With a pinched nerve in your back, you can experience back pain only, or a combination of back pain and leg pain, known as sciatica.
It can radiate into your hips, thighs, legs, calves, feet and toes all separately or all together.
The pain can range from a mild tingling sensation in the thighs or feet, to excruciating and often burning pain from the back down to the feet.
In the most severe of cases, the pinched nerve can cause weakness in your foot or leg. You may then find yourself dragging carpets or floors with your foot or feet (dropped foot), losing balance, or even falling. If there is severe weakness, patients should seek immediate attention.
A lumbar radiculopathy syndrome is typically caused by compression of spinal nerves, branches of the spinal cord. In the simplest of cases, a disc that has been thrown out of place causes compression of the disc. This is the case for disc herniations. In the most complex of cases, it may be multiple causes acting at the same time to restrict the spaces where the spinal nerves travel. These spaces are called the spinal canal and the foraminal canals. These complex causes may involve one of more of the following structures: discs, facet joints, ligamentum flavum, osteophytes, factures, and vertebral slippage. When tumors are present, they may also restrict those spaces or directly compress the spinal cord and nerves.
A history and physical exam by a medical doctor (M.D. or D.O.) is a required first step in evaluating your pain. In the majority of cases, an imaging study called magnetic resonance imaging (MRI) is used to visualize the anatomy involved in causing your pain. This is considered the gold standard in imaging for disc and nerve pain disorders.
Further diagnosis may include nerve tests which evaluate the electrical function of your spinal nerves. These tests are called electrodiagnostic nerve tests, or nerve conduction studies.
When symptoms are mild and intermittent, patients may usually try rest, icing, heat, and stretching. If symptoms interfere with work or sleep, oral medications can be prescribed according to the specific needs of the patient. Consultations with physical therapist, pain management, or neurology are usually ordered by the primary care physician. For those with premium insurance plans (PPO) or with Medicare, a self-referral is all that is needed to make an appointment with a pain management specialist, who will be very well versed in the diagnosis and treatment of lumbar radiculopathy, sciatica, and disc disorders. Only in rare cases, will patients need immediate or emergency surgery to alleviate the pain and the worrisome neurological symptoms of severe spinal cord compression.
Epidural injections have been used for over 30 years in the treatment of lumbar radiculopathy and sciatica symptoms. They have been quite effective in treating all ranges of back and leg pain symptoms. Their use is widespread throughout the United States and the rest of the World.