I have been suffering with what appears to be sciatic pain down my left leg for about the last 6 months - 12 months (initially it was mild but has gotten worse over time). I was sent for an MRI and the results are below.
I am currently waiting for an ‘urgent’ appointment with a neurologist. Would the above results explain the sciatic pain down my left leg, numbness, tingling etc More confusingly I don’t have any lower back pain really to go with it. Maybe a small twinge here or there. All the pain is felt through my left leg.
- Congential / anatomical variance with narrowing of the lower lumbar spinal canal in the sacral region.
- Disc degeneration / desiccation at L4/5, L5/S1 and hypotrohy of ligamenta flava at some levels
- L3/4 small posterior central disc protrusion with radial tear, flattening of theca without neural compromise.
- L4/5 annular disc bulge with central disc protrusion and radial tear impinging theca sac and contacting both descending L5 nerve roots.
- L5/S1 annular disc bulge with central disc protrusion and radial tear impinging theca aac contacting both descending nerve roots.
I’ve not yet had an explanation regarding what these results mean. Is there anything I can do in the meantime to improve things?
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Yes, it does make sense that you have pain down your leg, and blooming marvellous that you don't have lower back pain too!
My happy to give you my understanding of this, but I'm no doctor so always check with a real one. Essentially various things are squeezing your spinal column and particularly around L5/S1 which is where the sciatic nerve pops out of the spine to run down your legs. So you were born with a narrow spinal canal in your lower back to start with, and with age the discs in your lower back are starting to wear down and get damaged and the ligament that joins them together is also thickening. Unfortunately these changes are not just bulges, but are squishing the nerves - hence tingling etc.
As for what you can do - push and push for your appointment. And in the meantime no horse riding or extreme sports....
Thanks very much for the information that’s really helpful. Not sure how long I’ll have to wait for the appointment but hopefully it’ll come soon. I’ve been resting quite a bit lately and it does help but it’s obviously interfering with any exercise I try to do.
Agree with helixhelix’s description, the bit where it says ‘contacting descending nerve roots’ explains the pain in your leg as these are the nerves that branch out of your spine and run down your legs.
As for what you can do I can only relate my own experience, tell you what I wish I had done (or been told to do!) when I was in a similar position.
I had various symptoms of spinal / nerve root impingement on and off for a year or two including one obvious slipped disc at l4/5 that was treated with nerve root block injection. This seemed to clear up but then came back with a vengeance and long story short - two lots of emergency surgery, 8 prolapsed discs, scoliosis, spondylolisthesis, etc.
Following the second surgery, the loss of an unbelievable amount of lower body muscle mass and essentially partial paralysis (couldn’t even stand up unaided and constant pain in legs and back) I embarked on a program of supervised (by a qualified and good personal trainer) physical therapy in the gym. This was done with the approval / encouragement of the surgeon that operated on me.
The goal was (is) to help prevent falls (which are surprisingly dangerous and can lead to all sorts of further problems), improve my balance and mobility, increase muscle mass / strength in core and lower extremities (in fact all over really) and to help reduce pain.
What I always wonder is how much of what was to come I could have avoided if I’d started doing this when I first had symptoms. I’ll never know the answer to that, and it’s possible that it wouldn’t have prevented anything, but my belief is that it would have really helped and maybe prevented the nightmare 2-3 years I’ve just had.
So if I was in your situation, and knowing what I know now - that is what I would be researching. I would ask the most qualified doctor (preferably a spine specialist / neurosurgeon) that I could get access to for advice first, and then I would (slowly and carefully) start to build up my core muscle strength (with guidance from a professional) as these muscles support the spine and take some of the physical stress off it.
I never will get back to where I used to be, but if I hadn’t done what I have over the last 2 years I would be in a far, far worse place than I am. I no longer have sciatic pain, my back is stiff rather than painful and I can walk unaided (although use sticks when out and about). My balance will never recover fully, but again would be a lot worse had I not acted.
Please don’t act without advice from a professional - I would hate to give the wrong advice or cause further problems - but that is what I would do.
Thanks. I think you’re absolutely right about the exercise. I used to train in the gym with a Physio (I’ve had knees which get aggravated by certain exercises for years. I’m 34 years old).
I suspect the training is the reason why I have no back pain. I had to give it up though about 18 months ago when I developed Achilles tendonosis in both feet but worse on the left side. I swapped to doing a low impact class instead. The sciatica appeared at some point early on about 12 months ago and I originally blamed the pain on the tendonosis as it reaches all the way down to my calf/feet and it was milder then too.
I’m very glad to hear that you were able to improve. How long did it take you to build up and notice relief of the sciatica?
I will certainly ask the Neurologist when I see them about exercise I absolutely think you are correct that this would help in the long term and would love to be able to get back in the gym.
Did you find that any exercise would set off the pain at first?
It’s difficult for me to differentiate correlation and causation regarding pain etc, by which I mean the pain improved as I was going to the gym. Was the gym the reason, or would it have improved anyway? I don’t know for sure, but it sure seemed to make a massive difference.
To answer your questions I need to explain that I had surgery (a laminectomy at l4/5) to relieve the pressure on my spinal cord where a bulging disc was pressing into it, improved rapidly, relapsed overnight, had another operation (another laminectomy at c3) and had a series of nerve root ganglion block injections. None of this made much difference to my mobility / strength but did help somewhat with the sciatic pain.
8 months after the first op (and about 3 after the 2nd) I started going to the gym.
At this point I still had bilateral sciatic pain reaching from top of leg to toes, very painful glutes (or bum if you will) and my back was very sore. I used 2 crutches most of the time, although managed with sticks occasionally.
Not going to lie, the gym was a killer at first, and I’d never have had the confidence to continue without the professional advice. I do cardio to warm up, lots of stretching exercises, resistance / weights and core / abs type stuff.
At first I was in quite a lot of pain when I’d finished, and was shown how to use trigger point techniques along with shown which pain was muscular and therefore could be helped with these techniques, and which pain was more spine related and therefore needed a bit of care.
Over the first 2 to 6 months the sciatic pain reduced to the point I could no longer feel it (my god that was good) and most of the unwanted muscle pain, along with the post exercise soreness in my back eased.
By 12 months I would say that I was pretty much pain-free (RA aside), apart from my legs ‘burn’ more quickly than they ever have before when exercising, my back usually doesn’t hurt afterwards (if it does I did something wrong), it just feels rather stiff when I have been inactive for a long time, such as in the morning.
I have other lasting issues as a result of it all, such as left leg drop-foot (can’t lift my left foot upwards which is a nuisance) and my feet / toes are not as manoeuverable as they used to be. But when I read what others have to live with from seemingly less widespread spinal problems, I count myself pretty lucky. I have regained most of the lost muscle and perhaps 70% of my mobility (and still improving).
I have resigned myself to having to keep up the gym for the rest of my life really, but that’s no bad thing. Probably fitter than I’ve been for years!
I have become a firm believer that we control our own outcomes to some extent. I could have just used the pain as an excuse and not bothered. Hate to think where I’d be now if I had.
I’m sure your age and previous exercise regime will help you also.
But once again I’d say just get the ok from a doctor, and get help. Might cost a bit, but worth every penny in my opinion. There are also lots of videos and advice available online, just make sure the source is trustworthy. There are some vids on the NHS site for example that show useful stretches to help with sciatic pain (look into piriformis stretches), and they really do help - if you do them regularly and correctly.
Thank you for sharing your experience. Sounds like you had a tremendous journey to get to where you are today but certainly sounds like your efforts are paying off now and you’ve made some really good progress.
I’m hoping I do not need surgery (haven’t been told anything yet at all) but am keeping my fingers crossed!
I will certainly be taking a leaf out of your book though and will go down the exercise route (once I get the okay from the specialist).
I’m no neurosurgeon but surgery is a last resort with spine / disc problems and usually they won’t operate unless things have gotten pretty bad AND they think there’s a good chance that it will help.
You really don’t want surgery, a quick search of the Pain Concern board here on Healthunlocked will show up plenty of folks that have been left with serious problems following spinal surgery, or even less invasive procedures such as epidural injections and nerve blocks. But when people are desperate they will try anything.
By far the best thing is keeping the core muscles in good shape. As we get older our spines do change, discs bulge and lots more. In most cases it doesn’t end up causing too much bother but for those of us who aren’t so fortunate...
Rereading your post you say you were having Achilles problems so I hope you can find a program of exercise that doesn’t aggravate that too much. It’s not something I’ve had but there are plenty of things I do that I don’t think would cause problems. There’s even a cardio thing that’s like a bike that you use your hands to pedal - it certainly works to get your heart rate going!
Some of the things I do are based on Pilates and / or yoga so they may be an option. Swimming is often recommended due to being low impact and non weight bearing but personally I find swimming too much hassle and due to a ‘problem’ foot find walking around barefoot painful so its not for me.
Maybe your neurologist will be able to refer you on to someone that can help. I’d have thought they’d be more than happy to see someone that doesn’t want them to just fix it with a scalpel and / or painkillers (which aren’t a good log-term solution).
Yeah I really do not want to go down the surgery route if there is anyway to avoid it, i’ll try pretty much anything else first. I too have heard a lot of things about back operations the majority not very good.
I got a call today and my appointment with the Neurologist is the end of next week so hopefully I’ll get some answers there.
I got some tension bands to exercise my legs with as they are pretty low impact and not to harsh on either the legs or feet so I’ve been doing some of that but unfortunely the power in my left leg is pretty poor. I also no longer have a plantar reflex in my left foot and an area of numbness and tingling. I’ve been trying to do some exercise without further agitating my leg. I think I may do what you said and invest in a good private PT after I see the Neurologist and get some specific exercises given that I can do.
Have you had any experiences of osteopaths or accupuncture? I’ve been considering going to see them too as they might relieve some of the symptoms at least?
I would be cautious about an osteopath with your type of problems. And hopefully the appointment with neurologist will give you answers and a way forward - but if you have narrowing of the lower spinal canal it may well be that you will be advised to have surgery to correct that. My sister had similar recently as the numbness in her legs was getting worse so they needed to englarge the spinal canal and remove a cyst in it, and it was not a pleasure at all, but she is now back to nearly normal and with no leg pain.
Otherwise I agree with PKKAAde that properly focused exercises are the best thing for all your disc problems. Start slowly and gently tho'.
Just wanted to provide an update. You were absolutely right! I had my appointment with the Neurologist and he has referred me for surgery. Now have to wait for an appointment with the Neurosurgeon to find out what happens next.
Resistance bands are good and can be used in lots of ways.
Haven’t used an osteopath and have only had acupuncture for RA pain. It was through the NHS and done by a physiotherapist. I tried it twice, and was desperate at the time. I wasn’t expecting the actual placement of the needles to hurt - but boy did they! They were placed in between my fingers and then ‘wriggled’ about a bit, both of which hurt. It did absolutely nothing for me so I stopped.
Since then I haven’t read any convincing evidence that it is any more effective than placebo. On the other hand some people swear it helps, so I guess it’s one of those try it and see things.
Good that you have an appointment with a neurologist soon, fingers crossed you get some answers.
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