I'm 26 and I've had Sciatica (formerly advised it was a bad back) since about July 2010 and while annoying, its certainly not excruciating. It only really affects me doing certain stretches and my leg/bum goes numb if I sit a certain way for too long.
I recently started quite a bit of Martial Arts training and I went back to my doctor in August 2011 as I wanted to see if there was anything I could do to heal it as it had been a considerable amount of time. This is when I was told it might be Sciatica and not just a bad back. I then went to a PT for 1 session before deciding to try Chiropractic which while this helped briefly each time, (total 4 sessions) it went back to normal the next day but I was told a bit more about what could be causing the Sciatica. Turns out its likely to be a "Disc Injury". I've since been back to the doctor again to ask more about a potential disc-injury and he agreed. I've now got another PT session booked and have been taking the anti-inflammatories, using cold packs and doing the stretches I had been told to do. This only appears to actually help when using the cold packs and taking the medication. None of the medical experts I've seen so far have told me to stop training but said you may want to be a little bit careful and may need to stop further down the line if it doesn't get better/gets worse.
I have 2 questions, if i may:
1. I don't feel like this has been properly disgnosed and am not confident that the treatment I'm getting is right for my injury, what do you think? Should I be insisting on a specialist of some kind?
2. I've read that Sciatica caused by a disc injury can end up causing permanent nerve damage if left for too long so with it being 18 months I'm getting a bit worried, even though it hasn't got any worse. I'm still training btw and may even be competing as early as next yr if all goes to plan. I would really like to continue training as much as I am if possible but do you think this is a bad idea in the long run?
The fact that you get leg and buttock numbness when sitting, that tends to be the sciatic nerve. This is usually due to compression of the sciatic nerve as it passes under the piriformis muscle and out of the buttock at the gluteal fold (the lower edge of the buttocks).
A disc herniation, pressing on a nerve root, would cause a radiculopathy. This is numbness/tingling and pain in the dermatome of that particular nerve root. Such as, if it was the L5 nerve root, then the lateral side of the leg and top of the foot would be involved. The S1 root would get the lateral border of the foot and the back of the leg.
If your lower leg pain is worse than your back/buttock pain, then it is probably from a disc problem. But, if it is mostly in the back of the thigh, buttocks, back, then it is most likely from the sciatic nerve.
In terms of a disc herniation, a lot of research has been done as to the best treatment for these. It used to be taught that when comparing how patients did, between those treated surgically and those treated conservatively, at two years there was no difference. But, the patients treated surgically, felt better sooner. Since surgery has become much safer than in the past, most patients do not want to put up with the problem for that long and will elect surgical intervention. Again, this is for disc herniation specifically, not for nerve roots compressed by other materials such as the annulus, bone, or hypertrophied ligaments.
Most spine surgeons will allow their patients to do any activity that they are able to do. They definitely encourage the patients to stay as physically fit as possible, as a fit patient has less back pain than the sedentary patients. maintenance of proper weight and cardiovascular fitness is important. Strong core muscles are also very important.
If you feel that you need to see a spine surgeon, do so. A thorough evaluation and possible MRI should be done.
Thank you for your reply. It's very helpful to get your views and really appreciate you taking the time to respond. Going through PT at the moment so I'm hoping this will begin to help if not I will referred to a specialist.