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Old 03-26-2012, 11:17 AM   #1
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Lower Back Pain/Sciatica

Hey Everyone,

Over the last year or so I have had on and off lower back pain, that occasionally has spread down my leg. Recently, over the past 3-4 months, the pain has increased in regularity and intensity. It was so bad one day I had to leave work and go to a walk in clinic. The doctor their said it was most likely sciatica and gave me naproxen for the pain.

I have since gone to another doctor for more attention and got xrays. The results say a i have Grade 1 retrolisthesis at levls l1-l2 and l4-l5 and minor end plate sclerosis from t12-l1 to ls-l3. My doctor did not seem to concerned and said I should get physical therapy.

Over the last week and a half the pain has greatly increased in regularity, and has spread. I now get the pain 2-3 times a day compared to 2-3 times a week. It is always in my lower back and leg, but has increased in intensity. Half the time i feel that it spreads into my left shoulder. All pain is only on the Left side of my body.

The increases have scared me recently, which I am sure is not helping to prevent the pain lol.

I have left a call for my doctor but thought I would reach out here for potential advice.

Please let me know if there is any other information I can provide.

Thanks!

 
Old 03-26-2012, 12:14 PM   #2
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Re: Lower Back Pain/Sciatica

Welcome to the board.

The MRI is but one piece of the diagnostic puzzle. The results need to be correlated with what the doctor finds upon physical examination, a basic neurologic exam and patient history, including a detailed description of the pain symptoms.

It is hard to tell from your MRI report the severity of any nerve compression that may be a result of the retrolisthesis and stenosis.

Oops -- I see you had Xray but you don't mention MRI. The X-ray is only capable of showing what's going on with the bony structure. It cannot see the soft tissue, discs or nerves...so the doctor would not be able to assess the extent of compression that you are experiencing.

The spinal nerves carry signals out to the rest of the body in very particular patterns called dermatomes. The lumbar spinal nerves bundle together to form the "cauda equina" which runs down to the end of the back and then splits or branches into the two sciatic nerves that run down the back of the legs. A compression of a spinal nerve in your lower back can cause the pain you are feeling in your leg, buttock, and foot. They do not innervate the shoulder, so any pain you feel there may be due to you compensating for the pain in your leg. It may have affected your posture and gait; you may be favoring the one side, putting additional stress on the opposite side.

Your problems do not sound particularly severe, even though it is causing you lots of pain...but I personally think it is a good idea to consult with a spine specialist just to be sure you are getting an accurate diagnosis. This would be either a fellowship-trained orthopedic SPINE surgeon or a neurosurgeon whose practice is limited to problems of the neck and back.
Even though these specialties are trained as surgeons, they will explore all conservative modalities of treatment, leaving surgery as a last resort.

I wasted a year letting my well-meaning internist treat my back. He told me my MRI looked normal for someone my age. Turned out he had missed the most important issue which was causing an instability that resulted in horrid sciatic type pain. I might not have ended up with permanent nerve damage in my feet if I had not wasted a year when the nerves were compressed, believing that it wasn't anything significant and would get better on its own.

The retrolisthesis you have is a similar situation. It is a spondylolisthesis where one vertebra slides over the top of the adjacent vertebra. It is graded from 1 to IV with Grade I being from 1-25% slippage. Generally, Grade I does not cause major problems, but depending on whether a nerve is caught up in the slippage, it can be a pain generator....and if I were in your shoes, I would want to know whether it is causing the pain, or not, and I would find this out by going to see a spine specialist.

If your sciatic pain does not clear up within a couple weeks, you may want to get a lumbar spine MRI to see if there is more going on than is showing up on X-ray.

In the meantime, you can ice the area over your lower spine 15-20 minutes per hour for pain. Take NSAIDs if you tolerate them for any inflammation. Limit activities that require bending or twisting at the waist, pushing, pulling and lifting anything more than about 10 pounds until you know why you are having pain. But do not take to your bed. Gentle exercise will be good for you...like gentle walking on a flat surface (no incline or hills). Or walking in a pool is even better, if you have access to one.

 
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Old 03-26-2012, 11:31 PM   #3
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Re: Lower Back Pain/Sciatica

Good advice from teteri66, so I will try to not duplicate. One option would be to have your primary care doctor order an MRI, if you need a referral before seeing a specialist, or if you end up on a long wait list to see a spine specialist. As teteri66 remarked, making an appointment with a surgeon doesn't mean that they are going to cut you open right away.

The generalized pain that you have may be from muscle spasms, from the spine trying to stabilize a potential injury. If you are having severe pain, you might want to lie down for 15 minutes (not bed rest!), bend at the knees and allow your back to relax. You may also want to sleep with a pillow under your knees if you are back sleeper or between your knees as a side sleeper. Try not to sit for long periods; get up and stretch every half-hour or so if you have a desk position.

Did you follow up with any physical therapy? Did you receive any benefit? Even if you do have something other than a minor issue, physical therapy can be very helpful. I ended up needing surgery, but the surgeon indicated that a lot of my long-term spinal instability had been controlled by good core strength, due in part to lots of physical therapy exercises. Just don't do anything that exacerbates your pain.

 
Old 03-27-2012, 06:26 AM   #4
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Re: Lower Back Pain/Sciatica

Thank you both very much for your advice!

I will try and respond to most of your comments, but apologize in advance if I miss any.

Teteri66, thank you very much for the incredible detail. I feel like I have a much better understanding now than just having a few words written on paper and a brief explanation from my doctor. I have followed up with an appointment with my internist. My goal of this appointment is to get a referral to a specialist and potentially get an MRI scheduled as well, as it sounds like that may be the next step in figuring out what is causing the nerve compression.

I tried walking around my apartment last night when pain started and it seemed to work a lot better than lying down, or getting off my feet as I have been doing in the past.

I do have a desk position, so I will try today to get p frequently and stretch to help avoid the pain. I also found out there is a pretty good PT office in my building, so I will go down this morning to schedule an appointment to begin PT.

Thank you both for all of your advice! I will follow up as soon as I have met with my Dr. again and what the next steps I take are.

Thanks!

 
Old 03-27-2012, 08:20 AM   #5
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Re: Lower Back Pain/Sciatica

There is a product I have found useful. I know there are tons of lumbar support-type cushions on the market, but this one is different. Before I had surgery, I took it with me any time I was going somewhere that required sitting -- restaurants, theatres, cars, airplanes, etc. I don't know if it would help you...but I even use it in my ergonomic desk chair. It is called BackJoy and is available online. You might take a look at it and see if you think it might help.

Also, if you can get down on the floor (and, more importantly, back up) there is an exercise that stretches out the spinal nerves, unloads the discs and lets the muscle and soft tissue relax and stop "guarding" the tight area.

Lie flat on the floor, knees bent and with pelvis in a neutral position. Place arms close to the sides with palms facing upward. You can use a very small, flat pillow under your head if absolutely necessary, but better if you don't need it. Tilt chin ever so slightly tipped toward your chest (the idea is to get as much of your spine aligned along the floor without forcing it into an unnatural position). Then you relax and breathe from the belly. You just need to stay in this position for a few minutes, up to five minutes for some benefit.

A variation of this is to lie on the floor with your hips up against the edge of a couch, with legs swung up on the seat of the couch, calves and heels will be resting on the seat of the couch --be sure your are in straight alignment...this too takes the load off the discs.

Anytime I feel like I've done "too much" I get into one of these positions and rest for about 10 minutes, longer if I have time.

You need to do it every day to get full benefit from it. I've been known to find a quiet corner of an airport and lie like this in between flights or when I felt I just couldn't walk any further (I never wanted to ask for a wheelchair transport)....it is so much better for the spine than sitting in any chair.

Hope this will help.

 
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