Back pain radiating to the leg

Scott R. Greenberg, MDScott R. Greenberg, MD

Many of us who have had back pain will also feel the pain radiating down the leg, into the hip, and into the buttock. It takes a great degree of skill, experience, and knowledge to determine what the appropriate treatment is for a patient with these symptoms. We cannot just rely on the MRI, no matter how abnormal the disc or joint may seem. The following case will illustrate this:

Mr. AP is a diabetic 64 year old male who presented to me, Scott Greenberg, MD, with a horrible, stinging pain in his buttocks. This pain prevented him from driving any distance in his car, and he could not sit for any period of time. Furthermore, the nighttime was especially difficult and he had to try to sleep on his couch or recliner, because sleeping in bed was uncomfortable. He also felt pain in in the back, and his foot was numb.

Mr. AP had already seen the spine surgeon (who wanted to operate, but could not guarantee a good outcome), had taken pain medication, and also saw a pain management doctor who gave him 2 epidurals , which only helped slightly, but told him that the numbness in his foot would take at least a year or two to resolve.

Mr. AP decided to try something else, and had heard about prolotherapy and PRP, but he wasn’t sure if it would help him, as he was told he had “nerve damage”.

On examination, I found no evidence of nerve damage, as his strength was good in his musculature, but because of pain, he could hardly lift himself on the examining table. His reflexes were fine, and other tests for disc irritation were not found. However, palpation and manual testing revealed pain in the sacrotuberous ligament, the pyriformis, the posterior hip capsule, the gluteal muscles, and in the sacroiliac joint. He also had a complete pelvic tilt.

I reviewed the MRI, and also saw evidence of disc degeneration, arthritis, and spinal stenosis. I had a discussion with the patient of where I thought his symptoms were originating from, and also how they connected to the degeneration seen on the MRI. He did not want surgery, so I discussed the treatment options with him.

We used a combination of prolotherapy and PRP (platlet rich plasma) therapy on his low back. His pelvic tilt was immediately corrected and he started to feel some relief of the low back stiffness. Even after the first treatment, some of the numbness in the foot had resolved. He was treated every three weeks, and after 4 treatments was very comfortable sitting, as the stinging buttock pain was resolved. After 5 treatments, he was able to sleep comfortably in bed, something that he was not able to do for months and months. He was happy! He progressed until his back pain was resolved, and the numbness in the foot was completely resolved. Furthermore, he could hop up and down on the examining table, not crawl and struggle to get up as before.

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