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Severe Sciatic Pain, Standing and Walking.


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Old 10-24-2017, 09:33 AM   #1
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Severe Sciatic Pain, Standing and Walking.

I am new to the board so forgive me if this has been posted a dozen times and for being long winded just want to give as much detail as possible.
50 years old Male, 6 feet, 195 pounds in good shape. I have had some slight sciatica that started about 4 years ago(PAIN LEVEL 1.5 out of 10), MRI showed bulging disc L4-L5. I was very active and lost some flexibility in the left leg but the Pain was maybe a 1 out of 10 so I didn't see the need to get epidural injections. I was actually scared I would injure my back more if I could not feel any pain. I had problems walking or sleeping but would throw my entire lower back out from time to time, feel the pop and sick feeling, when you know your back just went out and you were going to be in pain for at least 2 weeks. I tried Inversion, PT, ICE, HEAT, Stretches, Yoga, Assisted Stretching, Continued to do Brazlian Jiujitsu but very careful, Spine Decompression, Chiropractors, Massage, Ice, Heat, TEMS, Cold Laser Therapy, Cryotherapy, Acupuncture.
Nothing really seemed to help so I just lived with it and it was not a big deal. It did not affect my sleep or work or exercise unless I over did it for a week and then the back would go out. Now about 4 weeks ago after 2 weeks of probably over doing it I was bending down to pick up something at home and pop the back went out like in the past, but this time I felt burning down in my left foot and my left foot went numb. I iced right away and the next day I woke up bent over forward and bending to the right right side of my body slightly as well. The sciatic pain in my lower left side of my back to my butt, thigh and calf was very bad, After the 2nd or 3rd day of sleeping maybe 2 hours a night, I went to the doctor. The pain level at this point was a 9 out of 10. (PAIN LEVEL 9 out of 10) I could not stand or walk without extreme sciatic pain. I moved around the house trying to find a position that would elevate the pain and settled on the bathtub with warm baths. This gave me the most relief but it would return when I got out. The doctor gave me Naproxen, which did nothing for the pain. I went to the Chiropractor who did Ice, Tens Machine and slight adjustment, No relief at all. I had to stop and kneel down during the X-Rays because I could not stand for more than 20 seconds. I feel like I have a high pain tolerance, as I have had ACL Surgery in both knees and never used the Morphine pump or pain meds after either of those full reconstructions. Have had broken elbows, and ankles and torn ligaments and never used pain medication more than aspirin. Made and appointment with Spine guy who did my MRI 4 years early but it was over a week away. I went to the urgent care because I was getting no relief or sleep. Doctor prescribed predniSONE, Gabapentin, and HYDROcoden-Acetaminophen. I did not take the HYDROcoden because I thought I could tough it out. I could tell my back muscles were healing as I didnt have to grab the head board to turn over, I could push my self off the ground but the Sciatic Pain was still at a LEVEL 9. 2 Weeks from injury, I found relief sitting in a work chair. I ended up dragging myself back to work because I had missed 7 days and I have never missed that many sick in work school or anything. I still have severe pain when I stand or walk but once I get to my chair the pain goes to a 1 or 2. I can not sleep sitting or in a recliner as some have. I try legs up on back, face down, on side, nothing really relieves the pain at all but I can get about 3 hours of sleep if I sleep with a Tens Machine on to distract the pain some. Its usually in 20 minute sessions though. I finally got to Spinal Doc, who gave me more steroids, a pack that was 6, 5, 4, 3, 2, 1, I assume a stronger Prednisone, He said after these run out if the pain is no better schedule MRI, This also did nothing for the pain, so after 3 days, I scheduled MRI, I finally broke down about 2 days ago and took the HYRDOcoden. I slept 8 hours and went to work. Had an MRI the next day and have an appointment with the Spinal guy to read them tomorrow at 1pm. My left leg is very weak so I assume the disc that were bad 4 years ago are worse now and pressing somewhere on the sciatic nerve. What I am wondering is if the pressure on the nerve is causing the weakness and how long before permanent damage is being done or permanent weakness in that leg? I assume no matter what the MRI looks like they are going to want to do some type of Epidural in the nerve. If so will that just make the pain go away? Will the leg still be weak when I walk or try and stand for more than 20 seconds? I tried to take 1/2 a Hydrocoden last night at midnight and it did nothing. It says take 1 every 6 hours for pain but scared I can't drive doing that or even work if I take one every 6 hours? Last detail I can give is if I stand in the mirror and lift my left leg, my body (CORE) holds pretty tight and stable, if I lift my left leg, my Core starts to turn and I see there is not enough support there, if this weakness again because of something pushing on the nerve? Anyway thanks for listening, and again, sorry for the long post!

 
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Old 10-25-2017, 09:04 AM   #2
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Re: Severe Sciatic Pain Standing and Walking NEW TO BOARD

Welcome to the board. From your description, I would not be surprised if your spine surgeon recommends surgery to relieve the pressure on the nerve. You may have a herniated or ruptured disc but you may also have spinal stenosis. Stenosis means narrowing and this occurs in two places in the back/neck: in the central canal and in the neuro foramen which are openings located at each vertebral level that allows the spinal nerve to exit the spine to go out to the area of the body it innervates.

When there is something pressing into the central canal like disc matter or an enlarged facet joint, due to lack of space, it can push over into the area occupied by the spinal cord/cauda equina. If the pressure is great enough, the nerves that bundle together to make up the "cauda equina" ( which is the continuation of the spinal cord, which technically ends around lumbar 1 in most people) don't have room to function normally and the result is pain, leg weakness, sciatic-type pain, tingling and numbness. This is most likely the L5 nerve that is being compressed. Sometimes people get temporary relief from leaning forward, like when pushing a shopping cart.

The Medrol pack you were given will reduce inflammation temporarily, but if the problem is "bad" it will have no long-lasting effects. Same with an epidural steroid injection. If the central canal is reduced in size nothing but a surgical decompression will resolve your issues.

If that is what's going on, the good news is that as back surgeries go, it is a fairly simple procedure. It can be done using micro surgery techniques and most stay just overnight in hospital. Healing is about six weeks plus whatever rehab is needed.

When you have the MRI be sure to ask for a copy of the cd and a copy of the written report. Start a personal file and keep those records. Plus you can then tell us what the report indicates is the problem.

I probably missed answering some of your questions. Feel free to ask again. I just had a similar decompression surgery three weeks ago after a L3-S1 fusion in 2010.

 
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Old 10-25-2017, 09:12 AM   #3
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Re: Severe Sciatic Pain Standing and Walking NEW TO BOARD

Wow... Thanks for the information.
I am leaving in about 15 minutes to go have the MRI read. You are right when I lean forward sitting the pain is the lowest. The Med Pack and other Prednisone did nothing for the pain, but maybe helped the muscles some. Would the spinal stenosis show on the MRI or would that show on an XRAY. I actually didn't do the xray this time because I had one done about 2 week ago and the Chiropractor said it looked fine. Would you recommend I get one? I have a feeling they are going to want to do injections but I want to ask the doctor will that give me the strength back in my left leg, if not then seems like they need to relieve the pressure on the nerve like you said and surgery would be a better route. Thanks again and good call on the MRI and NOTES I am going to call them on the way and ask for that so I don't have to wait around any longer at the office. I will keep you updated on what they say and thanks again for the reply.

 
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Old 10-25-2017, 09:20 AM   #4
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Re: Severe Sciatic Pain Standing and Walking NEW TO BOARD

The MRI will reveal whether there is room for the nerves. You don't need another X-ray unless it is a flexion-extension X-ray to check for spondylolisthesis. This is where one vertebra slips over the top of the adjacent one...often at L4-5 or L5-S1. That would be worth doing...esp. if you played a lot of contact sports or were engaged in an activity where the spine was in extension like diving, gymnastics, dance, etc.

 
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Old 10-25-2017, 07:27 PM   #5
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Re: Severe Sciatic Pain Standing and Walking NEW TO BOARD

How did your appointment go? What did you learn?

 
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Old 10-26-2017, 05:58 AM   #6
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Re: Severe Sciatic Pain Standing and Walking NEW TO BOARD

Well I will start off saying the Dr. I went too was sort of a jerk. He did not want to listen to anything I had to say. I asked him what I should be doing for the pain as I am only sleeping about 3 or 4 hours a night max. I told him I was in extreme pain had to stop and sit 4 times just getting from the car to his office. It was like he didn't want to hear anything just move on to the next person he had coming to see him I guess. He did not even show me on the MRI what he discussed and I could tell he didn't even read the medications I was given and had listed on the paperwork I filled out. Anyway he said I had herniated disc L4-5 and L5-S1. Just said Jelly in the doughnut was pushing out both and touching the nerve which was causing the pain
on the left side of my back and down the leg. He referred me to another office to do epidural injections. Of course I have to go there for consultation then at that time setup the procedure. I called back later and spoke to his nurse and asked her waht I should take for the pain, I broke down the other day and took the HYDROcondone Acetaminophen but it didn't really help with the pain but I guess it made me sleep. When I told the DR. that I took that his eyes got big, thats how I knew he never even looked at my stuff. Anyway the nurse said try the muscle relaxer Methocarbamol, I ended up doing that last night since it was 2am and I still couldn't sleep, It made my whole body hurt so I don't think i will take that again. I am wondering if I should try and go back to Naproxen but take it throughout the day as prescribed. She did say he could give me some anti inflammatory med that you take once a day not sure what it is or if it will work, maybe someone here has more information. Anyway Here is what the MRI LUMBAR said
Findings, The conus medullaris is normal in position and appearance. Heights of the lumbar vertebral bodies are preserved. There is no listhesis. There are no vertebral marrow lesions.
At T12-L1 there is partial disc desiccation. There is not disc protrusion or central canal of foraminal stenosis.
At L1-2 the disc is hydrated. There is no disc protrusion or central canal or foraminal stenosis.
At L2-3 there is partial disc desiccation. Minimal spondylotic ridging. There is no disc protrusion or central canal or foraminal stenosis.
At L3-4 the disc is hydrated. There is no disc protrusion or central canal or foraminal stenosis.
At L4-5 thee is disc desiccation with mild spondylotic ridging. There is a small left paramedian focal disc extrusion on the sagittal image 6 and axial image 16 causing posterior displacement of the traversing left L5 nerve root.

Impression:
1. Small focal left paramedian disc extrusion at the L4-5 interspace.
2. Small focal left paramedian disc extrusion at the L5-S1interspace.

I got a copy of the MRI but I have no idea what I am looking at. It looks like a .exe file that when loaded on my pc brings up a bunch of images that can be scrolled through showing the different slices the MRI I took. But again I have no idea what I am looking at. 3 Years ago you could see the L4-5 disc herniated and pushing into the nerve but the L5-S1 looked like it was about to go but at that time had not. I assume this is where the pain is coming from. Thanks again for any advice. I asked the Dr. if the strength would come back and numbness down left calf and foot was stop when I had the epidural or would it only mask the pain? He said I had not weakness and I said then why can I not stand on my left leg without falling and why am I limping so bad? At this point I will take any pain relief but if this wont fix the issue on the nerve is it safe to let the disc push on the nerve or should I consider some type of micro discectomy?

 
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Old 10-26-2017, 10:10 AM   #7
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Re: Severe Sciatic Pain Standing and Walking NEW TO BOARD

The epidural steroid injection (ESI) will not "just mask" pain. The steroid will reduce inflammation and hopefully, will cause the disc material to move off the spinal nerve. If this happens, the symptoms should go away.

When disc material comes out of the disc, if it touches a spinal nerve there is a chemical reaction that causes pain. It also causes nerve compression where the nerve can no longer function normally. This can result in tingling or numbness and even loss of muscle tone/muscle weakness.

The ESI is always the next step unless the compression is so severe that it is causing bladder /bowel issues. Then surgery would be done right away to decompress the nerve.

The injections are given in a series of three, spaced several weeks apart. I assume you were referred to pain management?

 
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Old 10-26-2017, 10:30 AM   #8
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Re: Severe Sciatic Pain Standing and Walking NEW TO BOARD

"When disc material comes out of the disc, if it touches a spinal nerve there is a chemical reaction that causes pain. It also causes nerve compression where the nerve can no longer function normally. This can result in tingling or numbness and even loss of muscle tone/muscle weakness."

So how long with the pressure on the nerve cause permanent damage? I currently have numbness in leg and foot and what feels like weakness when I try and stand on my left leg or walk, doctor told me however I have no weakness? Problem I am having now is the pain is crazy...
Like I said 9 out of 10. I have competed in sports for years broken bones, ankles tore Knees completely and used nothing more than ice even for post surgeries. I assume I will meet with them and discuss tomorrow then get scheduled for the epidural sometime next week, I hope sooner than later. If it does relieve some of the pain. Thanks again for the reply, as strange my doctor said the injection would only mask the pain and would not help the disc or nerve in any way and I asked him that specifically?

 
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Old 10-26-2017, 03:43 PM   #9
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Re: Severe Sciatic Pain Standing and Walking NEW TO BOARD

Was this doctor a spine surgeon? Regardless, I don't know why he would tell you that. Perhaps he misunderstood the question. You can look on any website pertaining to health issues and find that ESIs are standard treatment for back pain, and that they are given to reduce swelling and inflammation. The steroid reduces inflammation and the pain medication that is mixed in with the steroid temporarily provides some pain relief.

No one can tell you how long a nerve can be compressed before it causes permanent damage....because there is no one answer. Some people can have a compressed nerve for a short while and end up with permanent damage while others have been known to recover fully after having years of compression.

I think reputable health websites now say that a nerve should be decompressed after trying conservative measures for six months and having them fail. I waited about three years and wish I'd elected to have surgery sooner. The nerve damage in my feet and ankles is permanent.

 
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Old 10-27-2017, 10:28 AM   #10
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Re: Severe Sciatic Pain, Standing and Walking.

Did you play contact sports? If so, you should inquire about getting a flexion/extension X-ray to check for a spondylolisthesis.

You might want to get a second opinion or evaluation from a spine surgeon in a completely different practice. Personally I would recommend an orthopedic spine surgeon for your issues rather than a neurosurgeon.

Also, when you start physical therapy, be careful that you do not aggravate the sciatic nerve or do things that make the sciatic pain worse. Some therapists are not careful about this...so to some extent, you need to advocate for yourself!

Also, very important!!! When you get the ESI, stay off your feet as much as possible for the first 72 hours. Your doctor may tell you to stay off your feet the rest of the day and then it is OK to go about your normal routine the next day. If possible, do not follow this advice. Here's why: unlike when cortisone is injected into a knee or ankle, etc. where it goes into the joint capsule, the ESI will be floated into an area next to the spinal nerve root. It does not go into a contained area. If you are on your feet, you will be more active, which means your heart will beat faster, your metabolism will be higher and your body will use up the medication faster than if you lay on the couch all day and move to the bed for all night. You will maximize the healing power of the ESI by being a couch potato for 72 hours. This is the amount of time the drug will be active in your body. Beyond 72 hours, it is no longer "active."

I went to five different pain management specialists for epidural steroid injections and only one insisted his patients stay off their feet for 72 hours. I tried it and it did make a difference. So I highly recommend it!

 
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Old 10-29-2017, 06:18 PM   #11
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Re: Severe Sciatic Pain, Standing and Walking.

I feel your same pain my friend, served as conductor on the railroad for 30 yrs. just been diagnosed with carpal tunnel in both arms, now awaiting for dr to review recent mri, going for epidural in a different place & different entry in November. I got knocked off the back top of a cement hopper rail car back in 1973, fell an 20’ to the ground on my budocks & broke my wrist in 10 places, the in 1999, herniated two disc in my back, have had two laminacts and seems now another is approaching. No one knows the pain you have or how you feel until you experience the pain yourself. Take care of your back my friend.

 
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Old 10-30-2017, 11:28 AM   #12
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Re: Severe Sciatic Pain, Standing and Walking.

You aren't kidding about that, no one knows your pain. I have coworkers oh you aren't that bad. How about I call you during the night while I am crawling around the floor to get the bath tub to find some relief at 3am or at 4 am or 2 am... LOL
My grandfather retired from the railroad but that was in the state of Georgia. Said it was tough work but he loved it. Hope you feel better soon. Keep me updated.

 
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Old 10-30-2017, 11:46 AM   #13
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Re: Severe Sciatic Pain, Standing and Walking.

I have played sports most of my life, in HS baseball, football wrestling, Baseball in college and a few years after. Started doing Brazilian Jiu-Jitsu at 30 and had done that competitively up until about 3 years ago when the back pain first started. I was able to still do it a few times a week at a friends academy, just not at a high level with competitions because of the limited flexibility to my left leg. I coached travel baseball for 20 years so I am sure the twisting when throwing and hitting balls to players has not helped over use of my trunk.

Regarding the other question about who I saw I saw a Ortho Spine Surgeon who referred me to non surgical place for Injections. I have an appointment with Neurosurgeon 10 days after the injection if pain is not better going to have him review my MRI and see what he thinks. Its crazy my insurance company wanted me to go to PT before I could do injections. I told them I can not even walk or stand no way I can do PT. I have tried to do the Mckenzie flexion exercises and inversion and it just hurts the next day so bad I feel like I am doing more damage than good. I have also been doing tons of at home PT, with back exercises, bands, some Yoga stuff and flexibility stuff and that has never helped a single bit.

 
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Old 10-31-2017, 07:18 AM   #14
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Re: Severe Sciatic Pain, Standing and Walking.

If you should happen to have a spondylolisthesis, all those things that supposedly "help," like McKenzie, are exactly the things that make the situation worse.

Usually insurance carriers make the person have an ESI before they can move ahead with anything else.

 
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Old 10-31-2017, 08:06 AM   #15
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Re: Severe Sciatic Pain, Standing and Walking.

Thanks teteri66,
I just asked the Chiropractor that did recent x-rays if he saw any signs of spondylolisthesis or if he could even tell from the normal x-ray he did. I am going for shot tomorrow so I should know more in a few days.
Going to try and take advice given here and lay down as much as I can and let these drugs work.
Would the next step if these injections don't work be some type of micro surgery?
Thanks

 
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