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  • kenireland
    Member
    Post count: 3

    Hi Doctor,
    I am a 41 year old male who has over the last year being suffering from sciatic nerve pain which was worsened to include lumbar back pain and most recently pain in the ball of the right foot. I had an MRI in March 2011, of which I have a copy on disc and can see that the L5, S1 disc looks very narrow and appears to be bulging into the nerve space. Following unsuccessful results of a long course of anti-inflammatory and nerve related drugs my consultant is now recommending an epidural injection. From my own reading about such steroid injections they are a short term fix? I have since being visiting a Chiropractor who following treatments has asked me to ice my foot and has ordered orthotics. Apart from this I have recently added stretching exercises.
    I used to be a keen middle distance runner and tennis player and I have not been able to properly exercise for the past 4 months. My question is, if the orthotics help with my alignment and I get to the stage through stretching and core strengthening exercises were the pain is alleviated, should I go back running and is the disc able to repair its self over time?

    Many thanks for your time.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8408

    According to your report, you have significant degenerative disc disease at L5-S1 with a “bulge” that compresses the nerve root- most likely S1. Your symptoms are lower back pain and leg pain.

    In general, the symptoms of degenerative disc disease are pain in the center of the back (axial back pain) and symptoms of nerve compression are buttocks and leg pain. Pain in the sacroiliac region (off midline and slightly lower than the belt line) can originate from either cause. The percentage of back vs. leg pain is important to determine which problem needs more treatment attention. For example, if a patient had 80% low back pain and 20% leg pain, more focus would be given to the disc and if reversed (80% leg pain)- more focus would be to the nerve root compression. This is important with the focus of surgery also.

    An epidural steroid injection can be very helpful. In some patients, this injection will yield some permanent relief but in others, only temporary relief. It is certainly worth a try. The injection should be used in conjuntion with further physical therapy as a breakthough can occasionally be made.

    Orthotics will help the foot and the knee alignment but most likely be ineffective with lower back pain. The disc is avascular, so there is no chance of healing the degeneration but even so, can become less painful with treatment over time. Think in terms of management and not cure.

    Dr. Corenman

    PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
     
    Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.
    kenireland
    Member
    Post count: 3

    Dear Dr Coreman,

    Thank you for your response, the pain in my lower back is as you describe, but has lessened considerably since I stoped running and commenced treatment. The back pain is at its worst first thing in the morning and when I am sitting for long periods of time. There is no pain in the buttocks or leg anymore, but the pain in the ball of my right foot continues and is the more severe most constant pain. So, I understand that nerve root compression is causing this and would hope that the Orthotics will help with this foot pain?

    As there is no chance of healing the degeneration of the disc,should I discontinue running, even on grass? Is playing tennis likelly to make it worse over time? Would swiming and gym work using light weights and a back support be a better alternative?

    I would like to continue with some kind of long term exercise regime. I would assume losing weight, may also help and think regular exercise of some kind is important.

    Many thanks.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8408

    Severe constant pain in the ball of the foot could be from a number of sources. If the pain does not change with position of the spine, it may not be generated from the spine. However, if you get an epidural and the toe pain is relieved for three hours, then most likely the pain is generated by the spine. If the pain is constant and spine generated, it might be chronic radiculopathy (see website).

    Toe pain could also be from compression of a peripheral nerve in the knee or foot or even arthritis of the toe.

    The disc pain can get better with therapy and activity modification. You may have to give up running if the pain is spine generated however it is hard to say without knowing your situation personally. Cycling, hiking and swimming would be better activities for the spine with less force generated to the discs.

    Dr. Corenman

    PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
     
    Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.
    kenireland
    Member
    Post count: 3

    Dear Dr. Coreman

    Thank you again for this information. A feww final questions, if I manage to relieve the disc pain with treatment, will the disc at L5, S1 continue to degenerate over time regardless? degenerative disc disease would suggest this to me! “The disc is avascular”so does this mean it has no blood supply to heal? Do discs receive any fluids ot nutrients through movement? Do the cells of discs not regenerate? Are there procedures to artificcially repair a disc?

    Many thanks

    Donald Corenman, MD, DC
    Moderator
    Post count: 8408

    Yes, the disc will continue to degenerate over time but that does not mean the symptoms will continue. There are many patients with degenerative disc disease that have no pain. Remember that degeneration does not always equal pain. Yes, without blood supply, the disc will not heal. The key to disc pain is management. There are some activities that will aggrevate the back pain and need to be modified or avoided.

    There are surgeries used to fuse or replace the disc. If one disc is problematic only, a fusion is a great solution. The artificial disc replacement for the lumbar spine is not ready for prime time (see website for comments) although the cervical disc replacement does have some use.

    Dr. Corenman

    PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
     
    Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.
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