I have a lot of pain that radiates from my back into my buttock, and down the outer side of my leg at the back. It is worse if I walk a lot; and though I’ve seen doctors and a chiropractor, it keeps coming back. Do I just have to live with it?
The condition you have is often called sciatica, though perhaps a more highfalutin term is “neurogenic claudication.” It is a fairly common problem, becoming more common in older age groups.
The group of conditions causing this problem is called lumbar spinal stenosis, or a narrowing of the spinal canal through which the nerves must pass. A result of the narrowing is compression of the nerves, with resulting pain.
Lumbar spinal stenosis causes symptoms at an earlier age than other causes, often in people of 20 to 40 years of age. Such people are born with shortened, bony pedicles, which make the spinal canal narrow.
Degenerative processes are the most common cause. Here, osteoarthritis or degeneration of the intervertebral disc apparatus can result in bulging onto the nerves, or even a hypertrophy, or thickening, of the ligaments with a subsequent nerve compression. The typical age for symptoms to begin is between 60 and 90 years.
Other causes are trauma, and even surgery may be followed by stenosis at the level of the surgery or one space up or down. Movement of one vertebra upon the other, a condition called spondylolisthesis, can also compress the nerves.
Patients with this problem of spinal stenosis in their lumbar region have complaints like those you describe. If your doctor raises your leg while it is not bent at the knee, you may find the pain is made worse. You may also have difficulty walking with your eyes closed, because the position-sensing nerves may be compromised.
Osteoarthritis in the hip often causes groin pain made worse by rotating the hip inward, and a condition called trochanteric bursitis is associated with tenderness over the bony part of your thigh bone at the top. Pain in the calf when walking is not influenced by flexing or extending one’s back, whereas lumbar spinal stenosis is often made worse by extending backwards.
Unfortunately, treatment is not easy. Fortunately, the condition does not usually progress rapidly, but dramatic improvement is also unlikely.
Exercises such as bicycling and swimming are better tolerated than walking and running. Abdominal exercises help avoid excessive lumbar extension. Corsets may help with posture, so are worth a try. When pain medications—either in tablet form or injection—fail, a patient may consider surgery. Symptoms should be severe enough to justify what can be less than totally satisfactory surgery.
Studies show that although some 80 percent of patients may have some pain relief after surgery, at least a third will report back pain 7 to 10 years later.
Those with the most severe nerve root compression are most likely to have their symptoms relieved by surgery. Different procedures are being used, but the studies needed to define clearly the best approaches are limited in number at this time.
Before surgery, MRI imaging is usually necessary where it is available, and less aggressive treatments should have been tried. Maintaining the strength of core muscles is important, and avoiding jogging-type exercise is imperative. We suggest you see a physiotherapist or an orthopedic doctor for advice and suggested exercises.