Brief Answer:
Your symptoms are consistent with a lower back syndrome- L3/L4 likely

Detailed Answer:
I've read your symptoms and can tell you with fair confidence, based upon your symptoms that you are describing one of the several LOWER BACK SYNDROMES which likely involves the L3/L4 disc which appears to have PROLAPSED (herniated). When I first read your description I thought that your "small" dog that you moved was 245 lbs.!! HAHA!! I had to read it 3x to get the idea that YOU weighed 245 lbs. LOL....For a minute I thought you were the reincarnation of XXXXXXX Bunyon and you were moving Blue's calf off your bed.....(recall Blue was Bunyon's Blue Ox!)....so anyways, crazy as it sounds...unfortunately herniated disks can happen just that quickly and without any warning as one performs all sorts of routine activities that they've done 1000x before. For whatever reason, maybe the way you turned, the way you lifted the pooch, the way it may have squirmed and maybe you didn't want to exert a lot of force upon it so you allowed your back to take the brunt of the lift...perhaps the puppy was lower to the ground and you would've been better off FLEXING THE KNEES, cradling the do, and then, standing straight up as opposed what you likely did which was to bend over at the waist and then, try to lift a load strictly with your back instead of your legs. Maybe the dog is not as small as it USED TO BE?? Lots of variables to figure out exactly WHY this happened.

But nevertheless, it happened and your symptoms are entirely consistent with compression by the L3/L4 disk of the L3 nerve root itself along with some elements in all likelihood of some L4 nerve root compression. Unfortunately, the file you included is not readable on my end very well so I cannot see what you are trying to illustrate but it is not uncommon for MRI's to be absent in demonstrating XXXXXXX herniations. This is especially true in the lumbosaral spine where many more nerves need to bunch together and be open for irritation or damange from disks that are either protruding or "exuding" at specific levels.

I'm not certain what question you might be asking since you have merely stated examination results but if you are wondering why after 3 weeks symptoms have not yet abated or if your question is "next step?" well, then, I will tell you that 3 weeks is not a long time to pass in a situation like this. Compressive radiculopathies (and this sounds to be one) can takes months or even years to fully heal and depending on how aggressive you are both in physical therapy as well as how EARLY you return to normal activities (which is what everyone's concern seems to be) then, the time span to healing changes.

If I were your treating neurologist I would order an EMG/NCV at this point to see where the electrical blocks or slow downs may be since clinically we have a good idea where but if the MRI is not showing it then, we need electrical to confirm. I would also likely either redo the MRI or take a PERSONAL LOOK at the axial images because if the sagittal (side view) sequences don't show anything significant I would be very surprised if good axials don't show something. Most herniations occur "backwards and to the side" (POSTEROLATERALLY) and so I get if a sagittal image may not show everything since lateral movement of the nucleus pulposus is in the same plane as one is visualizing from the profile view. But I'll bet the AXIALLY (looking top down) something is right in the L3/4 area....I doubt it's farther down based on the clinical symptoms and reflex signs you mention though you also didn't mention other things that I'd look for as being NORMAL in the neurological exam so I don't know about your ankle jerk, foot/ankle movements etc. You've not said much about sensations that we usually test for either since this type of pathology usually involves sensory as well as motor.

At any rate, my money is going to be mainly on an L3/4 pathology as you've described it and I would invoke and electrical study as well as either redo the MRI or have the one that's already done get REREAD by the neurologist asking that they carefully read the AXIAL images to see if somethin in the L3/4 region isn't amiss and POSSIBLE compressing the L3 nerve root and maybe a bit of the L4 nerve root as well.

(incidentally, the L4 reflex you mention involves the knee and this is actually mixed with L3 fibers involved as well...so the likelihood is that both nerve root fibers are affected by giving you an absence of the knee reflex). Also, did the examiner try reinforcement maneuvers for that patellar reflex such as the JENDRASSIK maneuver or was it just a tap on the knee?

You've not said much in terms of intervention except the Medrol Dose pak...probably minimally helpful from a functional perspective but we doctors HAVE to give people SOMETHING, don't we for them to feel like we did anything for them! LOL....One of my favorite recommendations for herniated disk syndromes of the lower back is aquatherapy and to be more specific, I LOVE WATER JOGGING....terrific exercise that anyone can do for PROLONGED periods of time in the pool or on a treadmill (which is in the pool) without hurting themselves or hurting their hernia until it consolidates. And of course, there are ANTI-INFLAMMATORIES such as Motrin, Advil, Naproxen, etc. Diclofenac is a very good one which is time tested....so is Motrin...but it probably has the worst reputation when it comes to stomach upset.....

If I've provided useful or helpful information to your question could you do me the utmost of favors by CLOSING THE QUERY along with a few positive words of feedback and maybe even a 5-star rating if you feel it is deserving?

I am definitely interested in getting updated information on your condition if you'd care to drop me a line at www.bit.ly/drdariushsaghafi and let me know how things turned out.

You can always reach me at the above address for this and other questions. I wish you the best with everything and hope our discussion has aided in your understanding of a few concepts related to your concerns.

CHEERS!

This query required 35 minutes of professional time to research, assimilate, and file a response.

---

Brief Answer:
Your symptoms are consistent with a lower back syndrome- L3/L4 likely

Detailed Answer:
I've read your symptoms and can tell you with fair confidence, based upon your symptoms that you are describing one of the several LOWER BACK SYNDROMES which likely involves the L3/L4 disc which appears to have PROLAPSED (herniated). When I first read your description I thought that your "small" dog that you moved was 245 lbs.!! HAHA!! I had to read it 3x to get the idea that YOU weighed 245 lbs. LOL....For a minute I thought you were the reincarnation of XXXXXXX Bunyon and you were moving Blue's calf off your bed.....(recall Blue was Bunyon's Blue Ox!)....so anyways, crazy as it sounds...unfortunately herniated disks can happen just that quickly and without any warning as one performs all sorts of routine activities that they've done 1000x before. For whatever reason, maybe the way you turned, the way you lifted the pooch, the way it may have squirmed and maybe you didn't want to exert a lot of force upon it so you allowed your back to take the brunt of the lift...perhaps the puppy was lower to the ground and you would've been better off FLEXING THE KNEES, cradling the do, and then, standing straight up as opposed what you likely did which was to bend over at the waist and then, try to lift a load strictly with your back instead of your legs. Maybe the dog is not as small as it USED TO BE?? Lots of variables to figure out exactly WHY this happened.

But nevertheless, it happened and your symptoms are entirely consistent with compression by the L3/L4 disk of the L3 nerve root itself along with some elements in all likelihood of some L4 nerve root compression. Unfortunately, the file you included is not readable on my end very well so I cannot see what you are trying to illustrate but it is not uncommon for MRI's to be absent in demonstrating XXXXXXX herniations. This is especially true in the lumbosaral spine where many more nerves need to bunch together and be open for irritation or damange from disks that are either protruding or "exuding" at specific levels.

I'm not certain what question you might be asking since you have merely stated examination results but if you are wondering why after 3 weeks symptoms have not yet abated or if your question is "next step?" well, then, I will tell you that 3 weeks is not a long time to pass in a situation like this. Compressive radiculopathies (and this sounds to be one) can takes months or even years to fully heal and depending on how aggressive you are both in physical therapy as well as how EARLY you return to normal activities (which is what everyone's concern seems to be) then, the time span to healing changes.

If I were your treating neurologist I would order an EMG/NCV at this point to see where the electrical blocks or slow downs may be since clinically we have a good idea where but if the MRI is not showing it then, we need electrical to confirm. I would also likely either redo the MRI or take a PERSONAL LOOK at the axial images because if the sagittal (side view) sequences don't show anything significant I would be very surprised if good axials don't show something. Most herniations occur "backwards and to the side" (POSTEROLATERALLY) and so I get if a sagittal image may not show everything since lateral movement of the nucleus pulposus is in the same plane as one is visualizing from the profile view. But I'll bet the AXIALLY (looking top down) something is right in the L3/4 area....I doubt it's farther down based on the clinical symptoms and reflex signs you mention though you also didn't mention other things that I'd look for as being NORMAL in the neurological exam so I don't know about your ankle jerk, foot/ankle movements etc. You've not said much about sensations that we usually test for either since this type of pathology usually involves sensory as well as motor.

At any rate, my money is going to be mainly on an L3/4 pathology as you've described it and I would invoke and electrical study as well as either redo the MRI or have the one that's already done get REREAD by the neurologist asking that they carefully read the AXIAL images to see if somethin in the L3/4 region isn't amiss and POSSIBLE compressing the L3 nerve root and maybe a bit of the L4 nerve root as well.

(incidentally, the L4 reflex you mention involves the knee and this is actually mixed with L3 fibers involved as well...so the likelihood is that both nerve root fibers are affected by giving you an absence of the knee reflex). Also, did the examiner try reinforcement maneuvers for that patellar reflex such as the JENDRASSIK maneuver or was it just a tap on the knee?

You've not said much in terms of intervention except the Medrol Dose pak...probably minimally helpful from a functional perspective but we doctors HAVE to give people SOMETHING, don't we for them to feel like we did anything for them! LOL....One of my favorite recommendations for herniated disk syndromes of the lower back is aquatherapy and to be more specific, I LOVE WATER JOGGING....terrific exercise that anyone can do for PROLONGED periods of time in the pool or on a treadmill (which is in the pool) without hurting themselves or hurting their hernia until it consolidates. And of course, there are ANTI-INFLAMMATORIES such as Motrin, Advil, Naproxen, etc. Diclofenac is a very good one which is time tested....so is Motrin...but it probably has the worst reputation when it comes to stomach upset.....

If I've provided useful or helpful information to your question could you do me the utmost of favors by CLOSING THE QUERY along with a few positive words of feedback and maybe even a 5-star rating if you feel it is deserving?

I am definitely interested in getting updated information on your condition if you'd care to drop me a line at www.bit.ly/drdariushsaghafi and let me know how things turned out.

You can always reach me at the above address for this and other questions. I wish you the best with everything and hope our discussion has aided in your understanding of a few concepts related to your concerns.

CHEERS!

This query required 35 minutes of professional time to research, assimilate, and file a response.

---

Brief Answer:
No change in diagnostic impression nor suggested plan to treat

Detailed Answer:
Thanks for the additional information. Your concern for climbing down stairs is a legitimate one which by the clinical description seems to PRIMARILY include weakness in hip and leg adductors and/or knee extensors. Since I have not had the opportunity to personally examine you I cannot be certain of your distribution of muscle weakness. However, the most common problem for folks going DOWN stairs is buckling in the knees and probably the next most common would be inability to keep the leg stabilized when the bodyweight is shifted to that limb on the stepping down phase. These are the 2 moments in time when most people run the highest risk for falls. In both those instances (hip/leg adductors and knee extensors) the L3, L4 nerve roots are involved and this is consistent with the previous diagnosis I'd given you in the other response.

The pain upon standing seems more in line with an L1 or L2 type of sensory pathology but then, again it could be a mechanical phenomenon of causing pain in the hip joint due to weakened hip and knee muscles as opposed to a neuropathic pain generated by actual physical irritation of the L1 or L2 nerve roots which would then, suggest a more widespread type of problem. However, with a NEGATIVE MRI that seems a bit unlikely.

It sounds as if things are actually getting a little better over the past 3 weeks since you are including more than just SITTING as part of your activities. Bottom line is that your symptoms do continue to fit a scenario that would primarily involve some type of pathology involving the L3 and L4 nerve roots with heavier emphasis on the L3 nerve root BUT once again, I make a disclaimer that without having been able to carry out my own IN-DEPTH NEUROLOGICAL examination of both the motor and sensory integrity of your lumbar spinal nerves I can't really tell you with as much confidence which nerve root is affected than the other...and there certainly is room for additional nerve roots to be involved either proximally to L3 or distally from L4 (though so far you've presented very little evidence of either L5 or S1 involvement).

Again, you've not said what if any PHYSICAL THERAPY program you are currently enrolled in and just you know that if I had my druthers with you....I'd have you on a nice steady diet of AQUATHERAPY to range those lower limbs to their fullest extent and I'd be including strengthening exercises for the leg/hip adductors as well as hip extensors.

Epidural injections (in my experience) are a very temporary fix in most folks who are in neuropathic pain from something like this and they should not be injected more than a several times in a year due to the possible negative actions that some of the ingredients (including steroids) can have on the connective tissues such as tendons and ligaments and even directly on muscles. If your pain is critical to your quality of life then, I would definitely try the NONSTEROIDAL class of medications previously mentioned up top and I might even try other anti-neuropathic agents such as tricyclic compounds or even calcium channel blockers. I might also try agents such as gabapentin, pregabalin. duloxetine, and then, calcium channel blockers. I would try those oral medications before EPIDURAL INJECTIONS.

With good physical therapy support and guidance the amount of pain can be significantly reduced in someone such as yourself so as to perhaps be able to avoid injections suggested altogether but of course, if you've given it the old "college try" and you still get nowhere and the pain is really affecting your quality of life then, I would go to the injections.

Using the hip and leg on the affected side is a tricky question because of course, I would not suggest total immobility at this point. I believe a certain amount of stretching, ranging of motion, and normal activities of daily living in terms of ambulation, etc. is a very good thing to do for someone who is convalescing as you are....make Sense? Totally staying off the leg is both EXTREMELY DIFFICULT and could result in other unwanted complications such as a frozen or more stiff joint than what you might be experiencing now. I would ask to be enrolled in a good physical activity (AQUATHERAPY) program and I would also ask (as the doctor in the case) the physical therapists to really get aggressive with your stretching and usage exercises during water jogging or underwater treadmilling.

I very much like the idea of HEAT THERAPY given to the back, hip, and knee if there is bothersome pain and might even look to order DIATHERMY combined with ULTRASOUND as another facet to treat conservatively before resorting to epidural or facet injections of any sort....and also I'm taking into account that you are definitely showing signs of improvement.....a good PHYSICAL THERAPY program done not just at the time of therapy but independently may really start accelerating the healing process.

Remember, injections for pain do NOTHING for the healing process....PHYSICAL THERAPY done properly and DAILY (in one form or another)... are like studying for a test a little bit at a time each night instead of cramming the night before....you know what I mean?
Once again I'm grateful for your coming back with a follow up question and if I'd added additional information of a useful nature would appreciate your CLOSING THE QUERY along with POSITIVE feedback and a 5-star rating if you feel the spirit move you in that direction?

Please drop me a line at www.bit.ly/drdariushsaghafi and let me know how things evolve and what the EMG or repeat imaging studies might show.

You can always reach me at the above address for this and other questions. I wish you the best with everything and hope our discussion has aided in your understanding of a few concepts related to your concerns.

CHEERS!

This query required 95 minutes of professional time to research, assimilate, and file a response.

---

Brief Answer:
No change in diagnostic impression nor suggested plan to treat

Detailed Answer:
Thanks for the additional information. Your concern for climbing down stairs is a legitimate one which by the clinical description seems to PRIMARILY include weakness in hip and leg adductors and/or knee extensors. Since I have not had the opportunity to personally examine you I cannot be certain of your distribution of muscle weakness. However, the most common problem for folks going DOWN stairs is buckling in the knees and probably the next most common would be inability to keep the leg stabilized when the bodyweight is shifted to that limb on the stepping down phase. These are the 2 moments in time when most people run the highest risk for falls. In both those instances (hip/leg adductors and knee extensors) the L3, L4 nerve roots are involved and this is consistent with the previous diagnosis I'd given you in the other response.

The pain upon standing seems more in line with an L1 or L2 type of sensory pathology but then, again it could be a mechanical phenomenon of causing pain in the hip joint due to weakened hip and knee muscles as opposed to a neuropathic pain generated by actual physical irritation of the L1 or L2 nerve roots which would then, suggest a more widespread type of problem. However, with a NEGATIVE MRI that seems a bit unlikely.

It sounds as if things are actually getting a little better over the past 3 weeks since you are including more than just SITTING as part of your activities. Bottom line is that your symptoms do continue to fit a scenario that would primarily involve some type of pathology involving the L3 and L4 nerve roots with heavier emphasis on the L3 nerve root BUT once again, I make a disclaimer that without having been able to carry out my own IN-DEPTH NEUROLOGICAL examination of both the motor and sensory integrity of your lumbar spinal nerves I can't really tell you with as much confidence which nerve root is affected than the other...and there certainly is room for additional nerve roots to be involved either proximally to L3 or distally from L4 (though so far you've presented very little evidence of either L5 or S1 involvement).

Again, you've not said what if any PHYSICAL THERAPY program you are currently enrolled in and just you know that if I had my druthers with you....I'd have you on a nice steady diet of AQUATHERAPY to range those lower limbs to their fullest extent and I'd be including strengthening exercises for the leg/hip adductors as well as hip extensors.

Epidural injections (in my experience) are a very temporary fix in most folks who are in neuropathic pain from something like this and they should not be injected more than a several times in a year due to the possible negative actions that some of the ingredients (including steroids) can have on the connective tissues such as tendons and ligaments and even directly on muscles. If your pain is critical to your quality of life then, I would definitely try the NONSTEROIDAL class of medications previously mentioned up top and I might even try other anti-neuropathic agents such as tricyclic compounds or even calcium channel blockers. I might also try agents such as gabapentin, pregabalin. duloxetine, and then, calcium channel blockers. I would try those oral medications before EPIDURAL INJECTIONS.

With good physical therapy support and guidance the amount of pain can be significantly reduced in someone such as yourself so as to perhaps be able to avoid injections suggested altogether but of course, if you've given it the old "college try" and you still get nowhere and the pain is really affecting your quality of life then, I would go to the injections.

Using the hip and leg on the affected side is a tricky question because of course, I would not suggest total immobility at this point. I believe a certain amount of stretching, ranging of motion, and normal activities of daily living in terms of ambulation, etc. is a very good thing to do for someone who is convalescing as you are....make Sense? Totally staying off the leg is both EXTREMELY DIFFICULT and could result in other unwanted complications such as a frozen or more stiff joint than what you might be experiencing now. I would ask to be enrolled in a good physical activity (AQUATHERAPY) program and I would also ask (as the doctor in the case) the physical therapists to really get aggressive with your stretching and usage exercises during water jogging or underwater treadmilling.

I very much like the idea of HEAT THERAPY given to the back, hip, and knee if there is bothersome pain and might even look to order DIATHERMY combined with ULTRASOUND as another facet to treat conservatively before resorting to epidural or facet injections of any sort....and also I'm taking into account that you are definitely showing signs of improvement.....a good PHYSICAL THERAPY program done not just at the time of therapy but independently may really start accelerating the healing process.

Remember, injections for pain do NOTHING for the healing process....PHYSICAL THERAPY done properly and DAILY (in one form or another)... are like studying for a test a little bit at a time each night instead of cramming the night before....you know what I mean?
Once again I'm grateful for your coming back with a follow up question and if I'd added additional information of a useful nature would appreciate your CLOSING THE QUERY along with POSITIVE feedback and a 5-star rating if you feel the spirit move you in that direction?

Please drop me a line at www.bit.ly/drdariushsaghafi and let me know how things evolve and what the EMG or repeat imaging studies might show.

You can always reach me at the above address for this and other questions. I wish you the best with everything and hope our discussion has aided in your understanding of a few concepts related to your concerns.

CHEERS!

This query required 95 minutes of professional time to research, assimilate, and file a response.

---

Brief Answer:
Now you can appreciate my trepidation for epidurals as first choice options

Detailed Answer:
So sorry, that the epidural you chose to have done didn't work.

Now, you may appreciate the type of scenario I see in my patients on a regular basis that makes me wonder why other modalities of treatment are not considered first since injections very often times fail. You should be talking directly with the injector who performed the procedure to get their perspective on what may have happened (or NOT happened) because anything I say about the fact that you are still experiencing is speculative since I have neither examined you nor do I have any knowledge of how the doctor approached you or performed the injection.

If you'll reread the paragraph I wrote about injections you'll see just how XXXXXXX WARM I was when you mentioned the fact that you were going for injections.

I am very judicious in the patients I send for injections and I only send them to people whose track record I'm familiar with since it is a procedure that carries a high degree of expectation on the part of not only the patient but of the REFERRING DOC. If I as a doc send you (my patient) to someone for an epidural and you tell me that after 24 hrs. you are still in pain and discomfort.....I would feel that the failure reflected on me as much as the doctor to whom I referred you....do you agree?

In my opinion, the mechanism of the pain should be analyzed indepth before injecting someone and one should always narrow down the anatomy as much as possible through imaging studies, etc. to make sure that the right level is being injected. Again, in this case it is very difficult to even hazard a guess as to why you're not experiencing any relief since I don't know what level the shots were placed, how the needle may have been angled, your position during the epidural, whether the injector had any difficulties with needle placement or insertion, etc. These are all possible factors that can contribute to either failure or reduced efficacy.

And so again, while I can certainly list all of these as possible issues that could explain why your injection didn't work....all of them are speculative on my part. The only person who can vouch and talk to you about the technique and decision to inject in the first place given the data they had after examining would be the doctor.

In my opinion, in a patient whose MRI was clear and free from showing any nerve root impingements I would've considered that a red flag to injecting since the lack of at least visual evidence as to exactly which nerve or nerve roots were involved makes injecting the right place very difficult. Imagine your being told that you are throwing a ball for a teammate in a bowling tournament and it is up to you to pick up the spare. The only problem is you are given absolutely no information on which pins were knocked down....all you know is you've got to pick up the spare......would you have even a CLUE as to where to aim your ball?

Likewise, you've got an MRI that shows you no location where there appears to be encroachment, disk protrusions, bulges, herniations, or any other significant defects to explain your pain symptoms. In fact, the evidence you present (when taken in context with a negative MRI is highly suggestive of a MECHANICAL PROBLEM in the hip joint or leg...probably hip joint....and I think the low back is the least likely place to find pathology to explain symptoms based upon your story of how the pain is generated by bearing weight. That would make me second guess the idea of an epidural and either do more EXAMINATION or different imaging studies looking at other possibilities.

I would be much more confident if I could examine you and watch you walk as well as navigate stairs but just from what you're saying I would say that you could be having 1 of 2 issues for which an epidural would definitely NOT be helpful.

The first and perhaps slightly less likely condition would be a mild DISLOCATION of the hip joint on the side where you're experiencing pain. Usually, such injuries occur as the result of an obvious trauma like a fall, a skiing accident, a tumble, down stairs, or a hard hit in a football or rugby game where the head of the femur jars loose and is not outside of the confines of the joint capsule where it is being held in place by muscles and ligaments. In your case, I suppose it is possible that lifting your dog could be the trigger that caused the problem or it was just SPONTANEOUS and would've happened anyway even without lifting the dog. The pain you refer in the low back on the left side though while SEATED with ALLODYNIA over the skin in that region is consistent, HOWEVER, with a hip pathology.

The second and more likely possibility in my opinion is a THIGH STRAIN of either muscles or ligaments of the quads themselves which can cause a good deal of pain and burning in the thigh and especially become even more tender as you contract and relax the muscle as happens when walking or when climbing or descending stairs.

In any case, either of these 2 scenarios would be highly UNRESPONSIVE to epidurals since they involve so many other nerves and nerve roots other than the one that would've been blocked on the injection.

Therefore, my recommendation is that you be either evaluated by an orthopod who will do a bit more of a focused examination this time on your hip joint as well as the affected thigh muscles and/or hip girdle and not worry so much of the back since we have compelling proof nothing significant back there is the cause of the problem.

Another specialist that could probably do a very good job examining you and making some recommendations would be a PHYSICAL MEDICINE and REHABILITATION specialist (PM&R docs we call them). A really spot on PHYSICAL THERAPIST or REHABILITATION SPECIALIST would also have the ability to assess and identify either of these problems with a high degree of accuracy.

If the problem is SUBLUXATION (i.e. dislocation) then, obviously the FIX is to reduce the sublux'ed joint back into place. If you've never had that done...let me advise you that you may want to ask for a little anesthetic relief before they call in their STRONG BOYS to het your leg back into joint.....not trying to scare you but just giving the heads up as to how many people you may need to assist in case of subluxation. If on the other hand it is thigh muscle or tendon STRAIN then, rest, anti-inflammatory medication, thermal intervention, massage, and then, MORE REST will be the ticket to functional recovery.

Again, good sir: If I've provided useful information to your question would you consider CLOSING THE QUERY along with some positive feedback and maybe even a second 5-star rating if you feel I've done an adequate job covering the bases?

As before, I'm interested in knowing what direction your doctors plan on going in order for me to better help answer any questions you may have should you still require assistance.

You can always reach me at the above address for this and other questions. I wish you the best with everything and hope our discussion has aided in your understanding of a few concepts related to your concerns.

CHEERS!

This query required 155 minutes of professional time to research, assimilate, and file a response.

---

Brief Answer:
Now you can appreciate my trepidation for epidurals as first choice options

Detailed Answer:
So sorry, that the epidural you chose to have done didn't work.

Now, you may appreciate the type of scenario I see in my patients on a regular basis that makes me wonder why other modalities of treatment are not considered first since injections very often times fail. You should be talking directly with the injector who performed the procedure to get their perspective on what may have happened (or NOT happened) because anything I say about the fact that you are still experiencing is speculative since I have neither examined you nor do I have any knowledge of how the doctor approached you or performed the injection.

If you'll reread the paragraph I wrote about injections you'll see just how XXXXXXX WARM I was when you mentioned the fact that you were going for injections.

I am very judicious in the patients I send for injections and I only send them to people whose track record I'm familiar with since it is a procedure that carries a high degree of expectation on the part of not only the patient but of the REFERRING DOC. If I as a doc send you (my patient) to someone for an epidural and you tell me that after 24 hrs. you are still in pain and discomfort.....I would feel that the failure reflected on me as much as the doctor to whom I referred you....do you agree?

In my opinion, the mechanism of the pain should be analyzed indepth before injecting someone and one should always narrow down the anatomy as much as possible through imaging studies, etc. to make sure that the right level is being injected. Again, in this case it is very difficult to even hazard a guess as to why you're not experiencing any relief since I don't know what level the shots were placed, how the needle may have been angled, your position during the epidural, whether the injector had any difficulties with needle placement or insertion, etc. These are all possible factors that can contribute to either failure or reduced efficacy.

And so again, while I can certainly list all of these as possible issues that could explain why your injection didn't work....all of them are speculative on my part. The only person who can vouch and talk to you about the technique and decision to inject in the first place given the data they had after examining would be the doctor.

In my opinion, in a patient whose MRI was clear and free from showing any nerve root impingements I would've considered that a red flag to injecting since the lack of at least visual evidence as to exactly which nerve or nerve roots were involved makes injecting the right place very difficult. Imagine your being told that you are throwing a ball for a teammate in a bowling tournament and it is up to you to pick up the spare. The only problem is you are given absolutely no information on which pins were knocked down....all you know is you've got to pick up the spare......would you have even a CLUE as to where to aim your ball?

Likewise, you've got an MRI that shows you no location where there appears to be encroachment, disk protrusions, bulges, herniations, or any other significant defects to explain your pain symptoms. In fact, the evidence you present (when taken in context with a negative MRI is highly suggestive of a MECHANICAL PROBLEM in the hip joint or leg...probably hip joint....and I think the low back is the least likely place to find pathology to explain symptoms based upon your story of how the pain is generated by bearing weight. That would make me second guess the idea of an epidural and either do more EXAMINATION or different imaging studies looking at other possibilities.

I would be much more confident if I could examine you and watch you walk as well as navigate stairs but just from what you're saying I would say that you could be having 1 of 2 issues for which an epidural would definitely NOT be helpful.

The first and perhaps slightly less likely condition would be a mild DISLOCATION of the hip joint on the side where you're experiencing pain. Usually, such injuries occur as the result of an obvious trauma like a fall, a skiing accident, a tumble, down stairs, or a hard hit in a football or rugby game where the head of the femur jars loose and is not outside of the confines of the joint capsule where it is being held in place by muscles and ligaments. In your case, I suppose it is possible that lifting your dog could be the trigger that caused the problem or it was just SPONTANEOUS and would've happened anyway even without lifting the dog. The pain you refer in the low back on the left side though while SEATED with ALLODYNIA over the skin in that region is consistent, HOWEVER, with a hip pathology.

The second and more likely possibility in my opinion is a THIGH STRAIN of either muscles or ligaments of the quads themselves which can cause a good deal of pain and burning in the thigh and especially become even more tender as you contract and relax the muscle as happens when walking or when climbing or descending stairs.

In any case, either of these 2 scenarios would be highly UNRESPONSIVE to epidurals since they involve so many other nerves and nerve roots other than the one that would've been blocked on the injection.

Therefore, my recommendation is that you be either evaluated by an orthopod who will do a bit more of a focused examination this time on your hip joint as well as the affected thigh muscles and/or hip girdle and not worry so much of the back since we have compelling proof nothing significant back there is the cause of the problem.

Another specialist that could probably do a very good job examining you and making some recommendations would be a PHYSICAL MEDICINE and REHABILITATION specialist (PM&R docs we call them). A really spot on PHYSICAL THERAPIST or REHABILITATION SPECIALIST would also have the ability to assess and identify either of these problems with a high degree of accuracy.

If the problem is SUBLUXATION (i.e. dislocation) then, obviously the FIX is to reduce the sublux'ed joint back into place. If you've never had that done...let me advise you that you may want to ask for a little anesthetic relief before they call in their STRONG BOYS to het your leg back into joint.....not trying to scare you but just giving the heads up as to how many people you may need to assist in case of subluxation. If on the other hand it is thigh muscle or tendon STRAIN then, rest, anti-inflammatory medication, thermal intervention, massage, and then, MORE REST will be the ticket to functional recovery.

Again, good sir: If I've provided useful information to your question would you consider CLOSING THE QUERY along with some positive feedback and maybe even a second 5-star rating if you feel I've done an adequate job covering the bases?

As before, I'm interested in knowing what direction your doctors plan on going in order for me to better help answer any questions you may have should you still require assistance.

You can always reach me at the above address for this and other questions. I wish you the best with everything and hope our discussion has aided in your understanding of a few concepts related to your concerns.

CHEERS!

This query required 155 minutes of professional time to research, assimilate, and file a response.

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