Highlights From the Marc Darrow, M.D., J.D.
Is It Sciatica?
Caller: I have had back pain for some time, the pain radiates down my legs, I have had three epidurals and cortisone shots but without any relief, where do I go from here?
Dr. Darrow: The fact that you had three epidurals is a good sign because that means that the pain is not from an inflamed nerve. It is probably a ligament in the low back, most likely the iliolumbar or sacroiliac ligaments. These ligaments can refer pain down the legs and look a lot like a sciatica problem but is really not sciatica.
We get over a 100 new patients a month and I would say that 25% of them come in and say that they have been diagnosed with sciatica, most of the time it is not, but sciatica is such a common term for back pain that radiates down the leg that it gets used.
On examination we find the “sciatica” problem to be those ligaments mentioned or a bursitis or it’s the iliotibular band, the connective tissue side of the leg from the hip to the knee that gets irritated.
What Is Radicular Pain?
Radicular pain is described as deep and usually constant. It follows the nerve down the leg and is often accompanied by numbness or tingling and muscle weakness.
The most common example of this type of problem is the sciatic pain that radiates along that sciatic nerve – down the back of the thigh and calf into the foot. This type of pain is caused by injury to a spinal nerve. Some of the possible causes of this are a disc protrusion or bulge, arthritic changes or a narrowing of the opening through which the nerve exits.
While a few of these cases will require surgery, most respond to conservative care. Here the care will consist of multiple therapies, all designed to reduce Inflammation, balance your posture, strengthen supporting structures, attain normal motion and improve the health of the nerve that is involved.
In all types of back pain, your health habits play an important role. For example, there are certain foods that are high in the fats that cause more inflammation. Limiting intake of these animal fats and increasing your intake of the good fats that reduce inflammation may play an important role in your healing. Smoking is another health concern. Statistically, smokers are slow healers with respect to back pain.