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.

Dr. Barrie Lewis

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

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