Lower back pain and strange sensation in lower back including side of right thigh and left side sciatica

Hello Dr Lewis ,
I am 24 years old dental student. I have clicking in between l5 s1 for more than 1&1/2 year. But it never caused any limitation of movement or pain until 4 months ago when i got sciatica on left side as confirmed by my orthopedician. but there was no pain in back on bending forwards or sideways. And nothing showed up in radiographs of lumbar spine. Sciatica disappeared in 3 days without any medicine.
After 2 months i again got minor episode of left sciatica and got MRI done as orthopedician could not explain the cause of pain.
MRI L-S Spine:
1. Loss of lumbar lordosis is seen.
2. The visualized vertebrae show normal height, alignment and marrow signal.
3. L5-S1 disc show loss of height with mild posterocentral protrusion partially effacing the anterior epidural fat.
4. No evidence of facetal arthropathy or ligamentum flavum hypertrophy is seen.
5. Lower end of spinal cord and conus normal.
No pre/para vertebral collection is seen.
(radiologist didn't mention it in MRI report but verbally told me that there are muscle pulls)
This time doc advised me Muscle relaxant(thiocolchicoside) and ketoprofen combination + vitamins for 5 days.
Again LEFT side sciatica disappeared after 4 days. leaving a strange sensation in lower back and on lateral side of RIGHT thigh. Its like feeling of a Point or Dot(Painless) on right side of lower back some where between L5 and L2. Or sometimes i feel something is running around in between L5 and L2. Similar sensation also felt simultaneously in lateral side of right thigh like something is in my thigh and is trying to pull skin inwards. This happens when i am sitting. All of this disappears on standing or lying down. After about one month i still have similar mild sensation in the respective regions.

I have been doing lower back stretching exercising since 1 year as advised by my physiotherapist which i think is too much..(2 types of erector spinae exercises 10 repetitions each 2 times a day.)although it never caused any pain but sometimes discomfort.

What should i do now?
Should i continue exercises of lower back or take rest for a couple of days?
What stretching or exercises i should do, for how many times a day and how many repetitions each time for each exercise.
what is good sitting posture for studying for whole day?
Can i ride bicycle. and can i go for running 2 kms every day without hurting my back and sciatic nerve.
what is the possible prognosis for a 24 year old dentist?

Hello young doctor of the future, how nicely you have described everything.

Two things you haven't mentioned, do you get more pain on bending forwards or backwards, and do either produce a tightness or pain in one leg, compared to the other?

What's good is that these pains go spontaneously over, what's not good is that you are getting symptoms in both legs.

That numbness on the side of the thigh could well be Meralgia Paresthetica, a double pinch in the groin and facet syndrome in the upper lumbar spine. Press just medial to the ASIS and distally - any discomfort?

At the back of the other leg fits with a S1 sciatica.

Personally, I'm not much in favour of extension exercises, they quite often aggravate, and mostly we are weak in the abs.

Mostly I don't fuss over non-painful clicking sounds from joints, but perhaps in retrospect it was a warning that something was lying in wait. That's all set in concrete though, and you're looking to the future.

At C-H, you'll see a Search this site: "Lower back exercises." Every clinician has his/her favourite exercises, these are mine. I do them myself. They shouldn't cause pain or discomfort.

I'd start rather with walking and perhaps swimming, and cycling is usually okay, but be careful getting on and off. When you can do those without pain, then start jogging.

Sounds to me like it's time you started looking for a reputable chiropractor in your town! Take your scans... of course, I'm biased, but I and I presume all chiros treat these complaints on a daily basis.

Loss of the lordosis is usually caused by muscle spasm, but research shows muscle relaxants are ineffective.

Sitting is hard on the lower back, and yes it may inhibit you as a dentist, but you can get up between patients and walk around, even lie down and do two minutes of back exercises. Few of us are in perfect health...

Good luck, and I hope this has contributed. If you're half as good at understanding what is going on in mouth, as in your back, you have a great future!

One little tip: try and not take wisdoms out under GA in the future. Can cause havoc with the TMJs. Better in the chair.

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Interesting challenges of the day

1. Mr S is a 76 year old man with neck pain of some 9 months duration. Luckily, most of the discomfort is upper cervical which is only rarely arthritic; his lower cervical spine is a degenerative mess that I've left alone. After seven treatments his pain and stiffness is 50 percent better, and he's happy in the circumstances. He can sleep through the night now and that makes a huge difference.

2. Mr P is 32 year old man with very severe lower back pain radiating to the big toe which is 30 percent numb. He had an episode three weeks ago, took anti inflammatories and was soon better as is typical of the medial disc herniation. But before it healed, after a trivia it came roaring back, much worse. The characteristic crossed sign was evident; sitting in a chair, straightening the right leg provoked severe left back pain and tingling in the leg. He's doing well.

3. Severe lower back pain is scary; just ask Mrs P. Just watching her get out of the car I she was in trouble; she had a slipped disc at L4 making her lean towards the opposite side; luckily she had no pain in the leg. Despite family pressure that this was far too severe for a chiropractor, she persevered. Within five days she was standing upright, and after two weeks almost painfree. 

Despite a hectic job, she wisely took my advice and stayed home for what I call exercising bed rest.

4. Mr S has had lower back, groin and back of thigh and calf pain for fourth months.

He has a pincer deformity in the hip causing the stabs in the groin, and a degenerative facet causing the sciatica. Both are responding well to chiropractic and he's well pleased; sixty five percent better after three treatments.

5. Mr T is a wise man; he's taken a warning TIA seriously and has lost 15 pounds, and has at least as much again to lose. A change to a low starch diet and half hour daily walk has made the difference; but the walking is making his foot and back miserable. The expensive orthotic is hopeless; luckily his hips and back are fine, but he needs a simple heel lift.

6. I too have had serious lower back issues, luckily fixed by my own chiropractor; so I too have to do my exercises, take care when lifting supers full of honey, gardening and using the chainsaw. Regaining the function of your spine is just as important as the pain.

7. My own granddaughter, only 7 is hypermobile giving her pelvic, knee and ankle issues. Xrays show a mildly dysplastic hip. Years ago we would have called it growing pains. She too regularly needs chiropractic care and luckily responds well. Increased range of motion is more difficult than too stiff in my opinion. Our care is for kids too.

8. This 65 year old lady is a serious gardener; every day she is bending, lifting and digging for 2 to 3 hours a day. It regularly catches her in the sacroiliac joint, so she has a treatment once a month that sorts it out. She does her lower back exercises faithfully.

9. This 88 year old lady is an inspiration; every day she is busy in the community. With a nasty scoliosis she manages very well with a chiropractic adjustment every six weeks and exercises faithfully done.  

10. Mr X is a 71 year old retired man who wants to continue with maintenance care every six to eight weeks; he had suffered from two years of lower back pain when he first came a year ago. He has no discomfort now after 8 chiropractic treatments, but is aware that danger lurks.

11. Mrs C has been having severe headaches, and taking a lot of analgesics. It's a non complicated upper cervical facet syndrome, and she's doing well.

12. Mr D is a 38 old year man with chronic shoulder pain after a rotator cuff tear playing cricket. It responded well to treatment, but he knows he must do his exercises every day; for two years he couldn't sleep on that shoulder.

13. Mr D, a 71 year old man, has a severe ache in the shoulder and midback since working above his head. Trapped nerve tests are negative but he has advanced degenerative joints of Luschka; after just two treatments he is 50 percent better. Can we reach 90?

And so the day goes; chiropractors shouldn't be treating the elderly most medical sites state but that's so much bunkum.

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