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Lumbar Disc or SI Issue/Sciatica

I am new to the board. I am 26 years old, male, overweight (in the process of getting that down), healthy otherwise, fairly active (I teach & coach football for a living). I have had past back issues: When I was 19 I was diagnosed with a bulge in the L5 disc. I had injections done at that time and it really helped, have had SI joint issues also in the past but usually they resolve fairly quickly. A few weeks ago (4) I shuffled in a drill at football practice, my back felt like it gave out, had a shooting pain in my lower left back and was in pretty good pain for about two days. I went to the doctor and was prescribed Mobic & muscle relaxer which really helped the pain. Now I am having this issue, after about a week I began having Sciatica pain down my right leg, mostly the outside of my calf and top of my foot. My back pain is actually pretty limited but am having some stiffness along with a very tender spot to the right of the S1. My regular medical doctor has ordered an MRI and am waiting for insurance to approve (fun fun). Wanted to kind of see what y'all think may be going on if this is disc or si related and how serious do y'all feel this may be. I really would like to avoid surgery if at all possible. The sciatica pain is what is bothering me the most, 300mg gabapentin has helped and sometimes gets it to stop but I really don't want to be on it for the rest of my life. I have read a lot of threads on here and this seems to be a good community to discuss this in so thought I would join. 

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Comments

  • It's likely what you already know. A bulging disc. Or perhaps it worsened and is now ruptured and spilling out, and thus irritating your nerve. You'll know soon enough. Hopefully some weight loss and PT will cure you. Good luck

  • Ok so got my MRI results back, they are as follows:

    FINDINGS: Mild smooth scoliosis is
    convex left. Alignment is otherwise normal. No compression fractures or
    suspicious bone lesions. There is mild multilevel disc degeneration with
    multiple small degenerative Schmorl's nodes in the vertebral endplates. No
    evidence of discitis or osteomyelitis. Cauda equina and conus medullaris have
    normal signal and location.

    T12-L1 through L4-L5: No disc herniation,
    canal stenosis, or neural foraminal stenosis.
    L5-S1: Small left paracentral
    disc protrusion. No canal or neural foraminal
    stenosis.


    IMPRESSION:
    1. Small left paracentral disc protrusion at
    L5-S1.
    2. No canal or neural foraminal stenosis.
    3. Multilevel disc and
    endplate degenerative change.

    One question I have is what do they mean by "protrusion" is this more in line with a bulge or a herniation/rupture? I have to say my pain has improved over the past week & a half and I am also down 15 pounds over the last three 1/2 weeks. Down to taking a mobic in the morning and one 300mg gabapentin  in the evening. Still not 100% but closer to 80%. I am going to see my specialist Monday of next week to see what he has to say. 

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  • challengercchallenger Posts: 1,833
    edited 07/09/2019 - 8:50 AM

    Hopefully this is just a bump in the road but one you need to remember every time you start to do something, take that advice from a dummy that didn"t.  

  • VUDore92VVUDore92 Posts: 12
    edited 01/16/2019 - 11:52 AM

    Thought I would post an update. I went to my spine specialist in late December and he did not seem to think the disc bulge is causing my sciatica but ordered a Nerve Study anyway. After having the study it showed that I have Bilateral sciatica which seems odd for such a small bulge. I am scheduled next week to have Epidural Spinal Injections which I hope will help, I had them done in 2010 and it worked well for a long time. Have been excising, using the elliptical at the gym and have been stretching on a regular basis. Most of the pain/pins & needles feeling & pain has been in my calves & feet, nothing really above the knee.  

    I wanted to ask about this issue though: I have been having some urinary issues since around the time I started having back pain. On & off and mainly when I am sitting I have had a sensation in my urethra that there is pee stuck in it. I have never had an issue with emptying my bladder, no leaking, no bowel issues. Have had some spasms in the perineum area but not numbness. Felt like a prostate issue so went to an urologist who put me on an antibiotic and flomax. It has seemed to help but still have on and off bouts with this, just really annoying and was curious if it could be related to my back. Wouldn't think its CES because the MRI showed no issues in that area and my spine specialist didn't seem to think it was related to my back. Just weird how it mainly flares up when I sit & also seems to wax and wane with back pain. Could it be Pedunal Nerve Entrapment possibly? 


  • Any thoughts on this?

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  • You sound like a hypochondriac (although I am this way too so no offense intended).

    I have trouble getting a pee stream initiated too but I’m unsure if it’s a side effect to medication causing this or suspected nerve root impingement.

    Good luck with your injections next week. They didn’t help me. 

    After I had the follow up with the injections doctor following injections he wondered if they didn’t work because of aiming them at the incorrect body part.

    Only one doctor who’s looked at my lumbar MRI has said I have suspected nerve root impingement. And it wasn’t the injections doctor.

  • Yeah you might be on to something there, I can tend to use Dr. Google a bit too much on stuff and it will make you believe you are dying. Appreciate the feedback though, hopefully the injections work. Just weirdness with my back, but maybe it will improve.

  • If you really want to address the bladder retention issue try getting a referral to a pelvic floor rehab specialist PT. I'm female and have these issues but it has helped me.

  • That thought has went through my mind, the flomax has helped which tells me it’s my prostate, just may be non bacterial chronic so a pelvic floor Pt may help. 

  • I tried pelvic floor therapy and it didn’t help. 

    The therapist dismissed me a week early because it wasn’t helping and we both were getting frustrated.

    Sometimes it’s a pesky disc/nerve causing the symptoms.

  • Like I said the flomax has helped, seems to be improving also, so makes me think it’s a prostate issue but who knows. Could be nerve pain also, either way hopefully the injections work Friday. 

  • Ok, wanted to pass along an update. I went Friday to have the Epidural Steroid Injections done on the S1 nerve root on both sides. Procedure went well overall, had some pain when they got around the S1 Nerve Root on the left side but they said that was a good thing (guess they found the inflammation).  Suppose it gets a little worse before it gets better, I think the injections for sure set off the nerves but from people I have talked to who have had it done before that sounds par for the course. Seems to be improving a little each day. Not 100% yet and honestly I would be fine with 90%, they said according to the nerve study that it was "minor irritation" but its still rather annoying. Anyone have any tips on the ESI recovery & also when I should expect it to really kick in?

  • I did not have any additional pain from the injections. It was like a placebo in a needle because it didn’t appear to do anything.

    My doctor said to give the injections 2-10 days to kick in. 

    But they never kicked in I’m afraid.

  • Just wanted to provide an update. Still having some pain in my lower legs and feet despite the ESI, has kind of been worse than before but it finally seems to be getting somewhat better. I am going back the 27th for a followup with my ortho spine doctor. Still having some pain in the perineum area and a sensation like I need to go pee when I don't have to some, its not all the time but some. Again I am having no numbness and have full bowl and bladder control, this has been going on for awhile but just curious of what y'all think it could be from. I know there are no doctors but just curious if anyone else has this issue. I have appreciated all the feedback on here. 

  • Update: Ended up going back to the Urologist yesterday, he still believes the issues with the urinary stuff are related to a prostate infection that has been very tough to clear up, started me on a new course of antibiotics so we will see, its just weird because gabapentin seems to help those symptoms as well. As for the back and leg pain, I am still having issues with it. Nerve pain down the left leg is still fairly good and pain in the right leg is still there though I do believe it has let up somewhat. If the injections helped any it was only on the right side really. Going for a followup with my ortho spine doctor that did the injections on the 27th. Depending what he says I may go get a second opinion from a neuro spine surgeon. 

  • I go for a followup tomorrow but depending on what my ortho spine specialist says I may go get a second opinion, thanks for the response. 

  • Second and even third opinions are good at times, then you can compare opinions, you may also find that you really like one doctor over another, I also look for patient testomonials and ratings. 

  • VUDore92VVUDore92 Posts: 12
    edited 02/28/2019 - 11:58 AM

    Alright, had my followup yesterday with my Ortho Spine Specialist. He said that he thinks some of my nerve pain might be from some light stenosis at the L5 level, its on the nerve canal not the spinal canal. He said that he believes my biggest issue though is some major muscle imbalances stemming from my hamstrings and hips being very tight. So he has prescribed eight weeks of PT twice a week. I tend to agree on the muscles and flexibility, the legs up the wall hamstring stretch is one of the few things that has actually lessened the nerve pain some, my back is still really tight and he thinks that PT may help it some. Doesn't think the very mild bulge is causing my issues as my leg strength is very good still. Said the urinary issue is not spine related but possibly could be related to the muscle imbalances but said to go see an urologist (im getting a second opinion from another urologist next week). So my plan is to try the PT, I think he is correct on that maybe being a good move. Willing to give it a shot for sure & I know I am very stiff so I do not doubt at all that my muscle imbalances could be a big part of this issue. Said the EMG showed only very light irritation and the injections didn't help much so this has kind of led him to think it may possibly be this causing a lot of it. Just wanted to provide an update.  

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