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  • runner15
    Participant
    Post count: 5

    32 year old. Active (avid runner ~30-40 miles per week prior to injury, skier, cyclist, recreational sports). Began having sciatic pain episodes radiating from buttock to thigh. No notable numbness/tingling/weakness or gi/gu symptoms. Have had 3 sciatic pain episodes over the past year, with low back stiffness and intermittent dull ache in buttock.

    Stopped running 3 months ago once MRI was obtained. Have tried physical therapy with more than one PT, chiropractor, and yoga. Epidural shot x1 that provided some relief from the sciatic pain, but the stiffness and dull ache remains. Slowly easing back to activities while restricing bending, lifting, and twisting. Goal is to return to previous level of athletic function. At what point would conservative management be deemed to fail and surgery become a more viable option?

    MRI Report:
    L1-2 through L3-4: No disc herniation, foraminal or canal stenosis.

    L4-5: Subtle broad central disc protrusion with annular fissure. No foraminal or canal stenosis.

    L5-S1: Large disc protrusion (2.0 x 0.6 x 1.0 cm) dissecting below the disc level, eccentric to the left where it contacts descending left S1 nerve root in the lateral recess and approaches the right-sided S1 nerve. No foraminal stenosis.

    runner15
    Participant
    Post count: 5

    To give a little more information, the sciatic episodes are intense with sharp shooting pain in the butt radiating to back of thigh. With these episodes I have difficulty sitting and standing up. These episodes last about 2 weeks. Once they calm down, I have the intermittent butt ache, back stiffness, and occasional achey pain down my hamstring.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8459

    You have a relatively large herniation compressing the left S1 root. You are lucky to have only intermittent episodes of severe low back and leg pain. I’m happy you have stopped running as this can flair up the nerve pain. I hope you don’t have motor weakness as that would need to be addressed surgically now. See https://neckandback.com/conditions/home-testing-for-leg-weakness/ to understand how to test for this condition. Noted weakness should lead to surgery sooner than later.

    If you do not have motor weakness, you can try an epidural steroid injection and this might calm down the buttock/leg pain. You might be able to avoid surgery with treatment and time but with that size fragment, surgery still could be in your future.

    Dr. Corenman

    runner15
    Participant
    Post count: 5

    Thank you for your reply.

    No motor weakness. Tried the epidural. It helped calm things down and I am gradually returning to activities.

    I hope that I am able to eventually return to running at my previous level without the surgery.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8459

    It is a matter of time and activity restriction to determine if you can return to running. It will probably take 4-8 months.

    Dr. Corenman

    runner15
    Participant
    Post count: 5

    Gotcha! Fingers crossed.

    4-8 months from the last sciatic episode?

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