[likemike]

Hello

I am a 33yr old male of average height/weight and for the past 2 years have had recurring back and right buttock pain which usually subsided on it's own within a week to 2 weeks but my last episode has lasted 2 months now and is different then the rest in that for the first month and a half the pain was only
in my lower back and right buttock but about 2 weeks ago the pain seemed to lessen in my back and moved from my buttock down to the bend of my leg which in the past week has again moved from the bend of my knee down to my right calf and I do have some slight numbness in my right foot but for the most part it does not really bother me.

Anyway about a month ago I left my job because of the pain and a week ago I had my first MRI which showed I had a herniated disc on L5/S1 and was told I should go see a neuro but after shelling out over $2000.00 on the MRI (I don't have insurance) I cannot afford to go to the neuro so I found this forum while search the net for some advise and so here are my questions.


1.) Is the pain moving down from my buttock to my knee area and finally to my calf a normal thing ?

2.) If so does that mean it's getting worse or better ?

(I must say I can tolerate the pain in my leg better then I could when it was in my buttocks and I only take tylenol PM at nite to help me sleep and I don't take anything during the day on most days but I have been taking it easy for the past month or so)

3.) I would really like to go back to work but I am concerned because my job entails that I sit at a desk and my shifts are 10 hours long. I can get up and walk around every hour or so and I have the normal 30 min lunch break so I guess my question here is what can I do to during my off hours and during my breaks to keep my condition from getting worse or is it to soon to consider going back to work ?


Finally I just wanted to say thank you to everyone that does take the time to read this message and offers me some advise I do appreciate it tremendously.

Cheers,
Mike

[Chemar]

Hi Mike

I dont have info on your condition but I did want to welcome you to NeuroTalk

I am sure others with more knowledge on spinal matters will be along soon to offer insight

Cheri

[Bobbi]

Mike,

Without citing the city where you live, would you mind sharing which state? There are several areas that offer low to no cost health care; some, base services on ability to pay (sliding scale) and others, some services are free.

Do you have a copy of the MRI report/the radiologist's notations?

If so, please post the section under Findings or Impressions.

It could be sciatica, nerve compression or radiculopathy, but, only a medical professional would be able to determine that for sure.

The answer to your #1 Q.: No, it's not normal.

The answer to your #1 Q. may also answer your #2 Q.: Is pain "normal"? No. It's an indication that something isn't "normal."

You might want to do some reading at ChiroGeek's site, i.e.:

http://www.chirogeek.com/000_Sciatica_General_Infor.htm

[likemike]

I don't mind sharing my location. I live in Tennessee and I have already tried to apply for Tenncare (our states medicare system) but was denied and I went to the only free medical clinic in the city and the Dr. there was to say the least a joke. I went to him on 4 different occasions in the past 5 months and he told me there was nothing wrong with my back and to just do some stretching and I would be fine of course he was wrong and now my back is worse then it was when I first went to see him.

As far as the MRI report goes I was never given one however someone from the hospital I had the MRI done at called me on Monday to tell me that I did have an herniated disc on L5/S1 and I was given a cd when I had the MRI done which has images of all my scans and on them they do show herniation at that disc. Here is a sample of one of my scans

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I don't know if that helps answer any of my questions or not or if you can tell me if that is a mild herniation or a sever herniation just by looking at the image because I certainly don't have a clue.


Anyway my other question still does stand which is if I would be ok going back to work or not considering I sit in a chair for so long everyday and what can / should I do to minimize my chances of making this worse (like exercises or stretching or anything that I can do to keep things from getting worse but still having a somewhat normal life)


Thanks again in advance for your replies they really are appreciated.

Mike

[AK Kid]

First off Greetings from Alaska!

I visit your state a lot. I know that at the University of Memphis you could possibly talk to someone in the Human Performance Laboratories...if you are near Memphis that is. They could look at the pics and talk to you about your question regarding work.

You have one plus - a cd picture of your injury. If I were you and that free clinic were my only option I would show him a copy of the MRI. What I see from your picture is a L4-L5 herniation - (need a closer pic) but looks like your L5-S1 diminished space too -but cannot tell.

If you want to learn more about herniations - go to http://www.chirogeek.com/001_Tutorial_Birth_of_HNP.htm
This website helped me in learning about my back issues.

First off I am not a doctor but I would like to try to answer some of your questions -

1.) Is the pain moving down from my buttock to my knee area and finally to my calf a normal thing ? No - this sounds like you have a pinched nerve at the L5-S1 area of your back....called Sciatica.

2.) If so does that mean it's getting worse or better ? From what you described - and your pain levels combined with inability to work sounds like it is getting worse. There are stretches and heat/ice therapies that can help alleviate the pain - but you need to get this looked at. Sciatica from herniations is very very painful. I understand how you are feeling.

(I must say I can tolerate the pain in my leg better then I could when it was in my buttocks and I only take tylenol PM at nite to help me sleep and I don't take anything during the day on most days but I have been taking it easy for the past month or so) Taking it easy is the one of the right things to do along with keeping well hydrated, eating right and moving your legs if you can get physical therapy that would be helpful as well as chiropractic care. Tylenol PM would not cut it for me - I am on an NSAID, Muscle Relaxant, and a mild opiod.

3.) I would really like to go back to work but I am concerned because my job entails that I sit at a desk and my shifts are 10 hours long. I can get up and walk around every hour or so and I have the normal 30 min lunch break so I guess my question here is what can I do to during my off hours and during my breaks to keep my condition from getting worse or is it to soon to consider going back to work ?
Before you do anything else - appeal the decision by Tenncare - and go to Social Security as well. You really need to get to a doctor that would listen to your symptoms, look at the mri, and give you the right diagnosis.
If you decide to go back to work there are a number of strategies you can use to help with the pain. First request a orthopedic chair, 2nd have plenty of ice packs in the communal refridgerator and use religiously, 3rd during your breaks find someplace to lie down flat on your back and stretch it out and put your legs up on a chair, 4th get up and walk around frequently, 5th have a pillow to stabilize your back while sitting, and 6th have plenty of fluids - to keep joints and body hydrated. I know of some collegues that use the 8 hour heating pads that you can buy but those get quite expensive - and others that use aspercreme.

Good luck to you - and welcome

Kim

[likemike]

Thanks alot for your reply and I don't live near memphis so thats not really an option although I do live about 20 minutes away from the University of Tennessee, Knoxville campus so I might try calling them but I am not really sure what I need to say to the receptionist or what department to even ask for but guess I will find out when I call.

As for the free medical clinic goes I can no longer go there since you have to be working in order to go so as long as I stay out of work I can't go there either.

It's interesting you say it's the L4/L5 disc that is herniated and the guy from the hospital said it was L5/S1 herniation so which one is it or is it both. As far as pain goes I am not really suffering very much at all for what I expected with a disc herniation although I am in pain I have never felt that pins and needles thing most people talk about the the leg pain just feels like a bad cramp most of the time which is why I don't take anything other then a tylenol PM at nite I also don't have alot of numbness in my foot which is another thing I read alot about. I know I am one of the lucky ones when it comes to that or I have not had it long enough for it to get to that point, either way I don't have the same feeling most people seem to describe when they have a herniated disc.

I would also like to thank you for the advise about work. I have a heating pad that is built into a belt that I wear sometimes it doesn't seem to do alot but it does help a small amount. As far as ice goes I have tried it and it does nothing for me but make my back cold and sting so don't know bout that one.

The finding a place to lay down I think I can do on my lunch break in my car and like I said I take 5 minute breaks every hour and go outside to walk around so I could do some mild stretching at that time.

As for the water I have that covered I drink it like a fish (about 100 ounces a day) so I think I am pretty well hydrated. Eating hmmm thats a hard one because I barely eat anything these days because I have really bad stomach problems but I do eat healthy when I eat.

Finally I have a massaging back pillow that I bought about 2 months ago when I first started having the pain and use it most of the time so again I have that covered.

I will try to call the university in the morning to see what they might be albe to do for me other then that I think I am pretty ready to go back to work and even if I can't get the university to look at my charts I can at least go back to the free medical clinic once I have my job and show that Dr my scans and then he will not have a reason to not send me to a specialist.

I have rambled on enough it's time to take action and hopefully everything will work out in the end. I don't expect a miracle or anything I just want to be able to work and support myself like the majority of the rest of the world does thanks for the advise and allowing me to vent you all have been great.

Cheers,
Mike

[treesgirl]

Welcome Mike. I am also new here, but have already found a wealth of knowledge from other members.

I am 34 and have been dealing with a pretty large extruded disc at L4-5 along with a smaller herniation at the L5-S1. I have been taking a non-surgical route for almost 2 years now.

I am by no means a doctor, but i would highly suggest physical therapy. I think you could really benefit from PT!

HOW did you add that image into your message?

i have also wanted to see other peoples MRI's. I have spent hours on the internet looking for images of other people with similar MRI's -
it is just kind of fascinating to seen that we are not alone. it is so hard for people to understand that you have pain when they can't see it externally. kind of like if they don't see blood or bandages, it is hard for people to understand your pain.

That is what i like about this place thus far. Most people are sensitive and understanding because they also deal with pain...
if you would like to see my "ouchies"- click on the thumbnail...
; )



Again,
Welcome!
Theresa

[AK Kid]

Mike - the University of Memphis program I wrote about is as far as I know only in Memphis. They have studied back injuries extensively and I have spoken to staff there before regarding my back.

You could research the University of Tennessee near you and see if they have a comparable program.

Yes you are right - I looked at your MRI again and recounted your bones, it is the L5-S1 and the Sacrum has limited space. But like I said I am not a doctor. Regarding my MRI I relied on the report as presented by the radiologist. Funny that you did not get one with your films. According to my doctors what can floor me - it may not floor you - everyone is a individual - but know your symptoms.

Good luck in your endevors -

Sounds like you are doing everything right

[GJZH]

Mike,

Here is some information on Sciatica:

http://www.spine-health.com/topics/c.../sciaex01.html

http://spinetalk.conforums.com/index.cgi?board=Sciatica

Also you might want to read about spinal stenosis...

http://spinetalk.conforums.com/index.cgi?board=Stenosis

Spinal stenosis symptoms, diagnosis and treatment
Lumbar spinal stenosis

http://www.spine-health.com/topics/c...is/sten01.html


The term “stenosis” comes from Greek and means a “choking”. In lumbar spinal stenosis, the spinal nerve roots in the lower back are compressed, or choked, and this can produce symptoms of pain, tingling, weakness or numbness that radiates from the low back and into the buttocks and legs, especially with activity. Spinal stenosis in the neck can be far more dangerous by compressing the spinal cord itself and possibly leading to major body weakness or even paralysis. This is virtually impossible in the lumbar spine, however, as the spinal cord is not present in the lumbar spine.

In rare cases, lumbar spinal stenosis can go no further than to produce severe persistent disabling pain and even weakness in the legs. Most cases, however, have pain that radiates into the leg(s) with walking, and that pain will be relieved with sitting. This is called claudication which can also be caused by circulatory problems to the legs, as discussed later in this article.

Spinal stenosis is related to degeneration in the spine and usually will become significant in the 5th decade of life and extend throughout every subsequent age group. Most patients first visit their doctor with symptoms of spinal stenosis at about age 60 or so. Patients need only seek treatment for lumbar spinal stenosis if they no longer wish to live with significant activity limitations, such as leg pain and/or difficulty with walking.

Spinal stenosis can occur in a variety of ways in the spine. Approximately 75% of cases of spinal stenosis occur in the low back (lumbar spine), which is called

Practical point
Patients need only seek treatment for lumbar spinal stenosis if they no longer wish to live with leg pain that significantly limits their activities, such as difficulty with walking. lumbar spinal stenosis, and most will affect the sciatic nerve which runs along the back of the leg. When this happens, it is commonly called sciatica.

What is spinal stenosis?
The vertebral column in the spine and sacrum (at the bottom of the spine) is like a stack of blocks that serve to support the structures of the body. Each of these bony structures has additional bony attachments that serve to help stabilize the spine and to protect the spinal cord or nerves passing downward from the brain to organs, muscles and sensory structures of the body. Each vertebral body and its attachments and the disc between the adjacent vertebrae are known as a spinal segment. The entire length of the spinal column has a large central canal or passage through which the spinal cord descends, and holes to each side of the canal to allow emergence of spinal nerves at each level. The spinal cord stops at the upper part of the low back, and below that the tiny contained nerve rootlets descend loosely splayed out - like a horse’s tail – and are protectively enclosed in a long sack. All central nerve structures are protected further by membranes, with a tough outer membrane called the dura (tough) mater (mother).

Major types of stenosis include:

Foraminal stenosis. As the nerve root is about to leave the canal through a side hole (lateral foramen), a bone spur (osteophyte) that has already developed from a degenerating disc can press on that nerve root. This type of stenosis is also called lateral spinal stenosis. This is by far the most common form of spinal stenosis. 72% of cases of foraminal stenosis occur at the lowest lumbar level, trapping the emerging nerve root (which comprises a major part of the sciatic nerve).

Central stenosis. A choking of the central canal, called central spinal stenosis in the lumbar (low back) area can compress the sack containing the horse’s tail (cauda equina, or cauda equine) bundle of loose nerve filaments. Central spinal stenosis is more common at the second from the lowest lumbar spinal level and higher and is largely caused by a bulging of the disc margin plus a major overgrowth or redundancy of a ligament (ligamentum flavum) which is there to help protect the dura. This overgrowth is caused by segmental instability usually from a degenerating disc between adjacent vertebrae. The ligament arises from under the flat laminas of the vertebrae and the inside part of the facet joints (stabilizing joints located on each side at the back of the spine segments).

Far lateral stenosis. After the nerve has left the spinal canal it can also be compressed beyond the foramen byeither a bony spur protrusion or a bulging or herniated disc. When this happens, it is called far lateral stenosis.


These differences in anatomy may result in similar symptoms, which is why all forms of stenosis are typically referred to as simply ‘spinal stenosis’. However, if surgery is to be performed, the differences are very important in guiding the surgeon. That is, the bad spot(s) must be exactly known in advance to guide the approach for its proper treatment or removal.

[Bobbi]

Mike,

If you can/do go back to work, it is as AK Kid/Kim stated: ergonomics is crucial.

What I learned in PT is to roll up a towel and place it between a chair (even ones sold as being "ergonomic," which my office chairs have always been touted as by the sellers) and where the spine would naturally curve or arch; it adds the right type of support/positioning for posture to the lumbar spine.

As well, if you can stand - something I can barely do without support these days - stand against a wall for 10 mins or so a few times a day with your shoulders touching a wall and with your feet against the baseboard, without arching your spine, which should be having a touch point with the wall.

That's the "proper" alignment, but, again, that's also a lot easier for people without spinal conditions. But, if one can retain such posture, and make it a conscientious effort initially, it's supposed to become something that's a "staple" of living and done without thought after a time. In other words, it should get easier. If it doesn't go smoothly, though, don't beat up on yourself; I heard it from a PT whom was in great shape and minus spinal disease or conditions.

From what I've learned, over some years, after my spinal disease was dx'd (following a fall down a flight of stairs when my limbs were numb), lumbar surgery does not pan out with nearly the same "success" rate on fusion as does cervical spine fusion. I'm not saying that to scare you. Not at all. But, it may also be one of the reasons why so many insurance companies also "push" at least 12-weeks conservative approach toward treatment prior to even considering an authorization on invasive surgical proceedures.

Without insurance, I also would not rule out a teaching hospital, particularly if there is one within "reach."

This is an example of why I asked what state you're from:

http://neurotalk.psychcentral.com/sh...67&postcount=4

I am just so sorry you've been in so much pain. I also know how it feels to have the worry of no insurance looming; I recently went through a job transition and went through so much negotiating just to seal things to assure I had the insurance I preferred.


Treesgirl, I feel terrible about saying "welcome" since I know that you are also in pain, yet... I'm glad that you have found a place where you will also receive support and info.

Mike was able to include his image by linking from a photo image hosting site/server and using a hyperlink direct to the image.