Low back pain due to a pinched nerve (sciatica) is a common problem that used to require surgery most of the time. A big medical advance of the 1980s was the use of epidural steroid injections to reduce pain and decrease the chance that a surgery would be needed. However, is there hope when low back pain continues despite a cortisone injection? DE is a 51 year old woman who can serve as good example of what happens when there is no sciatica epidural recovery.
DE was seen by Dr. Newton in our clinic in February of this year with a history of several years of low back pain due to falling off a horse in the spring of 2012. Her pain was located in the left low back and got worse with intense fitness activity such as jogging-but walking standing, or sitting for long periods would also exacerbate her symptoms. She also had sciatic symptoms down her leg that started in November when she bent over and just twisted the wrong way. She tried two epidural steroid injections in December (by another provider), which did knock down the leg pain, but she continued to have low back symptoms. When she was seen this year, her pain on a daily basis still ranged from a 1 to 2 all the way to a 7 to 8/10.
One of the things that Dr. Newton immediately recognized was that just pumping more steroids into a middle aged woman by repeating the epidural steroid injections wasn’t a good idea. In part, this was due to recent research showing that this causes significant bone loss for every steroid injection. In addition, rather than having tunnel vision and thinking the patient must only have a sciatica disc problem, he understood that the first place to look for issues in a patient who has fallen on her butt was the SI joint. These strong ligaments help to hold the SI joint and pelvis together and when lax and damaged, will often mimic a herniated disc and cause not only low back pain, but also leg symptoms.
Dr. Newton used the Regenexx-DDD procedure to place the patient’s own growth factors around the irritated spinal nerves and also injected the same growth factors into these damaged ligaments. The results? Here’s a report from the patient:
“Hi Dr. Newton:
Hope you and your family are doing well. I wanted to give you a quick update. Absolutely, no pain anywhere!! I’ve been increasing my workout intensity. Here is my latest accomplishment – 15 unassisted bar pull-ups, 20 hanging leg knee raises and 15 hanging straight leg raises. I haven’t done any of these exercises in over 4 years or longer…
Can’t thank you enough for all you have done to greatly improve my back issues and obviously, quality of life!!
The upshot? All too often, pain management doctors get tunnel vision and only focus on one problem, in essence going after the “bright shiny object” that shows up on the MRI but ignoring what makes sense from the history (i.e. in this case that the SI joint ligaments are frequently injured in a fall). We will continue to follow DE as she gets back to more of the high intensity exercise!