Anyone have sciatica?

[Tenor CS]

Hey guys, although my health issues of last year have finally healed, I am now dealing with another issue.

My chiropractor is pretty sure I have a pinched nerve in my low back. I have an MRI coming up soon, but right now I am in almost constant pain.

If I am on my feet for longer than 5 minutes, the front of my thighs start this terrible burning sensation. It's alleviated almost immediately if I change positions, but for about 2 weeks, my thighs have had this weird tingly sensation that's especially bothersome if my thighs experience light pressure, like someone running their hand over them.

Any of you guys (especially my 300 lb+ BOTL) have this problem? Any tips, hints, tricks? How did you find relief? I'm hoping that if I have a bulging disk, I can maybe get some cortisone or similar shots to reduce the swelling and relieve the pain.

Any advice is appreciated. My MRI is still over a week away, and I'm friggin miserable right now!

[MajorCaptSilly]

I had it when I was younger. L4 went one way and L5 went the other, pinching the sciatic nerve. Made my right leg go numb or tremble. The back pain was horrific. Went to a doctor that said surgery was necessary. Went to another who told me cutting into my back at my age was a bad idea. He gave me a bunch of excercises to do and I went through a series of 3 shots into the spine to reduce the inflamation. I have been pretty good ever since. If I do too much pulling of heavy weight, it will act up for a couple weeks and I have some arthritus. I am not aa big fan of chiropractors but I know of people who say they have helped them with similar problems.

MCS

[Lobo]

Sounds like degenerative disc disease. Surgery is probably the most viable option depending on how severe it is. Chiropractic is great if the condition isnt too progressed. If you are overweight the first thing will be to lose some weight via dietary changes as your ability to move seems greatly inhibited. My dad has had 4 discs removed over the years and is doing really well. 2 helicopter crashes and bullet in the keister during Vietnam messed is back up pretty good. Cortisone is only a temporary solution and can only be used 3 times as cortisone will eat away at the joints it is injected in. Stay positive as there is a solution though it might take considerable work to effect it. Take care Brother.

[Blueface]

Well, my immediate wise remark is "everyone has one".
Actually, we all do.
An irritated one is the nasty one.

Normally, most will refer to this condition as radiculopathy. It is a nerve, impinged by a herniated disc that protrudes from its pocket. When you get the leg pains, that is an L4, L5, S1 region. When in the arms, it is a cervical impingement.

In the last 20 years, I have had many, many "fetal positions" thanks to my L4-L5 and L5-S1 herniations. Lots you can do and make sure you do it before anyone ever talks you into surgery.

There is pills (muscle relaxers and anti inflamatories), epidural blocks (have helped me tremendously but do only with flouroscopy so they can see the nerve live as they are injecting you), variable stretching machines (work very well but expensive), physical therapy, leg and back strengthening, etc. Lots that can be done. Many folks suffer like we do. Common problem.
Good luck.

BTW, best advice? Weight.
I gain five pounds, I hurt. I go down five pounds, no more pain.
Weight really, really affects herniations.

[Patrick B]

I had it for a while. Got one shot to reduce the swelling and worked on hamstring and back flexibilty - problem solved. I really believe stretching and strengthening the legs/back/core are great for dealing with this problem.

[Blueface]

Originally Posted by Patrick B

I really believe stretching and strengthening the legs/back/core are great for dealing with this problem.

As you can see by my previous post, you are certainly not alone in this well held belief.
One of the most common cures for back ailments is leg and back strengthening. However, 300 lbs. plus is a big, big hurdle preventing that back strengthening from taking place.

[longknocker]

Originally Posted by Blueface

Well, my immediate wise remark is "everyone has one".
Actually, we all do.
An irritated one is the nasty one.

Normally, most will refer to this condition as radiculopathy. It is a nerve, impinged by a herniated disc that protrudes from its pocket. When you get the leg pains, that is an L4, L5, S1 region. When in the arms, it is a cervical impingement.

In the last 20 years, I have had many, many "fetal positions" thanks to my L4-L5 and L5-S1 herniations. Lots you can do and make sure you do it before anyone ever talks you into surgery.

There is pills (muscle relaxers and anti inflamatories), epidural blocks (have helped me tremendously but do only with flouroscopy so they can see the nerve live as they are injecting you), variable stretching machines (work very well but expensive), physical therapy, leg and back strengthening, etc. Lots that can be done. Many folks suffer like we do. Common problem.
Good luck.

BTW, best advice? Weight.
I gain five pounds, I hurt. I go down five pounds, no more pain.
Weight really, really affects herniations.

Good Advice, Carlos! I've had a ruptured disc @ L4-5 and the neurosurgeon said it was the worst he had ever seen. Had 2 epidurals, lost weight, stretch regularly, and have no pain after 2 years. An orthopedic surgeon told me that there is no difference in patient outcome after 2 years whether you have surgery or not. Now, if you have "Foot Drop", that's a different story. Surgery needs to be done as soon as possible in that case. Good Luck, Brother!

[Riff Raff]

Originally Posted by Blueface

As you can see by my previous post, you are certainly not alone in this well held belief.
One of the most common cures for back ailments is leg and back strengthening. However, 300 lbs. plus is a big, big hurdle preventing that back strengthening from taking place.

I couldn't agree more. As callous as that sounds, losing weight is your best CURE! The others only treat the symptoms. I know from experience. It is not the easy way out, but the best usually isn't.

Hopefully your MRI will shed more light for treatment options for the immediate pain. I feel for you brother! I have been there. Hang in there!

Based on what you are telling me, it would likely be radiculopathy. Radicular impingements occur in regions where the neuron axons exist grouped into "nerve roots" as they leave the bulk of the spinal cord (spinal cord actual ends at the level of the lowest rib approx). These nerve roots exist as the the axon conduits until they further "bunch up" into proper nerves, outside of the vertebral column. Thus, inside the vertebral column=radiculopathy, outside the vertebral column (AKA passing through or between muscles) = peripheral neuropathy. In the case of the sciatic nerve = sciatica.

What is hard to understand unless specifically mentioned, is that not all of a nerve root will bunch into a proper nerve. Put another way, some axons in a nerve root will distribute into one nerve, while other axons, from the same root, may enter into another nerve.

How does one tell the difference? If its a radicular involvement, then the symptoms will "follow the dermatomes", striped nerve regions mapped to the surface of the body. If its a peripheral mononeuropathy, it will map to the respective nerve's distribution, which will seem like parts of multiple dermatomes, but not any one dermatome is completely represented by that nerve.

Thus, sciatica will demonstrate nerve symptoms to the posterior leg, pretty much completely across the posterior thigh, but not lower than the knee. Meanwhile, L5 will form a thin strip of symptoms all the way down the posterior lateral leg to ankle and foot.

So, what does this mean?

Well, if you have sciatica like symptoms, then the abnormality is in the region of the muscles/nerve, if its radicular in pattern, then its occuring inside the spine.

But this brings to us to an interesting point.....many studies exist that continue to re-inforce the fact that we really don't know where the abnormality is. Regardless of the pattern, we are just as likely to be right as to be wrong.

That colours the value of any therapies that might be considered:

Back surgeries show an average benefit of 2 months past recovery from surgery. Steroid injections also demonstrate a mean benefit timeframe of 2-6 months. By the way, 3 injections is a guideline and any specialist should be able to quote some study that shows this number to be fully arbitrary. And, the larger and more controlled the study, the less benefit chiropractic demonstrates (to the point of nothing greater than control group). Keep in mind, some people get permanent benefit from whatever treatment they get. They are few and far between, but they DO exist, and they are also the success stories we all want to talk about.

So, what seems to work. Well, if you are willing to do it, WEIGHT control is where the money is. Then strengthening is where to go next. You want a back so strong that it never fatigues, and supple enough that the muscles never get stretched beyond capacity. This requires focused strengthening and range of motion exercises FOR EVER. The medications' primary role is to create a window of opportunity to allow you to buy into the physiotherapy and weight control modalities.

Further, with weight control....expect the plan to be 2 years long once you find a method that works for you.

I was 255 lbs 1 year ago. 60 minutes of heart-rate>180 every day followed by 30 min strengthing/core exercises (well, 6 days a week) and I am down to 218. The rest of this year and I will be at my goal. Had lots of chronic pain before hand. Now, I am nearly pain free and loving it!

And, of course, if need be, we do have other potent drugs to nullify all your pain forever, but at the cost of your soul. Just kidding, but many people hate the side effects, fear the drugs, and I personally consider them a "last resort".

Well, that's about as much as I can type now....Time to go home. Will expound on this if you want, when I get home.

Cheers

John

[Tenor CS]

Thanks for all the posts, guys. I totally want/need to lose weight, but I desperately need to do SOMETHING to bring me immediate relief so that I can at least manage to GET on the treadmill. Right now, I'm in such pain, that I will never make it from my apartment to our complex's gym. I really don't want "cutting" surgery. If I can buy some time by getting a cortisone or similar injection, so that I can actually begin concerted efforts to lose weight, that would be great.

[tsolomon]

I have always had back problems, but when I hit 50 it just got to the point where I couldn't do the things I wanted to do. I went to the Orthopod and Chiropractor which helped, but it didn't last. Physical therapy and stretching helped, but I kept throwing my back out. 2 years ago a signed up for a yoga class that specialized in lower back problems and now I'm feeling better than I have in the past 10 years. I'm back to being active and I'm able to live an active normal life. I have to do yoga at least every other day to stay that way, but it's worth it.

That's where physiotherapy gets useful. I should have made that caveat. Physio that involves the therapist doing alot of different manipulations tends to feel good while they are doing it, but has no longevity. The only physio that ever works long term are those elements that involve "YOU" doing the work. Thus, it comes back to exercise, exercise, exercise.

And, once again, medications create the window of opportunity.

Consider an NSAID (diclofenac, high dose advil, naproxen), add in an opioid starting at tylenol#3 and ramp up through percocets and settle at oxycontins. Take a break from the meds every two weeks or so (for about 1-2 weeks rest, at least the NSAIDS, to protect your stomach), consider a PPI like losec/pantoloc to help avoid the stomach toxicity of the NSAID. Consider maintaining access to muscle relaxants for when it might be needed.

Then, consider augmenting/replacing with gabapentin (neurontin). Consider an SSRI (anti-depressant) to help increase your coping capacity for pain.

Then, aggressively maintain pain control and holidays from the drugs too. Then addopt the attitude that your exercise is a part-time job. You wouldn't call in sick to a part time job you really needed just because you are in pain right? That was the attitude I had to adopt. It was the only way to keep myself getting up at 05:00AM to hit the gym. "Gotta get up and go to work....boss will fire me if I don't show up....future is in jeapardy without this second job." Soon, I found that I was addicted.

As a further benefit, sustained aerobic exercise demonstrates as good a mood improvement success rate as do the anti-depressants....once you have it established.

Another idea I came up with was the "5 healthy things a day". Going to the gym counts as one, having a properly portioned meal counts as a point, going for a walk later in the day (as long as I have already gone to the gym) counts, not having a snack while everyone else has one counts as a point. If I can attain 5 points a day, I am proud of myself.

And then, you have to commit to 2 years. But, once those 2 years are up, you will be a different person.

Keep in mind, this is an aggressive plan of attack and deserves some direct supervision at times. I have detailed the aggressive plan so that you can see what it might develop into. There is alot of freedom to customize it to you. And, there is lots of depth if the first couple of layers aren't effective enough. And, it also gives you a timeframe to expect to work towards.

[Blueface]

Originally Posted by Tenor CS

Thanks for all the posts, guys. I totally want/need to lose weight, but I desperately need to do SOMETHING to bring me immediate relief so that I can at least manage to GET on the treadmill. Right now, I'm in such pain, that I will never make it from my apartment to our complex's gym. I really don't want "cutting" surgery. If I can buy some time by getting a cortisone or similar injection, so that I can actually begin concerted efforts to lose weight, that would be great.

Cyanide is a doctor if I recall and hence the great clinical advice.
One thing stands out for sure, all concur on weight loss, strengthening, with injections followed by drugs both as last resort.

For immediate resolution of what I call the fetal syndrome and the inability to put on ones own socks, I have found a combination of Naprosyn and Robaxyn have teamed up well to reduce the inflammation and relax the muscles to allow my disc to gradually recede. Pain killers such as Tramadol relieve the pain but I find they do nothing for the condition as the latter two seem to do. Avoid pain killers if possible.

Once you are able to, lay down on the floor and raise your legs or have someone help you so you can stretch them good. The more you stretch your legs, the better for your back. Weird but true.

Get a Tempurpedic mattress if this is long term. Expensive indeed but I swear it did wonders to help me live much better with this condition.

I have found going for long walks helps tremendously as well as avoiding a set position for too long, whether sitting or standing.

The only good news I can offer you is that no matter what estimate you read on how many Americans suffer from what we have, the number is under-estimated. Bet you more folks than you can imagine have herniations and think they have spasms. One thing is for sure for me, no Chiro with this condition. Don't need anyone snapping bones to address a herniated gook filled disk that can rupture and cause more problems. Ortho or Neuro is the only way I have messed with this for 20 years. Tried three Chiros early on and will never return. My apologies to any Chiros on the board and to the miracle healings you may be able to accomplish.

Last epidural for me was a couple of years ago and have been doing quite well considering. However, lost about 10 pounds along the way and really think that helped tremendously.

So, don't look for overnight miracles here. Won't happen and likely to be a life long condition, with some days better than others.

[Tenor CS]

Update: I had my MRI. I have two dessicated discs. One is between T12-L1 and one is between L5-sacrum.

I took my MRI films to an orthopaedic back specialist. He was useless. He is one of those guys who wants nothing do to with you unless he wants to operate on you. He gave me less than 5 minutes of his time, and all he said was, "You need to lose weight, I recommend gastric bypass." The visit was a waste of a copayment, and I would not recommend him to anyone.

I then went to a Pain Management specialist. He suggested 1 of 2 options. The first is a series of 3 epidural shots. The second, and the one I am more enthusiastic about, is a shot to block the femoral cutaneous nerve. He told me to google "femoral cutaneous nerve" and a condition called "Meralgia paresthetica." It sounds EXACTLY like what I'm dealing with. He saw an ever so slightly bulging disc on my MRI, but he doesn't really think that's what's causing my leg pain.

I'm looking forward to finally getting some relief from this. Wish me luck, guys!

[Savor the Stick]

Christian, Are you still going in on the 21st?

Praying for you pal.

[Tenor CS]

Yeah, but that's a different surgery.