Patients who complain of low back pain and sciatica are often confused as to the causes of these conditions, how they are related ,and what the correct treatment should be.
Patients often think that the only treatment for low back pain and sciatica are epidural steroid injections and possibly surgery.
Most patients do not want either one of these procedures and often opt to let their pain go untreated.
What causes low back pain?
Low back pain is often caused by arthritis of the joints in the lower spine. This is due to slow degeneration of the lumbar discs causing bulging discs or loss of disc elasticity. As a result, the joints in the back of the spine are overloaded and can become arthritic.
The pain from this arthritis in the lower back tends to be centred in the lower back, but may radiate to the upper buttock or the back of the thighs, but rarely radiates below the knees.
How is sciatica different from arthritis?
The nerves that exit from the spine and come together to form the sciatic nerve that goes down the back of the leg leave from the spine between the discs in front and the joints on the back side. They can become entrapped or compressed by a herniated disc, which is an extrusion of disc material.
Pain and symptoms consistent with sciatica are pain that radiates from deep in the buttock down the back of the leg all the way into the foot. It can be associated with numbness, tingling, and weakness in the foot or calf.
The nerve can be compressed by arthritis of the joints, pushing from behind or against the nerve. A nerve can be compressed either by the arthritis of the joints, a herniation of the discs or combination of both.
The location of the pain is significantly different if it is coming from arthritis in the lower back where it is more localized to the back and upper buttock than from the pain of sciatic, which is a pain that radiates from the deep buttock down to the foot. In fact, the patients with sciatica may not have any pain in the lower back at all.
How do you treat these conditions?
Conservative treatment is always a treatment of choice for these conditions. When the patient has acute onset of sciatica, it is due to the compression of a disc against the nerve or chemical irritation of the disc material against that nerve. This causes swelling of the nerve. The condition however may resolve on its own after a period of about six weeks with conservative care. Conservative care would include anti-inflammatory medications, steroid pills such as Medrol Doesepak, use of a back brace, physical therapy, rest and perhaps injects of cortisone into the spine to calm down those nerve roots. This is an epidural steroid injection.
An epidural steroid injection is usually reserved as treatment until the end of the six weeks period when conservative treatment has been given a chance to work. Epidural steroid injection and therapy are often treatments required before a spine surgeon would eve consider operating for herniated disc.
Pain in the low back from arthritic conditions can also be treated conservatively with bracing, therapy and anti-inflammatories. Injections known as facet blacks or nerve blocks in the lower spine are given on the surface of the spine to numb those joints and see if that can give some pain relief from the arthritis. A medical branch block is a good example of an injection that is both diagnostic as well as therapeutic.
If the patient continues with significant discomfort in spite of these treatments, x-rays and MRIs are often obtained to see what the exact pathology is and if surgical consultation is needed.
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