Sciatica & Low Back Pain: Diagnosis and Treatment

/ Thomas Cohn, MD

sciatica treatment st. cloudSciatica is a term used to describe low back pain that usually radiates into one or both legs. If the pain is radiating down the leg, it is likely being generated from a structure associated with the lumbar spine.

Radicular low back pain is pain usually generated from the lumbar spine.  Rarely, it can be from surrounding structures, muscles and pelvic or lower abdomen organs.  Radicular pain can be caused by any of the following:

  • Lumbar Discs
  • Lumbar Facet Joints
  • Lumbar Vertebra
  • Lumbar Nerves
  • Sacroiliac Joints

All the above structures are linked to the lumbar spinal nerves, and when irritated, send signals to the brain that are perceived as pain in the low back that radiates into the buttock or leg. Pain can be felt on one or both sides of the body with this condition.

How to Identify Sciatica

There are several common symptoms that could indicate sciatica, including:

  • Lower back or leg pain (either sharp or chronic)
  • A tingling sensation or numbness in one or both legs, that may extend down to the toes
  • Pain in the buttocks

Generally, sciatica only results in pain on one side of the body rather than both. People who suffer from sciatica can have widely varying symptoms. Some people experience intense shooting pain that makes it difficult to stand or walk. Others feel a subtler and less frequent pain.

Sciatica Treatment Options

Most radicular low back pain is not serious.  The condition can generally be resolved by using conservative treatment methods, such as:

  • Ice and heat
  • Keep rest to a minimum – movement actually helps most structures to heal, allowing blood to flow to the region that carries the body’s own healing tools
  • Use over the counter medication to reduce pain

If the pain does not resolve within a week of trying these methods, then help from a primary care provider may be beneficial to obtain stronger medications and physical therapy.  No matter what you do, most sciatica pain will resolve within a month.

If radicular low back pain does not resolving in a month, the patient should consult with a Physical Medicine specialist, especially one board certified in Pain Medicine.  These physicians can listen to your symptoms, examine the muscles, spine and nervous system, determine what more testing is necessary and design an appropriate individualized treatment program for you.

5 Must-Have Surgery Recovery Items

/ Thomas Cohn, MD

foot surgeryNote: This is a guest post from the folks at GoodbyeCrutches.

If you have to have surgery on your foot or ankle, you have some preparations to do in order to help the process go as smoothly as possible.  In the past, when you injured yourself, you would simply have to suffer through it.  Today, however, there are many inventions that can help you relieve yourself of the discomforts that surgery and injuries can bring to your life.  As you go through the recovery process, consider using a few of these items to help you get through it with more comfort.

1. Comfy Cozy Cast Toe Warmers

When you have a cast on your foot, your whole foot is covered, except your toes.  They are exposed and they can often get cold, even in the summer.  In past years, you just had to stretch a sock over your foot and do the best you could.  Today, though, comfy cozy cast toe warmers fit right over your exposed toes like a slipper and fasten around the back with Velcro.  Your foot might still hurt, but your toes will be warm.

2. Shower Stools

Taking a shower is tough no matter what when only have one foot to use.  It will never be easy, but in the past you just had to balance on one foot and do your best.  Today, there are shower stools available so you can sit and not worry so much about falling over.  You can also enjoy a longer shower since you will be sturdy and ready to go.

3. Cast Coverz

In the past, you would get a white cast and that was the only option.  After that, you had color choices, but once you picked one color, you had to stick with it for the duration of your recover.  Today, there are Cast Coverz that help you get through the recovery process in style.  There are a lot of different colors and patterns that you can choose from to make yourself feel better about your situation.

4. Cast Coolers

Casts can be rather itchy and hot.  If you needed relief in the past, you only had that straightened out coat hanger to help.  Today, cast coolers can be hooked up to your cast and a vacuum cleaner to suck the air from beneath your cast out.  They will dry the cast out and cool the area beneath it leaving you with a fresh, clean feeling that will allow you to feel and smell better.

5. Alternatives to Crutches

Crutches are wonderful mobility devices that can really help you balance and get around, but they can also be cumbersome and make you sore.  If you think you might be better served by something else, Goodbye Crutches has several great alternative options to crutches.

The recovery process is certainly never going to be easy, but today at least you have plenty of items that can help you make the time you have to spend on one foot easier, more comfortable, and as bearable as possible.

What Causes Carpal Tunnel Syndrome

/ Thomas Cohn, MD

carpal tunnel syndromeDo you have a constant or recurring pain in your hand, wrist, or forearm? You may have a common condition known as carpal tunnel syndrome. Carpal tunnel syndrome is a condition in which a pinched nerve in the wrist leads to pain in the hand and forearm.

Causes of CTS

The carpal tunnel is a channel on the inside of your wrist that protects a nerve and numerous tendons as they pass into your hand. When this nerve is pinched it can lead to carpal tunnel syndrome. Commonly, carpal tunnel syndrome is caused by one or more of the following:

  • Compressing the nerve by using a computer keyboard and/or mouse for long periods of time.
  • Using your hands to work with anything that vibrates intensely or results in high force impact.
  • Physical injury to the hand, wrist, or forearm.
  • Any other form of repetitive stress.

Symptoms of Carpal Tunnel Syndrome

So how do you determine whether or not you have carpal tunnel syndrome? There are a number of symptoms to watch out for that could indicate the condition, such as:

  • A tingling or numbing sensation in the hands.
  • Pain in your wrist that moves up into your palm and fingers, or through your forearm.
  • Weakness in your hands resulting in an inability to grip objects or make a fist.

Carpal tunnel syndrome is a condition that most people simply live with. But if you find that your symptoms are interfering with your day to day activities, it’s important to consult with a specialist.

Read our follow-up blog on treatment options for carpal tunnel syndrome.

How to Choose a Good Pain Doctor

/ Thomas Cohn, MD

pain doctorChoosing a good doctor is always a challenge. There are many options to consider, including:

  • Insurance Requirements
  • Where you Live
  • The Degree of Specialization of the Physician you’re looking for

The best pain doctors will be those who have a broad range of experience, and a broad range of ability to evaluate and treat a variety of problems.

The Definition of Pain

The International Association for the Study of Pain defines pain as: “An unpleasant sensory or emotional experience associated with actual or potential tissue damage, or described in terms of such damage.”  Pain is how the body interprets certain sensory signals in the nervous system, which includes how the brain processes the signals and determines how to react to them.  Pain sounds simple, but becomes extremely complex due to many causes and interactions.

Qualities of a Great Pain Doctor

A good pain doctor needs to have many qualities in order to successfully manage what can be an extremely complex problem.  Pain often comes from multiple sensory sources, and finding each sensory source is a challenge.  The start to finding the source is listening to the patient, the story, and where and what is happening.  The story is often critical, and a good doctor will be able to recognize what story matches various internal problems.  An experienced doctor can match a story very quickly to the pain problem.

In addition to listening to the patient’s story, a doctor may also need to perform other tests in order to grasp the full scope of your pain, such as:

  • Analysis of a patient’s movements
  • Checking motion in various body parts
  • Examining the neurologic and musculoskeletal system
  • Scans and X-rays

The best doctors have done this many times, and can put complex information together rapidly to determine a treatment plan.

Finally, all the good pain doctors should at least be fully licensed, and have subspecialty boards in Pain Medicine.  Backgrounds in Physical Medicine and Rehabilitation are also a huge plus.  Expect a good physician to be familiar with your history and examination, and have a comprehensive treatment plan, and be willing to address a number of complex issues contributing to your unique problem.

Low Back Pain: Causes & Treatment

/ Thomas Cohn, MD

Low back pain minnesotaLow back pain can be the result of a number of medical problems in a variety of areas, including:

  • Muscles
  • Bones
  • Ligaments
  • Joints
  • Nerves
  • Spinal Discs
  • Other Internal Pelvic Structures

Any of these can cause pain that may be interpreted as low back pain.  Fortunately, 95% of the time, the cause will heal quickly and the pain will go away no matter what treatment is performed.

Back Muscle Strains

The most common cause of back pain most people suffer is a muscle strain.  Pain from a strain is localized in the muscles along the low back and in the buttock and they feel like tight bands.  Usually this is from over stressing the muscles by lifting too much, twisting, and bending.

With mild to moderate strains, one is usually just sore and stiff when moving.  In more severe strains, one may feel like they can hardly move due to the pain.  If the pain is more severe, start with simple treatments such as:

  • Heat and ice
  • Stretching to loosen up the back muscles.
  • Over the counter medications like acetaminophen, aspirin, and ibuprofen

Joint Irritation in the Low Back

The next most common cause of pain is irritation of the joints in the low back or pelvis region.  The facet joints in the back occur on both sides of the spine at every level. They are the same size and structure as the joints in the fingers but carry the weight of the whole body.  The sacroiliac joints connect the bottom of the spine to the pelvis.  Both of these joints cause deep pain in the low back region, but it does not usually radiate beyond the area, and may be worse with certain movements.  Again, simple treatment with ice and heat, and over the counter medications will help.

When to See a Pain Doctor

The more complex the pain, the longer lasting the pain, the more benefit there is in seeing a doctor.  If the pain does not go away within a week, start by seeing a primary care doctor. Sometimes resolving the problem can be accomplished through physical therapy and stronger medications.  Rest is not recommended more than a day or two. The more active you are, the more likely you can solve the problem.

If the back pain continues for more than 4-6 weeks, then it is time to find a Physical Medicine doctor who specializes in Pain Medicine.  These are highly trained doctors who really understand the complex elements of the low back that can cause pain.  They can determine which structures are causing the pain and guide a person through successful long-term treatment.  A good pain doctor will diagnosis what is wrong, and work with you to find the best solution for your specific needs.