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Old 06-19-2009, 02:00 PM   #1
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gapcheryl HB User
back and muscle pain

I am an echo tech who works in a very busy lab. I started having sciatica like symptoms with pain in my lower back and shooting pain down my right leg into my ankle bone. I had an MRI, which I was told was not terrible but I did have herniated discs at L1 and L2. Which my doctor informed me was not conclusive to the pain down my leg. He performed an EMG which I am awaiting the results. What do you think this is? My doctor has no idea as of yet and told me he will look over everything and talk to me next week. My problem is my job knew I was having difficulties walking and sent me home, they will not let me come back without a note saying I can perform my job without liabilities to them. Now I am waiting still with the same pain, I don't know what is wrong or if my job caused this in the first place. A lot of my patients are over weight and are difficult to scan. Can you offer any advise?

 
Old 06-19-2009, 04:33 PM   #2
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Re: back and muscle pain

gapcheryl,

I am sorry to hear you are having problems that bring you to meet us here.

Unfortunately, sciatica and disc problems can sometimes be very difficult to diagnose. Often an MRI will clearly show the problem and the options for a fix are laid out, but sometimes the answers aren't clear at all and can be very frustrating to work through. I had one of the tough to diagnose cases. My sciatic pain was along the S1 dermatome, but the only problem that showed up on my MRI was a broad-based disc bulge at L4/L5 which usually doesn't cause S1 sciatica (L5/S1 usually does). Furthermore, I had an unsuccessful decompression surgery at L4/L5. After many second and third opinions and tests, a discogram and upright MRI finally showed a huge tear in my L4/L5 disc along with it bulging out severely to the back when I would sit. I recently had an L4/L5 fusion and while I still have a long road to recovery, I finally feel like my problem has been mostly fixed. I am still having sciatic pain when I sit, but it is not as bad as it was before.

In your case, an L1/L2 disc herniation is not nearly as common as the two bottom levels and doesn't explain why you would have sciatic pain into your ankle. Many disc herniations are asymptomatic and your L1/L2 herniation likely is that. I would suggest looking up dermatome charts on the Internet to see which disc level matches up with your sciatic pain. It may be a level off like mine was, but should get you closer to where the problem likely is. I'm no doctor, but I have a strong suspicion you may have a tear or herniation at L4/L5 or L5/S1 that didn't show up on your MRI. I once heard that MRI's only catch something like 85% of all disc herniations. Whatever the statistic, MRI's are less than perfect to show disc problems. Sciatica is almost always caused by a lumbar disc problem.

Do you find that your problem is worst with certain positions or activities (i.e., sitting, standing, walking, laying down, lifting, bending, etc.)? If your condition is worse with load bearing or sitting activities that place more pressure on the lumbar discs, I would suggest really pushing the doctors for an upright MRI. However, they often reserve this expensive test as well as many other tests for people more advanced than where you are at.

When dealing with a condition that has the potential to take you out of work for a period of time or that was possibly caused by your work, it is extremely important to get at least one or two doctors that are firmly on your side, and that will support you for LTD claims or worker's comp paperwork. Chiropractors and physiatrists are often helpful to consult with for this in addition to a spine surgeon.

EMG's don't always show a problem - they only show it if it is severe enough, so a negative EMG doesn't necessarily mean you don't have a problem.

Also, if you are not able to return to work really soon, it might be worth consulting a disability/worker's comp attorney for advice. It shouldn't cost you anything, and could be extremely valuable in case your problem requires future surgery or extensive rehabilitation. Sometimes they can present a case that your heavy lifting at work was the cause as you don't do heavy lifting in your personal life, even if there isn't solid proof that your job was the cause. Also, if you don't get relief soon and your doctor doesn't have answers, you may need to go for multiple additional opinions and tests and may need to be very assertive to get them. If your insurance allows it, a consultation with a fellowship-trained spinal surgeon would be helpful at this point also.

Now that I've covered some of the worst-case scenario issues, I want you to know that most cases of sciatica are corrected with time (lots of it!)
and conservative treatments, so don't think that you will necessarily need surgery or be out of work.

Best of luck to you and ask any questions you want here, and keep us updated with your progress! I ended up losing my job and having to go out on disability, and I understand how frustrating it is to be facing the decisions of what steps to take to protect your health and yourself financially.

 
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Old 06-20-2009, 06:58 AM   #3
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Join Date: Jun 2009
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Posts: 4
gapcheryl HB User
Smile Re: back and muscle pain

[QUOTE=brendaks1;4016877]gapcheryl,

I am sorry to hear you are having problems that bring you to meet us here.

Unfortunately, sciatica and disc problems can sometimes be very difficult to diagnose. Often an MRI will clearly show the problem and the options for a fix are laid out, but sometimes the answers aren't clear at all and can be very frustrating to work through. I had one of the tough to diagnose cases. My sciatic pain was along the S1 dermatome, but the only problem that showed up on my MRI was a broad-based disc bulge at L4/L5 which usually doesn't cause S1 sciatica (L5/S1 usually does). Furthermore, I had an unsuccessful decompression surgery at L4/L5. After many second and third opinions and tests, a discogram and upright MRI finally showed a huge tear in my L4/L5 disc along with it bulging out severely to the back when I would sit. I recently had an L4/L5 fusion and while I still have a long road to recovery, I finally feel like my problem has been mostly fixed. I am still having sciatic pain when I sit, but it is not as bad as it was before.

In your case, an L1/L2 disc herniation is not nearly as common as the two bottom levels and doesn't explain why you would have sciatic pain into your ankle. Many disc herniations are asymptomatic and your L1/L2 herniation likely is that. I would suggest looking up dermatome charts on the Internet to see which disc level matches up with your sciatic pain. It may be a level off like mine was, but should get you closer to where the problem likely is. I'm no doctor, but I have a strong suspicion you may have a tear or herniation at L4/L5 or L5/S1 that didn't show up on your MRI. I once heard that MRI's only catch something like 85% of all disc herniations. Whatever the statistic, MRI's are less than perfect to show disc problems. Sciatica is almost always caused by a lumbar disc problem.

Do you find that your problem is worst with certain positions or activities (i.e., sitting, standing, walking, laying down, lifting, bending, etc.)? If your condition is worse with load bearing or sitting activities that place more pressure on the lumbar discs, I would suggest really pushing the doctors for an upright MRI. However, they often reserve this expensive test as well as many other tests for people more advanced than where you are at.

When dealing with a condition that has the potential to take you out of work for a period of time or that was possibly caused by your work, it is extremely important to get at least one or two doctors that are firmly on your side, and that will support you for LTD claims or worker's comp paperwork. Chiropractors and physiatrists are often helpful to consult with for this in addition to a spine surgeon.

EMG's don't always show a problem - they only show it if it is severe enough, so a negative EMG doesn't necessarily mean you don't have a problem.

Also, if you are not able to return to work really soon, it might be worth consulting a disability/worker's comp attorney for advice. It shouldn't cost you anything, and could be extremely valuable in case your problem requires future surgery or extensive rehabilitation. Sometimes they can present a case that your heavy lifting at work was the cause as you don't do heavy lifting in your personal life, even if there isn't solid proof that your job was the cause. Also, if you don't get relief soon and your doctor doesn't have answers, you may need to go for multiple additional opinions and tests and may need to be very assertive to get them. If your insurance allows it, a consultation with a fellowship-trained spinal surgeon would be helpful at this point also.

Now that I've covered some of the worst-case scenario issues, I want you to know that most cases of sciatica are corrected with time (lots of it!)
and conservative treatments, so don't think that you will necessarily need surgery or be out of work.

Best of luck to you and ask any questions you want here, and keep us updated with your progress! I ended up losing my job and having to go out on disability, and I understand how frustrating it is to be facing the decisions of what steps to take to protect your health and yourself financially.[/QUOTE]

 
Old 06-20-2009, 07:06 AM   #4
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Join Date: Jun 2009
Location: Staten Island, New York, USA
Posts: 4
gapcheryl HB User
Re: back and muscle pain

[QUOTE=brendaks1;4016877]gapcheryl,

I am sorry to hear you are having problems that bring you to meet us here.

Unfortunately, sciatica and disc problems can sometimes be very difficult to diagnose. Often an MRI will clearly show the problem and the options for a fix are laid out, but sometimes the answers aren't clear at all and can be very frustrating to work through. I had one of the tough to diagnose cases. My sciatic pain was along the S1 dermatome, but the only problem that showed up on my MRI was a broad-based disc bulge at L4/L5 which usually doesn't cause S1 sciatica (L5/S1 usually does). Furthermore, I had an unsuccessful decompression surgery at L4/L5. After many second and third opinions and tests, a discogram and upright MRI finally showed a huge tear in my L4/L5 disc along with it bulging out severely to the back when I would sit. I recently had an L4/L5 fusion and while I still have a long road to recovery, I finally feel like my problem has been mostly fixed. I am still having sciatic pain when I sit, but it is not as bad as it was before.

In your case, an L1/L2 disc herniation is not nearly as common as the two bottom levels and doesn't explain why you would have sciatic pain into your ankle. Many disc herniations are asymptomatic and your L1/L2 herniation likely is that. I would suggest looking up dermatome charts on the Internet to see which disc level matches up with your sciatic pain. It may be a level off like mine was, but should get you closer to where the problem likely is. I'm no doctor, but I have a strong suspicion you may have a tear or herniation at L4/L5 or L5/S1 that didn't show up on your MRI. I once heard that MRI's only catch something like 85% of all disc herniations. Whatever the statistic, MRI's are less than perfect to show disc problems. Sciatica is almost always caused by a lumbar disc problem.

Do you find that your problem is worst with certain positions or activities (i.e., sitting, standing, walking, laying down, lifting, bending, etc.)? If your condition is worse with load bearing or sitting activities that place more pressure on the lumbar discs, I would suggest really pushing the doctors for an upright MRI. However, they often reserve this expensive test as well as many other tests for people more advanced than where you are at.

When dealing with a condition that has the potential to take you out of work for a period of time or that was possibly caused by your work, it is extremely important to get at least one or two doctors that are firmly on your side, and that will support you for LTD claims or worker's comp paperwork. Chiropractors and physiatrists are often helpful to consult with for this in addition to a spine surgeon.

EMG's don't always show a problem - they only show it if it is severe enough, so a negative EMG doesn't necessarily mean you don't have a problem.

Also, if you are not able to return to work really soon, it might be worth consulting a disability/worker's comp attorney for advice. It shouldn't cost you anything, and could be extremely valuable in case your problem requires future surgery or extensive rehabilitation. Sometimes they can present a case that your heavy lifting at work was the cause as you don't do heavy lifting in your personal life, even if there isn't solid proof that your job was the cause. Also, if you don't get relief soon and your doctor doesn't have answers, you may need to go for multiple additional opinions and tests and may need to be very assertive to get them. If your insurance allows it, a consultation with a fellowship-trained spinal surgeon would be helpful at this point also.

Now that I've covered some of the worst-case scenario issues, I want you to know that most cases of sciatica are corrected with time (lots of it!)
and conservative treatments, so don't think that you will necessarily need surgery or be out of work.

Best of luck to you and ask any questions you want here, and keep us updated with your progress! I ended up losing my job and having to go out on disability, and I understand how frustrating it is to be facing the decisions of what steps to take to protect your health and yourself financially.[/QUOTE]
Thank you so much for all your information, I will look into everything you suggested. I just want to get better and return to work. The unfortunate problem with working in Staten Island is that it is very small and all the doctors know eachother. They are affiliated with the same hospital. The neurologist I am seeing is reluctant to say what is wrong or how he can help me.
My pain is certainly dependant on how I sit, when I lay on my back with my feet propped up on pillow I literally have no pain. When I sit in a chair or in my car I get up crippled, like I am 90. It is so frustrating, as I am sure you understand. I am glad you got to the bottom of your problems.
My MRI did show abnormalities from T12-L5 but he said the only ones herniated were L1-2 which doesn't cause sciatica, so you may be right that it didn't show enough information of what I need to know the cause of sciatica.
Thank you again, I will check back here when I know more.

 
Old 06-20-2009, 07:47 AM   #5
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Baybreeze HB UserBaybreeze HB UserBaybreeze HB UserBaybreeze HB UserBaybreeze HB UserBaybreeze HB UserBaybreeze HB User
Re: back and muscle pain

Hi,

I'm sorry that you're in so much pain, I know exactly how it feels. From where you describe that your symptoms are located, it sounds like it would be coming from the L5/S1 level, but possibly even from L4/L5. I had it exactly where you describe..from my low back, into my rear, down the side of my left leg, and into my ankle and foot. It was absolutely terrible pain so I really sympathize with you.

Of course I am not a doctor, but from my own research, it's probably unlikely that your symptoms are coming from the upper lumbar spine. You can also look up a dermatome map, which is a map of all the nerve roots in the body, and the paths that they travel. It's all mapped out.

Like others have mentioned, just because your MRI did not find anything in the lower or sacral spine, that does NOT mean there is no problem there. MRI's don't always get everything and radiologists don't always find everything either. For myself, I knew I had a lot of problems before my surgery, but when I finally had my surgery, afterwards in the report, there were many other areas of stenosis and disk material that appeared to be really compressing me in there.....many of these never showed up on my MRI's. Doctors should know that not always everything shows up. They should also go by where your symptoms are and what they are. Perhaps you should have some other testing, like an EMG or something like that. If your current doc gives up on you, then you should definitely get another opinion...it is you who is living with the pain, not your current doctor, so you have to find out what is wrong. Also, some people can have massive herniations, but no pain....and others can seem to have very small ones that a medical professional would think would NOT cause any pain..but the person could still be in agony. Everyone is different. I do hope you find out where the problem is very soon...and that you will find something to relieve your pain!

 
Old 06-25-2009, 03:14 PM   #6
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Join Date: Jun 2009
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gapcheryl HB User
Re: back and muscle pain

Thank you for your advice. I did have an EMG and it was normal, and now they want to send me to pain management. My friend swears I should try acupuncture. I really do not know much about it. I do go to physical therapy, but I seem to walk out more crippled then when I walk in. They feel I pulled a muscle and it is pressing on a nerve. I am frustrated and now back to work which does not help the situation, but that is another dilemma!! I am going to see another neurologist and get another opinion. Thanks again.

 
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