Ignore this whole thing. Read this March 2017 update instead.
For the past four months I’ve had pain pretty much all day, every day. I think I’m finally at the end of it. I saw a lot of doctors, watched a lot of YouTube videos, and read a lot of articles, forums, and books. It’s difficult to get good information:
- Product reviews seem to say “I TOOK ONE DROP OF THIS AND MY SCIATICA IS GONE FOREVER AND MY HAIR GREW BACK!”
- Many books and articles promise quick solutions
- YouTube videos imply that this one stretch will fix all your woes and bring the spice back in your love life
- Surgeons say chiropractors can’t be trusted
- Chiropractors say the same about surgeons
- Group forums say nothing will ever work and you’d best get used to a life of misery.
So, at the risk of further muddying the waters with yet another individual experience that may not match yours, I decided I’d go ahead and document my process a bit in the hope it will help someone else get relief quicker than I did.
(I don’t know if I’m required to explain that I’m not a doctor and this shouldn’t be taken as medical advice, but if I am then I’m not and you shouldn’t.)
I’m 42 years old, by the way. And I had one other short stint of sciatica about 5 years ago, after a long (19 hours in the air, each way!) flight to/from India. It went away in a few weeks with a little physical therapy. Since then I’ve been medium consistent with daily stretching and exercise. And I’m the guy you see walking up and down the aisles during the flight, stretching his legs in whatever little space he can find between food carts and lines for the bathroom.
This time around the pain started with a sore back after a Turkey Bowl football game on Thanksgiving morning. Then I helped someone move and felt a quick bolt of pain in my lower back as I lifted a couch. Within a few days sharp pain entered my hip and then gradually worked its way down my right leg. For a couple of months it was constantly in the back of the knee and felt like repeated tetanus shots, every few seconds all day and all night. It was miserable.
Mornings were worst. After a night of tossing and turning for a comfortable position, I dragged my leg like Igor to the shower. My hip muscles ached because they were working overtime to accommodate a new way of walking. Sitting was painful, so I assembled a laptop stand to work standing up. If I iced my back and never sat down I could halfway enjoy the afternoon. Then it was time for bed and everything would start over.
A few things provided temporary relief during this period:
- Ice therapy – This was the most reliable source of short- and medium-term relief. I used a Bed Buddy Back Wrap, which didn’t get cold enough by itself (it’s apparently much better as a heat wrap), but it was great if I wrapped it around my waist and slipped a regular lunchbox ice pack between it and my lower back. I would do this for 30+ minutes every morning and again during the day if pain sharpened.
- Heat therapy – this seemed to help sore muscles more than the nerve pain, but sleeping with a heating pad seemed to give me some relief.
- Walking – I didn’t feel like walking, but 10 minutes into it I always felt better. Walking slightly downhill felt best. Aerobic exercise is extremely important in the healing of your back – keep it up!
- Hot chocolate – I’m pretty sure chocolate has no ingredients that actually heal a degenerated disc, but I swear it brings me more relief than ibuprofen. For you it may be something else, but find something that brightens your mood and relaxes you. It’s your brain that’s deciding how to react to pain, so give it something it likes and it might get distracted for a bit. My current favorite is the Starbucks double chocolate packets, especially that last spoonful of melted chocolate at the bottom.
- Yoga/stretches – I found a few exercises in the book Treat Your Own Back by Robin A McKenzie that helped somewhat. They didn’t give the long-term relief the book promised, but maybe they’ll work better for you. You basically just lie on your stomach for 3 minutes (trying to relax your legs and hips), then lift yourself up on your elbows for 3 minutes (still relaxing your hips and legs on the floor), then do some “cobra” pushups with your hips still on the floor.
- TENS therapy. This is the electrical stimulation you may have had at a chiropractor or physical therapist. I used the Icy Hot Smart Relief system because it was the first one I saw. It worked pretty well at interrupting the pain and was very portable since it was battery-powered. I could actually wear it to long meetings without being noticed. I’d sometimes wear it all night and turn it back on every time I woke up. But the battery power also meant I had to replace them often. It’s just cheap watch batteries, but it’s still a little bothersome.
I alternated between ibuprofen, aspirin, and acetaminophen – none of them seemed to help much and started to upset my stomach. My doctor prescribed a narcotic, Norco (Acetaminophen / Hydrocodone), which didn’t seem to relieve the pain but made me care less about it. I only took a total of 4 or 5 of them when the pain was at its worst since they made me babble like an extrovert (how do they live like that?) and feel loopy.
I count at least eight doctors that saw me, including x-ray and MRI techs. It took about 2 weeks between each visit, which I think (and at least one doctor confirmed) they do intentionally to see if it will go away on its own. I started with a sports doctor, specializing in orthopedics. He put me on an oral steroid, which made me think I was cured for about 1 1/2 days before wearing off. He also referred me to a physical therapist who was a super nice guy but only made things worse in the 2 1/2 weeks he worked on me (3x per week). By the end of each physical therapy session I could barely walk to my car. My right foot would go completely numb (which never happened on its own) and I wanted to kick puppies and punch cars. My doctor said I could quit physical therapy and referred me to get an MRI.
The MRI showed that I had an unhealthy and bulging disc at L5-S1. This means the disc where the lowest lumbar (L) vertebra meets the upper sacral (S) vertebra, right below the belt (depending on how low you wear your pants).
Here’s what it looks like.
Healthy discs show up with whiteness in them – unhealthy ones are dark. And that poky part I circled is not good. That’s where the disc is bulging out and pressing on my sciatic nerve (the white band cutting through the middle of the picture, top to bottom). There’s another slight bulge three discs up. I also apparently have “congenitally short lumbar pedicles resulting in a predisposition for spinal canal stenosis”. Thanks, ancestors! What this means is there’s less room than usual for the nerves to hang out in the spinal canal, so when the disc bulges it can’t help but aggravate the nerve. Others might have the same disc bulge as me but never know it because they have more wiggle room.
After reviewing the MRI results, the doctor referred me to an orthopedic surgeon. Two weeks later, he reviewed everything and said the next step was a steroid injection. That happened yesterday and I currently feel better than I have in 4 months.
Here’s a picture I took of the x-ray showing a needle (bottom right) in my spine, filling it up with juicy goodness.
The puncture didn’t hurt much, but it did all manner of weirdness to my leg, especially down by my right ankle. I also found out that I have six lumbar vertebrae instead of the usual five. He counted twice via x-ray and then said, “You, sir, are an anomaly!” Apparently, about 10% of the population has this abnormality, which doesn’t usually cause any problems by itself.
The steroid is supposed to shrink and calm down the nerve long enough for the body to heal the disc and get things back to normal. Sometimes another round or two is required. And if it doesn’t help for long, the next step is surgery: a microdiscectomy, which is a minimally invasive slice in the back to slice off the bulging part of the disc. Since that destroys the annulus, or the crust that’s holding the gel in place (that’s the way I think of it and may not be anatomically accurate), scar tissue develops to hold things in place again. My surgeon says the surgery itself is very straightforward and safe, but recovery is about three months.
I also looked into several other solutions:
- Deep tissue massage – this gave me some temporary relief, but not much.
- Acupuncture – I didn’t try this, but I’ve heard from others that it can buy them a few days of relief at a time.
- Acupressure – I bought a mat from Amazon and would lie on it for 20 minutes most nights. It’s like a bed of nails. It’s supposed to encourage blood flow and do magical things. Maybe it helped a little.
- Magic Back Lumbar Support Stretcher – the jury is still out on this one, but it does seem to help.
- Inversion table – also seems to help. Hard to say in the short term.
- Spinal decompression treatments (the Axiom DRX 9000!), laser therapy, etc., from a chiropractor. I read this very well-done ad in a mailer and was almost convinced to throw down the $10,000 (some covered by insurance) for 20 treatments. I was ultimately convinced by Internet forums (I found spine-health.com to be very helpful and relatively unbiased) that DRX 9000 claims are dubious at best and the main benefit comes from the exercise part of the plan, which you can get without throwing down so much cash. I was also warned by two doctors and one physical therapist to not get any chiropractic adjustments in my current state. I don’t have anything against chiropractors and have been helped by them in the past, but I decided this wasn’t for me right now.
Pretty much every day something new arrived from Amazon and my wife would smile in that one way you’re all familiar with and say, “Hey, another back thing!” If Amazon sold hot tubs I’d probably be cured by now.
In my case, nothing could control the pain until the steroid injection. From what I gather from my doctors, there’s a sequence they go through from conservative solutions to invasive ones:
- Physical therapy
- Oral steroid (Prednisone)
- Steroid injection (possibly multiple)
I’m glad no one tried to rush me to surgery. I wish the path to what eventually worked would have been shorter, but at least I can be sure the more conservative steps didn’t work.
[Update a week later: I still have some pain, but it’s much lighter and less-sustained than before. My Igor gait is gone. Sitting for something I enjoy (a basketball game or a concert) is bearable but sitting for something I’m required to attend is still painful. I’m hopeful that things will continue to improve now that the nerve is less irritated. I walk at least 40 minutes a day and do McKenzie exercises and a few others.]
Here’s what I’d do differently next time:
- Go to a doctor sooner. I spent almost 2 months thinking this was piriformis syndrome (where the piriformis muscle in the hip pinches the sciatic nerve) and I just needed to do some stretches on my own. By the time I went to the doctor I was in serious pain and it was having a big impact on my daily activities.
- Start with a physiatrist instead of spending (wasting) time on a series of referrals. According to a large Back Pain Survey performed by Dava Sobel and Arthur C. Klein, the authors of Backache: What Exercises Work, the premier back doctor is a physiatrist. “These practitioners rarely prescribe drugs and do not perform surgery. They prefer instead to use individually prescribed exercise regimens and physical therapy to treat back pain.” This was the last specialist I was referred to, the one who did my steroid injection. He works closely with a surgeon and can refer me in that direction if that looks to be the best route.
- Don’t help people move.
Hopefully some of that is helpful to someone out there. May you find rapid relief. I’m currently working out my daily exercise routine and might post it later.