Question
The pain in my right hip area started about a month ago. It came on unexpectedly and without an injury or accident happening. It started as just an ache that I thought was arthritis. After two weeks the pain then started affecting my leg. The pain will radiate down my right leg and cause numbness, tingling and burning. My doctor has guessed that I have sciatica and has treated me for that. I haven't noticed any changes or improvements with the medications she has prescribed to me (Naproxen, Flexaril and Prednisone) X-Ray's showed no abnormalities. In the past three or four days I haven't been able to straighten my back. When I try to straighten it I feel slight pain in my lower back, but the pain isn't very severe. It's more that my back simply will not straighten, not due to pain, just due to inability to. What could be causing this?

Answer
Hi Bekah,

Sorry to hear you are suffering.

I am also sorry to hear your doctor is guessing. I would hope your doctor would refer you to an orthopedist to look into this more carefully. Even a chiropractor might be able to examine you in a way that would reveal more evidence, rather than guess and prescribe.

It is not unusual for this type of guessing. I have even seen it with an orthopedist, who guessed the patients knee pain was due to the back and even bet the patient, who was certain it was not, a quarter! Well, it was the knee and the orthopedist paid up, but, there was an MRI to determine this.

I am not going to see a potential herniated disc that would cause sciatica on an x-ray. Although it is reasonable to prescribe these medications for a disc related sciatica problem, it is also reasonable to investigate it further with an MRI or, at least, refer for an orthopedic exam and let the orthopedist make the decision.

I'm not sure about the timing of the medications, however, if there is inflammation from a disc problem, the predisone should help within a week, as it is a strong steroid and reduces inflammation rather quickly.

So, I would insist on an MRI or referral to an orthopedist to determine if the guess is correct. This can show the discs and any spinal cord pressure. Typical herniated discs are going to be aggravated by sitting, straining and coughing/sneezing, where this would reproduce your leg symptoms. It would be a little better when standing and significantly better when lying down.

It is possible for a herniated disc to have more leg pain than back pain and this is seen with more severe herniations. There could be reactive muscle spasm in the back to protect the nerve and straightening out may place more pressure on the disc.

Regarding other causes, there could be others. A blood test could be done to rule out any rheumatoid type arthritis or ankylosing spondylitis. It could be a problem with the sacroiliac joint or a spasm of the piriformis or even psoas muscle involvement. There could be a combination of these or it may be related to the hip or sacroiliac joint. Not sure where the x-rays were taken, I would assume if she thought it was the back, that back x-rays were taken. This should include views of the sacroiliac joint, however, it may not and I would certainly have hip joint views taken.

So, you can look at the disc and pain patterns at http://www.necksolutions.com/back-herniated-disc.html and compare this with a prirformis muscle syndrome which can effect the sciatic nerve at http://www.necksolutions.com/piriformis-syndrome.html and sacroiliac joint pain at http://www.necksolutions.com/sacroiliac-joint-pain.html

This may help, but this is the job of a good doctor. It is concerning that you are not responding well to the medication and a clear indication for further investigation.

I hope this helps and that you will feel better soon.

Kind Regards,

Dr. Steve