Lower back pain with shooting pain down the entire leg

by Jake Jeffries
(Toronto, Ontario, Canada)

Hi there, thank you for taking my question.

Firstly, I'm a 34 year old male in great shape and very active. I have a desk job so during the week I'm usually tied to that from 7am-6pm.

Three years ago after a round of golf my back felt stiff. The next day I couldn't walk with very intense pain shooting down my right leg. After a visit with my Dr. that day, he sent me to physiotherapist diagnosing me with a pinched nerve causing sciatica. After about 2 weeks of physiotherapy I felt great again and resumed normal activities (golf, hockey, baseball, weight lifting, etc.).

Three months ago, I was in a baseball tournament and my back felt stiff the next day, but I went and played volleyball anyway. Half-way through volleyball I couldn't even walk off the court and needed assistance getting home as the sciatic pain was back again in full force. The next day I went to physio again but this time it took three months and approximately 12 physio sessions of acupuncture and Active Release Therapy and I was only around 80% back to feeling well again, then I re-injured it having sex of all things.

The next day pain started creeping in until it was a full 10/10, the worst pain I’ve experienced in my life. My entire leg felt like knives were being repeatedly twisted in the hip, side of knee, back of calf, ankle, and bottom of the foot. Not only was the leg pain unbearable, my back completely formed into a hunch almost instantly. For the lack of a better descriptor, I looked like Quasimodo. I was hunched forward past 45 degrees and leaned to the left at about a 45 degree angle as well. I could hardly walk, I couldn't lie down on my back, side, or front as the pain was intolerable.

This pain went on for three week and in that time, I was sleeping sitting straight up on my couch with pillows on my lap - picture a kid sleeping at his desk in class. I was forced to take time off work as I was completely incapacitated. The day the intense acute pain started I went to a walk-in clinic and the doctor diagnosed me with a full herniation of my L5-S1 disc and prescribed me 1000mg / day of Naproxen and told me to take Tylonol for the pain. Tylonol clearly did nothing for the pain.

During night 3 of my acute phase, after only sleeping about 1-2 hours per night due to the pain, I woke up at 3am with such pain that I went right to the hospital. The doctor there prescribed me 2-4mg of Hydromorphone to help reduce the pain so I could sleep. Unfortunately, the Hydromorphone had no effect on my pain.

The next day I had an appointment with a new physiotherapist but when I finally made my way to his office, he said he wouldn't touch me because I was in too much pain and was afraid anything he did might rupture the disc altogether. He said I needed to get to a doctor that would send me for an MRI to figure out what was going on. I forgot to mention at the beginning that I'm from Toronto, Canada and contrary to popular belief in the USA, public healthcare is atrocious and they do anything they can to save money on resource usage so finding a doctor who will give you a requisition for an MRI is nearly impossible. At this point, I had already asked 2 doctors and neither of them would do it (as mentioned - one prescribed an anti-inflammatory while the other prescribed a highly addictive narcotic instead).

After 10 days of this and my pain subsiding to an 8/10 vs. the 10/10 it started at, I finally got in to see a medical sports doctor who told me to get off the Hydromorphone and put me onto Lyrica to cope with the nerve pain while I got through the acute phase. He too, would not send me for an MRI.

So fast forward - it's been 4 full weeks since the acute pain began. I've seen a new physiotherapist twice this week and started seeing a chiropractor last week. Both seem really good and knowledgeable. I'm currently still taking Lyrica, the pain is now down to a 2/10 and last night was the first time I was able to sleep in my bed (on my left side only) rather than sitting up on my couch. I'm still waking up at night and lying on my stomach or back is still quite difficult and can only be done for a few short minutes. The issue now is that over the last 2 weeks my lower spine has started protruding outwards and has lost the normal inward curvature.

That worried the sports doctor so he sent me for lower spine and SI joint x-rays.

I apologize for the verbose letter, but writing it was rather therapeutic. I've attached my x-ray images and hope you can tell me what you see.
Many thanks,
Jake

Hello Jake,
Actually it's very nice to receive your "verbose" letter; so many folk say they have a sore back and it's goes down the leg, and what's to be done. All this detail is helpful.

Clearly you've had a full prolapsed disc, almost certainly at the L5-S1 level. The change in the shape of the disc seen on the lateral xray explains your posture and the loss of the inward curve that concerned your sports doctor.

A scan would be useful, but the result is highly predictable; a large postero lateral bulge, possibly into the IVF. I know something of what you've been going through, because I've treated hundreds, perhaps thousands of similar cases, and been there myself, just at a higher level which affected the femoral nerve. The pain in the leg is unbelievable, so don't feel you're being a baby; it hurts big time.

What you haven't mentioned is if there is any weakness in the leg. Can you stand on your toes, raising the heel, and can you raise the big toe?

The first serious and difficult question you have to face is why you had to work an eleven hour day, presumably plus travelling time. You're lucky it was your back and not your heart that rebelled. There you get no warning.

And now you have two options.

1. Stop, stay with your chiropractor and give this time to heal. That means not sitting for at least a month, possibly longer, stay out of the car, take walks and swims and recuperate.

2. Go and have the herniated material surgically removed; that will give you fairly quick relief in the hands of a good surgeon, but you will still have to stop for a period, go through rehabilitation and it will almost certainly not be as good in the end.

There's no inbetween; you've tried that and it failed. It's hard, but stop, stay at home and rest and recover is in my view the best option.

That's the route I took, with gentle chiropractic treatment and I'm again lifting beehives and gliders, digging in the garden; it was hard to stop, but the ever present threat of FBS frightened me into acquiescing. Use google to find out what FBS stands for.

Good luck and God bless; let me know in a month or two how you get on.

Dr B



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