Sciatica

Jim Cardinal* was better today when I saw him in follow-up for his left leg
pain and numbness. He elected to treat his sciatica just as I would have
elected the same conservative treatment for myself If I had his problem (and I did at one time and so I can empathize). Three weeks ago this 40-year-old typesetter for a local newspaper presented with left buttock pain radiating to the left leg which was quite severe and which had not responded to symptomatic measures at home over the previous 4-5 days. In addition to the sciatica-type pain, he was also having muscle spasms in the lower back.

My presumption at that time was that he had a bulging intervertebral disc pinching the sciatic nerve. The muscle spasm was caused by the lower back muscle reaction to the inflammation, swelling, and pain. He received the normal therapeutic ultrasound and electrical stimulation treatment in the office which relieved some of the spasms. He also received anti-inflammatory medication and stretching exercises. He understood that the various options for treatment of this problem all resulted in the same outcome in the long term and so he elected to treat his sciatica problem conservatively.

When I talked to him by phone a few days later he was still having a great amount of pain despite pain medication and so I ordered physical therapy. He had 3 or 4 sessions of physical therapy with the local physical therapist and so between that and the medication and time he was much better today when I saw him.

On examination, he still had a slight loss of ankle jerk reflex consistent with sciatic nerve irritation. I again gave him options for further studies and neurosurgical consultation but since he was feeling a lot better and able to work he declined further studies, consultation, or therapy. He promised to continue regular exercises, back stretching, and in general, staying in shape with walking. He also wants to lose weight which I definitely concur with.

I think in the long run if he stays in shape and continues to keep his weight down he should do fine. He may have an occasional flare-up of the sciatica but so might he with any other more aggressive treatment.

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