was even worse, and was struggling to put weight on my right foot too. I painfully got into the car, only to find I was unable to press down the pedals to drive it. I was still unable to bend, though the lumbar pain was lower down. It extended from the top of the right buttock, throughout the back of the thigh and calf and foot, right down to my toes. It felt weak, tight, and seriously more painful than anything I have ever known, and my foot also had pins and needles. It became constant agony for a couple of hours. I could barely cope and was shaking and sobbing. I eventually found some relief by lying on the floor on my front and when that no longer worked, on my left side, and taking co-codamol and using deep heat, until I could get a lift to the doctors in the afternoon.

After asking about my symptoms and examining me, he saw my sacroiliac joint was inflamed and said there was no curvature as there should be in the base of my spine. He said I had sciatica caused by disc protrusion and prescribed Tramadol and Diazepam (I am allergic to NSAIDS due to a previous gastric bleed), and told me to stay of work for a week as I have a desk job and they will make me drowsy, but to try to move around as much as I am able.

I then saw my sports injury therapist on Thursday, when I had begun to improve, and he said I had sacroiliac tenderness and so much pain in the glute, especially to the side, which was worse than the pain in the lumbar spine, that he was not convinced it was a disc issue, or that perhaps it was but there was a secondary muscular issue too.

Having googled extensively I have established and become confused by the following information:
Pain all the way to the toes usually indicates that the issue is disc relatedSacroiliac pain rarely extends beyond he thighPiroformis Syndrome can be excruciating but is uncommon and again does not often extend right down to the toes.
I am convinced I have 1, 2 or even all of the above issues, but don't know which, or how to treat myself accordingly.

A little potentially relevant history:
I'm a 36 year old woman and I've had no children.I exercise regularly, I'm not at all overweight, and am of average height.I had an accident at 12 years old whereby I fell head first on to concrete, which caused me no major problems at the time, but at 16 I began to suffer neck pain and saw an osteopath, who said I had 4 compacted vertebrae in the top part if my spine. I've had considerable regular neck and shoulder pain ever since.I had my first bout of severe lower back pain 4 years ago, another a year ago, another this January. The pain left me bent forwards, unable to straighten my back. The most recent time it was accompanied by painful spasms.Last year I also began to develop RSI in my hands and a small bunion on my right foot.
This may seem like a lot of information, but as it all seems to be muscle and joint related, I thought it may be relevant in terms of diet, supplements, therapies etc. I am also vegetarian but consider myself to have a fairly well balanced diet.

I've already decided to replace my bed and am considering swapping running and aerobics for pilates or yoga. I am also thinking of investing in products like a back support belt and a seat wedge, but before doing so would like to understand what my problem is so I can get the right products.

I am very much open to opinions on these ideas and other suggestions too.

Thank you so much if you have read this far, and I look forward to any input you may have!

 

[good y tu shoes]

Hi Nijiro

Sorry to hear you're in so much pain. Without Xrays or scans, it's difficult for a GP to be 100% certain of any LBP diagnosis, and not even with them. Sciatica certainly gives the symptoms you describe, but it could easily be attributed to piriformis syndrome. Lay flat on your back and look down at your feet. Normally they would be in the "10 mins to 2 o'clock position" or thereabouts, so if one points much more outwards than the other, this may indicate a hip rotator tightness. To stretch the hip and lower back, pull up the knees to the chest one at a time, and hold for a few seconds. Then sitting up in a hard chair cross the ankle over the opposite knee in a figure 4, and gently lean forward. This is likely to feel tight and sore on the affected side, so gently does it!

I treated someone with this problem in my acupuncture clinic this week- she came in with severe pain, and went home with a big smile! You could consider an osteopath for a few sessions too; chiropractors tend to want to tie you in to long expensive courses of treatment, during which time the problem could easily resolve itself, so again, try just a few sessions before committing yourself. Deep tissue massage can also help, just make sure of the therapists' qualification, as there are a few very short training courses around that are probably too short!

Best wishes for a quick recovery

 

[Les]

The orthodox view of sciatica being a trapped nerve rarely does justice to the complexity. Any or all of the factors described can be involved. And when one structure begins to struggle, others lose their health also by reflex response. So who really knows how these things begin and develop?

There are cases with MRI confirmed disc ruptures and nerve compression who have hardly any symptoms. And there are people with raging symptoms that clinically appear to be classic disc trouble, and on the MRI there is nothing to be seen. So the theory is lacking.

Another way to view this is not as a trapped nerve, but an inflamed nerve. The sciatic nerve is living tissue, same as any organ, and it can become diseased like any organ. In turn, the spine and pelvis are not dead mechanics like a car, but are living tissue, always adapting and responding. The sciatic nerve is also related to the adrenal glands, again this is a reflex relationship.

So this is a general health problem. It usually follows a period of exhaustion, so the answer is not more hours in the gym strenghtening the core (not immediately, anyway). There will be depletion of nutrients, possibly dehydration, and build up of toxic metabolites of repair. And a major feature of inflammation is loss of function, in other words the nerve fails to act as a nerve, hence numbness etc may follow. The disc may be involved, but just as likely as another affected factor as a primary cause. If muscles are tightening, they are doing so to provide support and protection for now vulnerable areas. Aiming to loosen them off may offer temporary reduction in pain at the cost of loss of support.

Anti-inflammatories are anti-our-most-basic-healing-process, so they can be counterproductive also. If inflammation is excessive, then we need ask ourselves why.

So the first step with pain is always - always - to obey it, the second step is to seek help with the underlying cause, which is a pattern, a cycle, a feedback process, and not simply a single thing.

Rest is absolutely vital, that is when recovery takes place. Nutrition - deficiency of the usual suspects (vitamin D, omega 3, minerals etc) can exaggerate the effects of inflammation, so good nutrition is important, and good hydration. Lots of vitamin C to counter the build up of free-radicals etc.

Any constipation needs addressing, and any unnecesary imnplants ie contraceptive coil, consider having removed. If walking helps, then get some daily fresh air, but avoid fatigue and don't push through any pain barriers.

Mechanical ease is important, in allowing the knock-on and associated effects and reactions to subside, eg destressing the structures involved. So check out sitting positions - avoid low chairs and deep sofas. Working at laptops stresses the whole spine, so make sure to set up any desks etc properly. Beware of soft foam matresses, especially memory foam, as it tends to hold us in one position and not allow us to find the best posiotion for ourselves naturally. Sinking deep into foam means that turning in bed uses much more energy. So a stack of yoga mats or duvets on the floor may be required for a few nights. And of course, help with posture and alignement from the right therapist may be important, not just now, but in preventing further episodes. But as you can see this is not about simply correcting a slipped disc and releasing a nerve. And just getting a rub for all the tight muscles can - can - be disastrous.

Trying to 'stretch out' the problem areas is usually not a good idea. The aim is to put your whole system at ease and let nature resolve the situation at its own pace - and it will, providing you give it a chance. Remember, acute problems by definition are ones that recover, so doing less is often the answer.

I would disagree that piriformis syndrome is rare; put it on a general spectrum of multifactorial patterns of referred pain and inflammation, and I'd say we see variants of these syndromes all the time. Almost never is there a textbook case of anything. So trying to put the problem into a strict compartment is often misleading.

Lastly, there are potentially nasty consequences of this, especially if it is mismanaged. Just beware of any numbness in the saddle area (between the legs) and any loss of bowel or bladder control. These require an immediate trip to A&E.

This is a very unpleasant situation for you, but remember that time is still the greatest healer; and lots of little things can be what makes the difference, usually more than one heroic action.

Hope that helps, good luck.

 

[Space Gazer]

Thank you both for reading my long post and providing helpful and considered responses!

Firstly, David, I tried your hip rotator test. My right leg is the one in which I have been experiencing the problems, and my left foot was pointing outwards just slightly more. Is this the right way around to suggest a tight hip rotator?

I also tried to do the streatch you suggested but struggled greatly. We do a similar stretch to this when I go to aerobics, only lying on our backs and without bending forwards, and I have always found it uncomfortable with the right leg. My sports injury therapist says this is because I have a tight 'IT band'. In addition I have always had tight hamstrings. I shall preserve gently in another day or 2.

I had not thought about acupuncture so this may be worthwhile considering. My sports injury therapist does deep tissue massage, I have been using him for over a year, mainly for my upper back/shoulders, and find he helps to keep my tension at bay. He has also completely cured the pain I had in the front or my right shoulder, and the muscle that was lumpy there is now smooth. He is a member of a professional body for physiotherapists the exact name of which I forget, and is always very booked up so I think he is one of the better ones.

KVDP, I agree with a lot of what you say about not focussing on a single issue and dealing with this problem holistically. I was trying to pinpoint the cause because I wanted to make sure I sought the most effective treatment for it, but if the treatment is much the same then I don't suppose it really matters whether a disc or a muscle is the main culprit. I also understand that an issue with any one of these areas might put stress on the others, and so I could have a combinations of issues causing my pain.

Exhaustion makes a lot of sense - I have been under huge pressure at work and struggling to sleep. In fact, I have said to friends that I almost feel like my pain enforcing time off is my body's warped way of doing my mental well being a favour!

I am conscious of how I sit and always prop myself up with many cushions on the sofa, but I think my office chair is appalling and I am never fully comfortable. I managed to get out for an hour today to look at beds (much pain but I am so desperate for a new one I thought it was worthwhile!) as I never feel like my hips are aligned when I lie down. I always feel that my right side is slightly lower and I am sure this causes muscle strain. I tried about 10 beds in 3 stores and the only one I found that was comfortable and seemed to stop this from happening was one with 1000 pocket springs under 1400 mini springs with a generous layer of natural fibres on top. It felt soft and contoured to my spine, yet fully supportive. I think I am going to order it tomorrow.

I eat a lot of veg and take additional vitamin C. I think I have quite a good diet and have no constipation issues, although I probably don't get enough essential fatty acids. I try adding omega seed mix to meals but often forget and I know it's not enough. I need to give refining my diet some consideration. Would additional protein aid muscle repair?

Do you (or anyone) have any thoughts on which I would benefit from most - pilates, yoga, Alexander technique or something else? I really feel that I must give up my high impact exercise for the time being, but as soon as I am sufficiently recovered I am keen to begin working on my alignment, balance and strength.

Also I'd like to know if seat wedges, support belts etc are worthwhile.

Many thanks to you both for your input!

Sara

 

[Maddy P]

Okay, from that it seems as if several things are jointly causing this, none of them alone is 'the' culprit. Crucially, you seem already to know what they are.

Right now this is an acute problem. That means it is a healing process, the key is to do whatever your body is asking you to do while it recovers (granted, it is not always obvious what your body is asking for). Start by pain avoidance by limiting activity.

Remember, it is far better to take a week off work, than to keep going until you need surgery and THEN take a week off work!

Behind every acute problem is a chronic state - that's the background set of conditions that enable this to happen, and from which the body is trying to recover, VIA the acute process. We should MANAGE acute, and TREAT chronic. [Most practitioners seem to get this the wrong way round - that's our medical brainwashing kicking in! Most aren't trained how to resolve a chronic situation, and acute gets better anyway, providing we don't do anything silly.]

The time to be considering pilates yoga etc or to make big lifestyle changes is when you are NOT in an acute crisis, but during the rest of the time. It's too easy to ignore the minor signals that our body is struggling unitl, as you say, it screams at you for attention.

But it is the chronic state that is to be addressed by a yoga class, for example. In other words, now is not the time. Personally I would favour yoga or feldenkrais, but crucially, you need a good teacher.

In your nutrition list, don't forget vitamin D, there is much evidence that we can benefit from 10,000IU of D3 (avoid D2) per day in winter months, in summer, unless you work in the fields with shirt off, I'd suggest 5000IU daily minimum (that's 125 microgrammes). This is at least an order of magnitude more than the official recomendation. However, the recomendation is based on avoidance of rickets, and not general health requirements.

Lastly, what this really needs is direct, tailored guidance from a practitioner, mixing and mathcing theories culled from the web is the route to other problems, I'm afraid. It matters not which therapy you choose, IMHO, the important thing is the vision of the practitioner. Best get a recommendation if you can.

Good luck!

 

[Natalie Blackmore]

Hi KDVP. Thanks for answering my questions!

I like to think I'm reasonably clued up about health and fitness in general, but when it comes to ailments and injuries like this I have minimal experience
I hadn't given much thought to vitamin D, and as a pale skinned, facter 20 wearing office worker I probably don't get anywhere near enough, so that's a something for me to address.

I'm going to call the Yoga teacher in my area and see what I think from what she says as I have done it years ago, and when my teacher retired I never found another that I liked, so I understand the importance of that. Certainly not planning on taking anything up just yet though!

My doctor is quite good in that having advised me to take last week off, he has signed me off this week too, as I am still in quite some pain, particularly when sitting, which is what I have to do at work all day. Good news that I have time to heal, and I am limiting my activity - the pain is giving me little choice! He is reluctant to refer me at this stage though.

I have just one further question with regard to practitioners. Do you mean people like osteopaths? I have had a recommendation for one this week. Or did you mean something more alternative? I do already have deep tissue massage each fortnight which I generally find helpful, but I am of the view that both joints and muscles are contributing to my problems, and feel that I may need to have two different types of treatments for this.

Thank you very much for all your help!

 

[khyva92]

Well, osteopathy is my field. All osteopaths are different, which is as much a strength of our profession as an inconvenience. I would reiterate, however, that there may be brilliant people in other fields just as capable at helping - what matters is the quality of the practitioner more than the school they went to. So if you have a recommendation, that's great.

Alternative means having another way of looking at the problem, that's all. The point is not to take a medical definition of the problem and find another way to treat it, but rather that an entirely different set of priorities may be taken to tackle the problem. Osteopathy can be a very deep rabbit hole indeed, depends again on the practitioner.

Your osteopath may disagree with this, but I would recommend you to avoid mixing and matching therapies. At least get his assessment and his opinion about whether you actually need any additional intervention. My own style of working is that I prefer to provide a complete and coordinated package, if anything is missing it is usually for a reason - or if something else is needed, let's get that right. Personally I find it much harder to help if the patient has already done the rounds of every therapist in the neigbourhood.

Especially, I would avoid deep-tissue massage while there is suspicion of a prolapsed disc. It may make you feel more comfortable by relaxing some of the muscles, but the relief will prbably be short lived. Importantly, those irritated muscles are a symptom, they are likely part of the protective mechanism that is stopping the damage from getting worse and warning you to rest while repair is taking place. At least hold off until you have your osteopath's advice on this, as a primary care practitioner he needs to bring his understanding to bear on the direction of the programme.

Seems like you have a good attitude to recovery, however. PM if you want to.

Mend well.

 

[gorgesauto]

Thanks for your input, particularly regarding osteopathy. That's really useful. I'm going to find out more from the person who recommended them to me, about the problems of the people who had success.

I also spoke to the yoga teacher and she does 'yoga therapy'. I don't really know much about what this involves, but I'm going to see her this afternoon to talk some more and see if she might be able to help, because I really liked her holistic approach to well being when we spoke on the phone. It may not be right for me at the moment but it certainly interests me.

The whole reason I started having the deep tissue massage was for a different problem entirely. Well, I say that, but then I realise they are all interlinked to some extent or another. This was with my shoulders mainly. I will see how they are without it, but I may see him only for that if they get bad again.

Thanks again for all your help! I will indeed PM if I have any more questions, about the osteopathy in particular.

 

[Shiraz]

I'm sure you will ask the right questions and find the help you need. It is a moot point of course whether two problems are ever unconnected. As long as the backbone is connected to the arm bone, I think it difficult to imagine how these can be seperate issues entirely.

 

[vjejwuroilaizweob]

Thank you, and I agree, I'm sure it's all related in some way or another.

 

[Adam Gough]

Hi all havent posted for awhile i was waiting for my contrast mri result which i hoped to get in feb but my appointment was cancelled. I got them last wednesday and i must admit i was sure in my mind that i would be told the scans were fine and the pain was all in my head(my doctor told me i was depressed and that depression causes pain). Last april i had l5/s1 microdiscectomy after years of pain and large prolapse on left side,at first things were great then the pain started again but mostly in lower back and hips then it progressed to pins n needles and cramps in both legs and pain down left leg and foot getting worse. The results are same disc has bulged again at same side, nerve has glued up and has no movement and faucet joint is loose, this is why im in pain and back feels like it is snapping in two. Im now in for pre op next week for fusion to help with pain and to free up the nerve.Has anyone had this problem and if so how did you get on? im frustrated with the doctor and his attitude and im nervous about the op but i want my life back(if poss)