Lower back pain Sciatica. Interesting case

[oddscwodd]

August the 1st 2011, Deadlifting felt a little pain and what i could call the feeling of something ripping or tearing. Carried on in my set and finished my session.
Next day could not move and had sciatica in my left buttock. My physio instantly thought disc damage and put me on a programme of treatment to good success. Although the sciatica never quite went. That was August 2011 and since december the pain and soreness has got worse. Had an MRI in December and the specialist came back saying that the backs structure was sound and showed no herniation or damage. He compared it to an MRI of the lower spine done in June for a Brachial plexus injury. He would not say anymore as he had to go. "It's fine." Were his final words as he left.

Anyway I teach in my own gym so I am struggling with this problem as I can not lift more than 20kg without sciatica coming on strong. My Physiotherapist, who is excellent, kind of has no idea whats going on as i get pain on hyperextension only, and is currently carrying on with treatments for disc problems. Yet I have constant sciatic pain.

Options are.1, Carry on and hope it goes away.
2, Get a private session at £200 with nuerosurgeon guy.
3, .............................

My GP has put me on Lyrica for the problem a nuero pain killer. With little or no difference.
Any ideas please?

I am 37years old and try to be active if possible.

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[GrantP]

hi
this will be difficult over web and u obviously have faith in your physio which is very important and infinitely more important but may have some suggestions. need more info though, what do u mean by 'to good success'? also then when got worse, what and why? where is the referred pain go to, what makes it better/worse etc. just ramble on as much as u can and we can get something from it

[oddscwodd]

Thanks for your interest.

Been at physio twice a week for 6 weeks. The sciatica eases but never goes. The Sciatica is mainly in the left buttock. It feels wooden and solid. If I lift anything over 20kg the sciatica increases down the whole of my leg and is quite debilitating. My Physio is Stuart Barton. A very well thought of private sports Physio who has worked for lots of top sports people. He is convinced that the problem is some kind of disc problem although the MRI showed my lower back to be structurally good with some bulges but none showing any impingement on the nerves. He has said that the MRI taken lying on a board and standing up are incredibly different things.

I have been an active person all my life and need to keep active to maintain some prior injuries. Brachial plexus injury being the big one. My Physio has no idea what more to do so has asked me to try to get a private consultation with a private surgeon.

Been back to my GP he agrees with Stuart and although has tried Lyrica, amytriptyline at high dosages for the nerve pain says that more has to be done.

That's where I am now. Thanks for your interest. Any ideas would be great. Tried massage, acupuncture and such.

[GrantP]

thanks for info. dont know your physio so wil llist al options and you can check if been considered. firstly agree that MRI doesnt always hold the whole truth. also where was the initial 'tearing'sensation u describe?

things to check,
ligament atttachements around back and buttock
piriformis and gluts in general - muscles in buttock
QL and paravertebrals - muscles in back
sacro-iliac joints, for dysfunction or actual injury some therapists do not believe it causes problems - but I do
slump test for neural scarring or tethering, reflexes, strength in leg, to differentiate actual sciatica from neural irritation
function of lower back, I am aware talk of disc but has lumbar manipulation been tried (with caution) if some degreee of facet involvement etc
also moving up the chain and checking thoracic and cervical spine, shoulders etc for good function

hope this helps, take it to your physio and discuss but it sounds as though he is confident of your problem and has probably considered all these things anyway

again diff over the net, but some things off top of my head

[physiofi]

Thought I'd add my thoughts:

would agree with checking out piriformis syndrome - lots of glutes and piriformis stretching as tight glutes and piriformis will put extra strain on sciatic nerve (particularly piriformis as the nerve runs right underneath the muscle/actually through the muscle in a small no. of the population).

Just because the bulges aren't 'prolapsed' or impinging on the nerves as reported on the MRI doesn't mean this translates literally functionally. Most people with disc bulges find that they are aggravated with lifting / repetitive or prolonged flexion and eased with extension (and repetitive extension) which encourages the disc bulge to decrease.

Be very careful with posture - good posture and lots of core stability work is essential. Avoiding repetitive movements and prolonged positions, especially lumbar flexion is important. Would suggest addressing muscle tightness (piriformis/glutes/hamstrings) and lots of core work and then re-assess.

Obviously important to trust your physio as cannot diagnose and assess thoroughly over internet. If piriformis is a problem then self-friction massage (or from physio) will help as will heat and lots of stretching!

Hope this helps.