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Sciatica

Old 01-22-18, 03:53 PM
  #26  
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Ok, I went to the MD and spent about 1 hour with him. First, the Piriformis thing. His take is that its not just that muscle. He worked that right side in the buttocks region and pressed the area, then releasing the pressure and some shaking of that area. Seems like trying to undo the tightness. Its several muscles and I think he was loosening them up by pressure. And yes, it hurt, sharp pain. But I didn't cry.

Now, two days off the bike and no hammering.

I never did go to physical therapy or massage therapy. But I think what I got was like it, only maybe the MD was more experienced. Not too many MD's would do this. Didn't want to say this, but the MD would prescribe physical therapy and maybe some pain medicine to relieve the symptoms.

Last edited by Garfield Cat; 01-22-18 at 03:56 PM.
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Old 01-22-18, 04:24 PM
  #27  
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Originally Posted by Garfield Cat View Post
Ok, I went to the MD and spent about 1 hour with him. First, the Piriformis thing. His take is that its not just that muscle. He worked that right side in the buttocks region and pressed the area, then releasing the pressure and some shaking of that area. Seems like trying to undo the tightness. Its several muscles and I think he was loosening them up by pressure. And yes, it hurt, sharp pain. But I didn't cry.

Now, two days off the bike and no hammering.

I never did go to physical therapy or massage therapy. But I think what I got was like it, only maybe the MD was more experienced. Not too many MD's would do this. Didn't want to say this, but the MD would prescribe physical therapy and maybe some pain medicine to relieve the symptoms.
Just to be clear, the doc literally “shook your booty.”? 😜

Sound like you’re making progress. Get the PT and you’ll be in the hike in no time.
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Old 01-22-18, 07:35 PM
  #28  
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Originally Posted by fixedweasel View Post
That's a pretty bold Diagnosis from a PT eval. Holds no water and shame on her for telling you that. These are tough threads to respond in/to because of so many variables. Low back pain in itself can have many origins and several solutions depending on what/where the specific problem is. You will hear many suggestions on what to do and how to treat your pain. Be careful. If the pain persists, worsens, you have increasing numbness/tingling, or start having any weakness in the leg, see a Neurosurgeon* right way. More urgent for the weakness as there never is a guarantee that you will get that back. Nerves are a fickle beast and do not heal like other parts of the body, so haste with weakness is important. To truly "see" what is going on you will need an MRI. Again, only if it persists. Obviously if it is transient, no worries. In any case, a Plain Film (X-Ray) or CT is basically useless. An MRI will show the tissue and bone proper and will specifically pick up the cause. Whether it be a Spinal Stenosis, Lumbar Radiculopathy, Degeneration, Spondylolisthesis, etc. it will be crystal clear once reviewed. From there, you will now have a proper working diagnosis and can confidently implement a plan of care. Since there are so many back problems out there, there are a few things that all of us can do to help out that long hanger.

1) Lose weight. One of the most common irritants of the low back
2) Stretch after warming up and do it every day.
3) Strengthen your core. Another common problem that throws our low back out of alignment are weak abdominals.
4) When you are ready, start exercises to strengthen your low back progressively
5) Use proper body mechanics.................always. Bend at the knees and not at the back.
6) If lifting heavy objects for a long period of time, consider a back brace or abd binder

There are more, but you get the idea.


As a note: I began working as a Nurse in Neurosurgery back in 1987, from there to the MICU, Cardiac ICU and now have been back in the Neuro ICU for the last 20 years. Our Hospital does some of the most complicated and largest multi level back surgeries** in the State.




*do not go to an Ortho guy and most definitely do not go to a Chiropractor
**in all areas Cervical, Thoracic (not as common) and Lumbar/Sacral
I’d back most of this up and add that a diagnosis is key. “Sciatica” can mean many different things and is not a term used by specialists. Also, no one should have surgery for isolated pain from a protruding or fragmented disk without getting transforaminal steroid injections for pain relief first. Surgery is required if there’s active compromise of motor, bowel, or bladder function, but carries an appreciable rate of scarring around the nerve root, which can cause worse and permanent symptoms. Disk rubble is 80% water and goes away on its own.

Last edited by MoAlpha; 01-22-18 at 07:42 PM.
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Old 01-22-18, 08:11 PM
  #29  
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I met with my doctor today. She is now thinking that I have spinal stenosis. My physical therapist first mentioned this term last week. I am meeting with a specialist tomorrow regarding my back in hopes that I will get an actual diagnosis and some pain relief. I will certainly ask if I can get an epidural. I've now missed a full week of work and I would love to be able to get back on my bike again.
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Old 01-22-18, 08:51 PM
  #30  
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Originally Posted by jskash View Post
I met with my doctor today. She is now thinking that I have spinal stenosis. My physical therapist first mentioned this term last week. I am meeting with a specialist tomorrow regarding my back in hopes that I will get an actual diagnosis and some pain relief. I will certainly ask if I can get an epidural. I've now missed a full week of work and I would love to be able to get back on my bike again.
Spinal stenosis is another general term, referring to a spinal canal narrowed by something at multiple levels. If this is not getting better with rest, you need a specific anatomical diagnosis, which sounds like it may be afoot. Incidentally, epidural injections have not been shown to be of much benefit in localized pain from nerve root compression, but transforaminal injections have. I have some professional background in this area, but more importantly, I’ve lived it as a patient and come out the other end pretty happy.
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Old 01-22-18, 09:25 PM
  #31  
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Originally Posted by MoAlpha View Post
Spinal stenosis is another general term, referring to a spinal canal narrowed by something at multiple levels. If this is not getting better with rest, you need a specific anatomical diagnosis, which sounds like it may be afoot. Incidentally, epidural injections have not been shown to be of much benefit in localized pain from nerve root compression, but transforaminal injections have. I have some professional background in this area, but more importantly, I’ve lived it as a patient and come out the other end pretty happy.
Thank you for the information. I think it is good to go into meetings with doctors equipped with as much information as possible.
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Old 01-22-18, 09:41 PM
  #32  
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Originally Posted by jskash View Post
Thank you for the information. I think it is good to go into meetings with doctors equipped with as much information as possible.
Keep in mind that we're all different, and the EXACT causes will be different, even if the general cause is the same. Decades back I had a problem that manifested as a hip joint issue (even to where specialists suggest hip surgery). Eventually it was correctly diagnosed as an effect of sciatica caused in turn by spinal stenosis (confirmed by X-rays).

While there was an option for a surgical solution, the surgeon felt I could beat it with physical therapy, and management. part of his advice was the usual, no lifting heavy loads, rest, etc + the usual exercises to improve flexibility, and relieve local pressure.

The program worked, but when I had to reported that rest wasn't helping, and I usually felt better after hard physical work doing things like lifting and tossing boxes. The surgeon didn't blink, and said that what works trumps any of his expertise, so we made adjustments. It's now down to a science, and I know how to manage the problem very effectively.

Ironically, after we solved the original sciatica issue, I started suffering from other somewhat related issues like piriformis syndrome, which I'm finding tougher to manage effectively.

My point isn't to say you'll have the same experience as me, but show you how it can vary, and that the canned advice from the doc may not be exactly right for you. So, it's about dialog, observing what works, and open conversation, as you negotiate between what the doc and your own body are saying.
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Old 01-29-18, 08:17 PM
  #33  
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MRI is scheduled for Saturday. Physical medicine doc thought my condition it may be spinal stenosis but wants to do the MRI to make sure. She already brought up the idea of giving me an epidural once things are confirmed.

When I got home from school today I decided to go out on my bike and see how I felt. It was better than I though it would be. I have not been on the bike for 15 days. I only rode 10 miles, but I feel fine and it certainly did not make me worse. Riding when I get home seems to be a good plan for now instead of riding in the dark before school.

Last edited by jskash; 01-30-18 at 07:33 PM.
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Old 02-09-18, 10:02 PM
  #34  
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My doctor confirmed today that I do have lumbar spinal stenosis. I have a phone appointment with her Monday when we will set up the first epidural. Fortunately, I have been able to ride my bike the last two weeks. It feels good to be back on the bike, and riding doesn't hurt!
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Old 02-14-18, 09:02 PM
  #35  
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Originally Posted by JohnJ80 View Post
... piriformis syndrome.

...$40 iPad app that allows you to peel away the layers of muscle, tissue and nerves as you go down.

There are a lot of good piriformis stretches if you google them. Find the ones that work best for you.J.
I found this to be the source of my sciatica lighting up - of course, perhaps not the OPs situation. Once you "get" what the stretch is supposed to feel like, it is a piece of cake to revisit the stretching whenever the nerve trunk starts becoming irritible.

I also found that supine leg lifts with ankle weights to strengthen the psoas to be of help, but you always have to balance this with the piriformis stretches, otherwise you can strengthen yourself into piriformis issues!

J, which iOS app are you referring to?
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Old 02-14-18, 11:36 PM
  #36  
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Originally Posted by CrankyFranky View Post
I found this to be the source of my sciatica lighting up - of course, perhaps not the OPs situation. Once you "get" what the stretch is supposed to feel like, it is a piece of cake to revisit the stretching whenever the nerve trunk starts becoming irritible.

I also found that supine leg lifts with ankle weights to strengthen the psoas to be of help, but you always have to balance this with the piriformis stretches, otherwise you can strengthen yourself into piriformis issues!

J, which iOS app are you referring to?
Essential Anatomy on the iPad (iOS).
https://itunes.apple.com/us/app/essential-anatomy-5/id596684220?mt=8

Great app. Use it all the time when things are tight or hurt.

J.
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