Disc Bulge - Sciatica pain for 4 months

[gcoe]

Yes what you describe sounds a very typical sciatica. While only your clinicians can diagnose this, All of what you described fits the sciatica picture.

The right disc bulge visible on the MRI could well explain the incursion of the nerve root while the spondylolysthesis is probably unlikely to be the culprit - the shift sounds too minor. However all this has to be taken in perspective - the diagnostic accuracy based on an MRI is not that great and lots of people have sciatica without demonstrable signs on and MRI. Likewise you can have huge disc bulges and no symptoms.

The fact that you have "atrophy of the paraspinal muscle bulk" may indicate that you have back muscle weakness and/or those local muscles that control and stabilise those spinal segments may be disrupted. In the former case strengthening the back muscles may be warranted but you need help with this - doing it willy nilly might just set your leg off. In the latter case you may benefit from specific training of these local muscles to stabilise the segment and this could result in reduced irritation of the nerve.


If you are getting a lot of loss of feeling and a lot of weakness in the lower leg due to the nerve being impinged upon then the spinal consultant can advise you on surgery options. However if it is just pain and you are not getting any (or just mild) sensory and strength changes then there isn't much evidence for surgery helping you - and you may well be advised to stay clear of the knife.

If there is a dynamic component to the behaviour of the sciatica (ie certain movements consistently make matters worse and others consistently improve matters) a manipulative physiotherapist or a physiotherapist who is trained in the McKenzie method may be worth consulting. Sometimes very specific exercises (not just extension exercises) can really help.

I wouldn't be too concerned about the comment from the radiologist is causing "the disc deformity to be permanent" It isn't just a matter of the disc. It is the fact that the disc has irritated the nerve root - setting off an inflammatory process. If the inflammatory process dies down with a bit of luck it may stop being a problem for you. Lots of us have structural deformities of the spine and most cause us now problem. You can have the disc bulge there and it not cause you problems. Likewise having the disc taken out surgically may not necessarily fix things.

These are specific issues that a good MSK physio can assess and help you with. Whether or not any of these options help you there is some overarching general advice that you definitely should be doing:

1. Keep active. Try not to limit you physical activity. In fact you should be thinking of increasing your physical activity. And a balanced programme of aerobic fitness along with strengthening can in the medium term be very helpful. If you are having trouble with such things as walking long distances due to increased pain get some advise from a physio about what specifically you can do to be more active - this can be an exercise in pacing - that is working out what you can manage but slowly increasing your output as you can do more. If one posture makes you uncomfortable then have a stretch in the opposite direction and keep on the move. Just avoid staying in one positions for too long. If you are better sitting with a support in your low back then use a support in your low back. You work out for yourself what works best. Bed rest is the worst thing you can do. Don't put yourself to bed. Instead opt for keeping moving with changes in posture.

2. Stop worrying. If you are anxious about the problem or concerned about making the pain or condition worse this has been shown to make matters worse, such as the pain and how you manage the problem. Again get some advice about how to manage this if you need to.

The final thing to say is generally sciatica does settle down and episodes of back pain come and go.

All the best with your management and recovery.

[jannie]

Thank you so much for your very informative and helpful reply. Its nice to get some constructive advice and reassurance asI seem to have had this condition for what seems like an age!

I am actually seeing a (NHS) consultant on 3rd August, not 10th as previously stated, so not too long to wait. I intend requesting a referral to a good physiotherarpist for the very reasons you state: manipulation, advice on strengthening back muscles, physical activity, etc. If that isn't possible for whatever reason I will self-fund as I definitely think a physio is the way to go - I wouldn't feel too comfortable seeing a chiropractor, for example.

Thankfully I haven't yet lost any feeling in the leg and hope to avoid any medical intervention, be it surgery or any form of injection as have read they don't necessarily improve things and can make matters worse.

With the pain under control I am managing to carry on pretty much as normal (just have to be careful lifting and bending) and know that the worse thing is to do nothing, especially sitting down or bed rest. Increasing active exercise does make sense and I guess, pending seeing a consultant, there is no harm in at least starting some regularly walking, starting with short distances and building up - I shall see how that goes.

I used to do a lot of high impact aerobic/step exercise in my "younger" days - This type of exercise is certainly out of the question at the moment but what about pilates, yoga or swimming?

Thank you again and I shall report back with, hopefully, some progress.