Sciatica or pinched nerve pain is one of the more frustrating pains with which I've helped patients.
This type of pain can cause an electric-like sensation, sometimes a tingling, aching or burning down the hips or the buttock, possibly shooting down the legs past the knee. Sometimes, there is just a vague sensation in the back of the leg, which patients sometimes attribute to muscle soreness or a muscle pull. At times, there can be associated weakness or "giving out" of the leg. We can also see similar things in the arms or hands as well, which can originate from the neck. This pain might be stemmed from a herniated or bulging disc in the spine pressing on a nerve.
If a patient comes to me with this kind of pain, the patient and I first talk about what he or she has been experiencing and we perform an exam on the area of concern. Then, we consider obtaining an image of where we think the problem might be coming from. Once we get the result, I like to read together with the patient over the radiology report so we can both best understand what the findings are. Sometimes, there are bulging discs however, if there is stenosis or something call spondylosis or spondylolisthesis, I like to explain what this means with a spine model.
If we see a bulging disc, we talk about what we can do about it. Based on the patient's goals, we can be conservative or aggressive in our treatment choice. However, all bulging discs don't necessarily need treated. Frequently, small bulges don't cause any pain or other symptoms and only require observation. In my practice, I've found I've been the most effective when I have used imaging to clarify a patient's pain or symptoms, rather than trying to make a patient's symptoms fit the imaging, where findings may not be causing issues or be asymptomatic.
Fortunately there are a variety of options that our office, Bellevue Pain and Wellness, has that can help when this terrible pain comes about. Once I'm able to best explain to a patient where his or her problems are coming from, the patient and I come up with a customized plan to fit their lifestyle. A large portion of herniated discs can go away without needing surgery, so sometimes the goal is to eliminate or lessen the pain or weakness while the disc is going away on its own.