Suggest treatment for lower back pain

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Posted on Mon, 15 Jun 2015 in General Health
Question: Hi Dr XXXXXXX
You helped me months ago when I hurt my neck on my hot tub cover. I am back now with a lumbar problem.

On 5/3/15 I noticed my left glute started hurting after a 2 hour plane ride. I was sitting on the left side of my rear for most of the flight while tending to my child to my left. Over the next few weeks, the left-sided gluteal pain continued to worsen until I could no longer bend over to put on my pants. My mid lower back/sacrum area also hurt severely when I'd sneeze or cough.

On 5/14/15 I saw a sports medicine doctor who suspected a disk problem or SI joint issue. I had an MRI on 5/21/15. See attached report. I have a CD of images but do not have a way to upload the actual images via this computer. The gluteal pain still hurts but is better than it was.

I now have a lot of pain right over my lumbar spine in what I think is the L4-5 area. As of yesterday, I am also now having some tingling along the outside of my lower right calf and in my right foot (along the top and outside). I have no muscle weakness.

I am taking Advil in the morning and at night. I am alternating heat and ice trying to see what helps more. It hurts a lot to sit. Walking slowly and laying down feel best.

What would you recommend? How serous is this situation, and do you think it will resolve in time by itself? What do you suggest to resume my life and do you think this pain will resolve itself in time, or is there something else I need to do? Thank you!
doctor
Answered by Dr. Richard Jackson 8 hours later
Brief Answer:
Same problem as your neck

Detailed Answer:
this is actually the exact same problem you had before just in your back instead of your neck. how is your neck doing and what did you end up doing about it?
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Richard Jackson 23 minutes later
It is? How strange. The back pain is definitely more severe than the neck pain was. The severity of the neck pain went away in time although it still hurts occasionally.

What are your thoughts re my lumbar pain from reading my MRI report and hearing my symptoms? What would you recommend, and do I have a greater likelihood of herniating this L4-5 disk in the future?
doctor
Answered by Dr. Richard Jackson 23 minutes later
Brief Answer:
Yep

Detailed Answer:
yeah it's actually not strange if you think about it. the two places you use the most in your spine would have the same problems. the interesting part is that one can actually cause the other. when you change the way you walk you start to put pressure on areas not meant for strain. probably you have had that disc herniation at l4/5 for a while but it's just now causing you problems. you have what's called a dynamic radiculopathy meaning something you do, such as abnormal seating posture, can irritate the nerve roots. when you get tingling in the top of the foot and side of the calf it's an l5 nerve root so you already had a problem in your spine at that level and then you irritated the nerve with your posture. it will probably go away with time just like your neck. chiropractic therapy would probably work well for you since you have minimal arthritic disease and dynamic compression
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Richard Jackson 19 minutes later
Thanks. Before I run out of questions here, can you tell me what might help besides chiro? Should I ice? Heat? Rest? Anything I should or should not do? How can I calm the nerve roots? Sneezing is excruciating. Am I at increased risk for herniation of L5?
doctor
Answered by Dr. Richard Jackson 23 minutes later
Brief Answer:
Everyone is different

Detailed Answer:
Hard to say what will work best for you. The reason the muscles hurt is because the nerve going to them is irritated. To treat the nerve you have to calm the inflammation around it. Medically prednisone works best. Non medically you have to try to keep from continuing to irritate it.

It improves in the same way it worsened so it will get better in the calf, then the thigh, then the gluts and finally the back but it's takes months just like your neck.

In the meantime heat is good for stretching when to not painful, physical therapy or googling radiculopathy stretches is probably second best. Ice is for pain control of the muscles that are hurting. Basically try to avoid anything that makes your back or the muscles hurt because you'll keep the cycle going. You will undoubtedly go through this and the neck again. Catching it early and correcting the problem is the key. Your disc at l5 is now weak and at higher risk for further herniation in the future. use good lifting techniques ect and you can minute the risk but you can't predict things like car accidents, falls,etc. You can go about your normal life. Even if you irritate further it's just pain not anything life threatening even though it feels like your leg is being torn off.

Hope this helps
Above answer was peer-reviewed by : Dr. Prasad
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Dr. Richard Jackson

Neurologist

Practicing since :2010

Answered : 120 Questions

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