Welcome, Friend!

It looks like you're new here. If you want to get involved, click one of these buttons!

Veritas-Health LLC has recently released patient forums to our Arthritis-Health web site.

Please visit http://www.arthritis-health.com/forum

There are several patient story videos on Spine-Health that talk about Arthritis. Search on Patient stories
Protect anonymity
We strongly suggest that members do not include their email addresses. Once that is published , your email address is available to anyone on the internet , including hackers.

All discussions and comments that contain an external URL will be automatically moved to the spam queue. No external URL pointing to a medical web site is permitted. Forum rules also indicate that you need prior moderator approval. If you are going to post an external URL, contact one of the moderators to get their approval.
Attention New Members
Your initial discussion or comment automatically is sent to a moderator's approval queue before it can be published.
There are no medical professionals on this forum side of the site. Therefore, no one is capable or permitted to provide any type of medical advice.
This includes any analysis, interpretation, or advice based on any diagnostic test

What causes my chronic low back pain with no sciatica?

cwdlaw223ccwdlaw223 Posts: 8
edited 06/11/2012 - 8:43 AM in Lower Back Pain
What actually causes my low back pain with no sciatica? I have an 8mm herniated disc at my L5-S1 level without any sciatica. Is my pain in my lower left back caused by my muscles being over-worked to keep my body in balance? I'm confused with my pain because I don't have any sciatica. I've had this pain for years and the past 8 months it has greatly increased. I don't know how I get muscular pain as a result of the herniated disc.


  • Herniated discs cause pain in multiple ways, with nerve compression (ie- sciatica) being only one way that they cause pain.

    The disc itself can be painful because there are nociceptive nerve fibers (pain receptors) in the annulus (the wall) of the disc. When the disc is herniated the nerves in the wall of the disc get aggravated and can cause pain. So, your pain could be coming from the disc directly because it is an innervated structure.

    There is also the muscle issue. Herniated discs cause some of the small stabilizing muscles in the back to shut down (the multifidus, in particular). Even when the disc heals these muscles tend to not automatically turn back on. This causes patterns of muscle substitution that can be very painful and cause a lot of spasm, trigger points, etc. One common pattern is that the quadratus lumborum becomes overactive to compensate for shut down multifidi segments. These defective muscular recruitment patterns can then go on to cause further pain because they put unnatural stresses back on the spine.

    It can really become a vicious pattern, and the best way to break it is by seeing a competent spinal physical therapist. You really need a *good* physical therapist who can help you re-activate any muscles that have shut down as a result of the herniation (they usually do this by doing manual work on the muscle tissue itself), and who can give you exercises to promote the correct muscle recruitment. I cannot emphasize enough how important it is to see a physical therapist who is qualified to work with spine patients. There is a *huge* range of physical therapy out there, and it can make a world of difference to seek someone with experience dealing with these types of issues.
  • Another source of back pain can come from the facet joints. Those are the bones that you feel running down your back. They come in pairs. Often the joint can become arthritic which puts pressure on the nerves. If your pain increases when you bend backwards there is a good chance the facet joints could be the cause.

    Another source of low back pain can be the S.I. Joints. These joints are tiny but have a huge work load as essentially they connect the upper body to the pelvis/lower body. The easiest way to locate the SI joint is to find the beginning of the gluteus crest (butt crack~sorry) and move slightly to the right or left and that is the SI Joint.

    In addition to the muscle imbalance that Lala talked about can be your body's aleignment. The body is all inter-related and pain/guarding/weakness can lead to your body getting out of aleignment. Recently, I started experiencing pain in my knee and ankle. I thought it was weakness, but one of my hips was 2 inches out of aleignment. As Lala suggested, a Physical therapist with spinal cord/ortho training can work her "magic" and you are back in aleignment.

    Hope this has helped! Good luck!
  • I have severe back pain with absolutely no sciatica whatsoever. Like Lala329 said, "The disc itself can be painful because there are nociceptive nerve fibers (pain receptors) in the annulus (the wall) of the disc. When the disc is herniated the nerves in the wall of the disc get aggravated and can cause pain. So, your pain could be coming from the disc directly because it is an innervated structure."

    My annular tears tore enough to let the gel-like substance in the discs to leak out, which caused me severe pain. It's lasted 13 months now.
  • Welcome to Spine-Health.

    Can we assume you've had an MRI that shows you have a herniated disc at your L5/S1 level? Your questions is very vague and you don't mention what, if any, doctor said to you regarding your disc problem.

    That would be the best place to start. Your problem may or may not be helped with PT and I suggest you start at the beginning - talking with your PCP or a spine specialist about what's going on and let him or her suggest your path of treatment.

    With spine problems, it's imperative to get the correct diagnosis from a qualified physician and thus, get the proper treatment for your particular problem.

    Take care,

  • When the doctor does the discography will he see these other reasons why you are in pain?

    Meaning if it is the tears, facet joints, muscular or SI joints will he see that or only rule out herniation?

  • Hi JS, I'm not sure what you are asking. LOL Maybe it's the pain meds confusing me? Anyhow, about the discogram. I had one done and here is what I can tell you about it, and what my doctor told me:

    They are going to inject a dye into the discs they suspect are damaged, plus a disc that they know is ok--the 'control' disc. When they inject the control disc, you should only feel a little pressure, no pain. The discs that are bad, have annular tears in them, when they inject dye into THOSE discs, you will feel pain, and lots of it. But it won't be any worse than the worst pain you've alredy felt, is what they told me, and I found this to be true. The discogram, for me, wasn't very bad, painful yes, but not more painful than the pain I'd already been experiencing all along.

    Within 2 hours of having the discogram done, I had to go and have a CAT scan, which was simple, so simple, and took less then 5 minutes, and from this they got a picture of where the tears were and how it looked as the special dye leaked out of my discs.

    My doctor and a surgeon both told me the same thing--the discogram is only done to discover which discs are causing the pain---HOWEVER, they do not kow what the cause of the pain is. The discogram identifies the discs that are bad, the ones that are causing you the hurting, yet they do not know exactly WHY they cause the pain.

    That is why my doctor has tried all kinds of different injections on me, just to see if anything might help, but so far, nothing has. He knew as soon as he saw how my annular tears looked that even physical therapy was not an option for me, he said YOU NEED MULTI LEVEL FUSION SURGERY! and my mom about fell out of her chair.
  • If the discs though do not produce pain with the injections, can they diagnosis other possible causes other than a tear/herniation?

    I am a bit disappointed that they can not be more exact other than just knowing that is the disc that is producing the pain. He says since I have small herniation on both my L4/L5 and L5/S1 that he needs to do it.

    But every other doctor including him at one time believes it has to be the L4/L5. Makes me wonder since no new info but I believe he really may just want me to try this new therapy and they say a discography is needed before the IDET.

    Also it seems based upon your experience that they can have a better idea which form is treatment will help.

  • I had an MRI that showed the 8mm tear at the L5-S1 level. I have had several opinions. I believe the best opinion is from my osteopath and a chiropractor that I don't want to hear: (a) spinal fusion, (b) disc replacement surgery, or (c) do nothing and live with the pain.

    What additional tests could be run to better locate my pain? I had a SI joint injection the other day that has helped, however, it still didn't take away most of my lower left back pain. I hate to admit it, but I'm damaged goods at this point in my life. My body is already starting to adapt by putting more weight/stress on the right side of my body.

    I am/was a very active adult and don't believe physical therapy will help my condition at all. In my case, I view physical therapy as asking me to do tricep exercises to "strengthen" my arm to deal with my torn bicep. I have plenty of core, back and leg strength.
  • How would I know if a muscle has shut down? Other than my pain, I have adequate strength. How can physcial therapy heal my torn disc?
  • A discogram does not even necessarily prove that a particular disc is the painful one. It is possible for a disc to have small tears in it and still be asymptomatic. This is one reason why the results of the test are considered subjective.

    Also, when the disc is pressurized and the saline solution leaks out, there may be other reasons for pain as well, or, in addition. The discogram only indicates if the disc is intact.
  • I had a herniated disk 8 years ago (I think, I can't remember exactly when it was!), and the muscle spasms were so bad I had a 30° scoliosis! I did have sciatica, but at the time I didn't understand about the muscle structure issue Lala discussed, and it all really scared me. I thought my back was really structurally damaged. Imagine my surprise when a few months (OK, maybe several months) later it all went back to normal!

    Physical therapy helps not only by strengthening the muscles that support the spine and preventing future injuries, but also by using modalities to relax the muscles that are in spasm. But more than any other medical specialty I've found a huge variation between physical therapists- I went to one once who handed me a sheet of exercises and said "well, I guess you could do these." I went to one where the PT put me with a PTA (assistant) who had me doing exercises that exacerbated the condition and the PT never even checked on me. And I've had PTs who were truly amazing and gave me a great deal of relief. So if you go to one and think "is this supposed to help?" try a different one!

    Now that my back really IS structurally damaged, PT is a part of past, present, and future. I swear by it!
  • How much different is a physical therapist than a chiropractor?
  • I haven't had a chance to welcome you to the board.

    I just wanted to mention that patients are often not satisfied with the results of a fusion when their pre-surgery symptoms are lower back pain without sciatic-type nerve pain. I believe the reason for this is because often the source of the pain is not "corrected" with the fusion.

    My suggestion to you would be to keep gathering information until you are reasonably sure what the pain generators are in your spine. A fusion is a rather drastic surgery that is best to avoid if there are any other options.

    I couldn't tell from your posts who is treating you currently.

    Have you found the wealth of information in various articles and videos that are found on the main part of this website? Perhaps this article will help:

  • I had an SI joint injection the other day that worked for a little bit. The doctor said I had discogenic pain. I suspect this means nobody really knows why I have the pain or what to do to stop it. Logic tells me that my 8mm herniated disc at the L5-S1 level is either causing the pain itself through the tears of the disc or weakening everything around me (or possibly both). When I sit (like I'm doing now) with my legs out on an ottoman I can really feel the pain in my lower left back more than sitting in a chair all day long. The pain has gotten worse over the years and my herniation isn't the result of a sudden accident.

    Would you recommend a discogram procedure to see how quickly the dye leaks out of my disc? I'm not sure that disc replacement surgery is the way to go, however, my back has taken away my active lifestyle.
  • Are you going to a fellowship-trained spinal specialist? I can't tell from your posts who is coordinating your treatment, sending you for the SI injection, suggesting a discogram, etc.

    I personally would not recommend a discogram unless your spinal specialist felt there was no other way to get the information he/she is seeking. They are somewhat controversial and not all spine specialists believe in putting their patients through them unless there is no other way to determine which disc is causing the pain. But that is just my opinion, and I have no medical training....I would first get an opinion from several spinal specialists until I felt comfortable with the diagnosis. Then I would proceed with whatever conservative treatments were recommended. But again, that is just how I would go about it.
  • Hi Gwennie,
    What you said in an above post really scares me: "I just wanted to mention that patients are often not satisfied with the results of a fusion when their pre-surgery symptoms are lower back pain without sciatic-type nerve pain. I believe the reason for this is because often the source of the pain is not "corrected" with the fusion."

    That is me, completely. I have absolutely no sciatic type of pain, yet my Neurologist and surgeons I've consulted all say one day, I will need the multi level fusion.

    Yesterday I woke up feeling great! I swear, my pain after I took my morning lortab was way down, to about a 4!! First time in literally months. And then, I was just walking through my house, not even bending or anything, just walking to the bathroom, when I felt something snap-pinch-rip-tear down there. Not sure how to describe it. But whatever happened, my pain shot up to a 9 all day and I was in a terrible state. My mom had to go to the pharmacy and buy me the handrails that you attach to your toilet, so I could sit down and get up from there. I feel so humiliated having this 'thing' attached to my toilet, but let me tell you, what a HUGE difference it made having those handrails to help me get up and down! Only problem now is that the rails make it a lot more difficult to twist to --ahem--, wipe--- I need to adjust the width of them so I have a little more wiggle room. And lost some more weight!

    But wow, see how fast the pain can come back? Just like that, it ruined my day and my mom left here so upset she left going the wrong way!
  • Sometimes it's so difficult to find exactly what's going on when you have lower back pain. I had lower back pain, hip pain, and pain down the back of both of my legs down to my knees.

    Although I did have a disc bulge at L4/5, my surgeon diagnosed my problems as facet problems and stenosis. After conservative treatments failed, I had a fusion at L4/5 to take care of the problems.

    After the surgery, my surgeon said he found more stenosis than he'd originally thought and that the facet joints were very bad. He said he found more instability than he originally thought also, so he was very glad I had the surgery.

    I got my Operations Report a couple of days ago, and it opened my eyes to some things that I never knew I had such as spondylolisthesis. My L4/5 was a total mess and the surgeon knew that to some degree but didn't realize just how bad until he got in there.

    I'm just telling you this because it's such a journey to find out what's wrong and it can be so complicated in the lower back. My cervical problems were very bad also, but it was clear on my MRI what my problems were. No conservative treatments were suggested, surgery was the only choice.

    So, hang in there. I agree with Gwennie to find a fellowship-trained spine surgeon, ortho or neuro, and find one that you feel you can put your complete trust in.

    I'm sorry you're having so many difficulties and hope you find a solution, but like the others have said, a second and third opinion might be a good option for you at this point.

  • I think also there's a desire by people to want the most severe and long-lasting pain to not be muscle strain, because we've all experienced that, right? Muscle strain is like when you twist your ankle. It hurts for a day or two and then it's better.

    The size and complexity of the muscles in the back, and the level to which the are innervated, makes them a whole different animal. Sometimes the spine becomes unstable, and the body does some pretty maladaptive things in an effort to "fix" it, and those things hurt. A lot.

    Anyway, 2 1/2 years later I have two major, large muscles that still haven't realized that they can go back to their regular jobs now. The PT wasn't even able to convince them with his elbow and lots of pressure and work. It hurts. When you have pain, don't automatically think it has to be disks or bones or pinched nerves, because although those things might start the cascade that gets the muscles going, the muscles can cause a whole lot of discomfort on their own.

    (and in terms of whether a fusion is needed, unless I had spent 6+ monts doing physical therapy 3x/week with someone who was really good at core stabilization, which is like making your own body its own little fusion surgery with no knife, I wouldn't do it. But that's just me, and I am, as the saying here goes, very much not a doctor)
  • Is it just because you have multiple discs that are show protrusions to determine the real culprit?

    In my case on the MRI I have a very small protrusion at the L5/S1 but a slightly larger one at the L4/L5. It is only to tell which one is the real culprit but can still be wrong?

    Also if you feel pain, get the dye shot and the CT scan. Does the doctor see the extent of the damage to the disc. It must have more detail than the MRI?

  • My Family Doctor told me he's seen GROWN MEN come in there crying with muscle spasms in their lower back. At first, we thought this was what was going on with me, but after I had an MRI, he said he could see bulging discs, and he sent me to the pain management clinic, and then the found the tears via a discogram. Now my family dr. feels sorry for me! :( Man, that sux! LOL

    But like you guys were saying, muscles sure can cause pain too. My doctor has recommended I do NOT do phys. therapy for fear my tears my tear more I guess. He said Phys. Ther not an option.
  • I'm not arguing with your doctor, but I'll say second opinions are always your best bet before you go into surgery. In fact, I'm getting ready to go on a search for a second opinion about whether the decision NOT to do surgery is the correct one. You only get one spine.

    So during the discogram, did they diagnose the pain source, or just the tears?
  • I thought I'd clarify that the trunk stabilization program at my PT starts with laying on your back and creating pressure on the table with your tummy muscles- that's it. Not exactly the stuff back injuries are made of. Didn't even hurt my back!
  • I am wondering if yoga would be good? I don't know much about it, other than you hold poses for long times, and breathe slowly and focus on muscles. Not like doing jumping jacks, and any exercise that doesn't require exercising suits me, LOL! Yoga looks so easy, but they say it is really difficult. When mom did some phys therapy they had her doing that "cat" and "camel" positions. One where you arched your back while on your knees, and the other the opposite.

  • I don't know girl, every time I've tried something without professional supervision I've ended up injuring myself, LOL! I don't even bother anymore.

    For me, yoga and pilates of the standard type are no-go because of the amount of mobility they require in the lower back.
  • Years ago, I had severe lower back pain with no sciatica.

    I had an MRI that showed a severely herniated L5-S1 disk, but my Osteopath said it wasn't quite touching the nerve root, so just leave it alone (big mistake in retrospect because it was causing nerve damage as I moved my leg -- the MRI was a static picture and didn't show what was happening as I moved).

    Two years later, the lower back pain was worse. However, I never had pain in my leg -- just numbness in my toes. My Osteopath said that he thought it was a sacro-iliac joint problem and that I could try Yoga (wrong! twisting my lower back exacerbated my symptoms). He also prescribed PT, but sometimes PT can further herniate a disk, which it did for me (confirmed by another MRI).

    At a routine visit with my PCP (a pulmonologist of all things!), I happended to mention my symptoms and he said that it was urgent that I go see a neuro-surgeon immediately. I had a discectomy within two weeks which did alleviate my symptoms (until I reinjured myself 6 months later).

    A year after that, having had another discectomy, and a brutally painful discogram that "suggested" a problematic L5-S1 disk (ya think??) causing disk pain, I had a spinal fusion in late January of this year.

    14 weeks after the fusion, I still have severe lower back pain and some numbness in my foot.

    Why do I say all this? I think many of the previous posts confirm what I now believe -- this whole process of diagnosing back pain is an incredible mystery. Yes, some people are successfully treated and I thought I was one of them after my first discectomy. However, many of the tests are actually controversial as to their conclusiveness, and I see why.

    Getting back to the original question in this post, I firmly believe that there are other cases out there where herniated disks are being misdiagnosed, as mine was, due to the lack of sciatic pain. Meanwhile, potentially irreversible nerve damage may be occuring, which I believe is my case.

    Obviously, I am not a doctor. I don't want to discourage anyone from getting medical treatment. On the contrary, I would encourage you to get multiple opinions, but also to educate yourself early on so that you can question things that don't make sense to you. I wish I had challenged my Osteopath on my original diagnosis and treatment. I think I would be in a better position than I am in today if I had done so.
  • I have no nerve damage and a herniated (bulged, prolapsed) disc L4 L5 and there is massive pain with no muscular issues, according to my MRI and the report from that that is, what is causing my pain is a combination of scar tissue from the 3yrs of the disc being out, but the major pain I have now that has been since a bad fall nov 09 is from the disc coming out further and the disc itself can cause pain alone.
    I do get pain going down into my leg but they (the dr's) have said it is just cause the disc pain is bad and there is no nerve dammage on the scan, it will be the severity of the disc pain traveling. Also I am mostly unable to walk too far and when I do that makes the pain worse as does sitting and things like that.

    Hope that might lend some light on your pain, if you want a profesionals idea look for a really good ortho/back surgeon, but be warned they can be a bit clinical and mine did try to make lite of my pain and blame it alot on my mental health but my OT (Occupational therapist) said alot of her paitients have extreem pain like me and it is just from the disc and nothing else. Mine is so bad Im waiting on surgery.

    Hope that might help KB
  • zekozzeko CaliforniaPosts: 1
    Hey I am suffering from bilateral lower back pain without sciatica ....will it be helpful to visit physical therapist? My doc suggested me to do so till my next visit... But am not sure to go! My condition is so severe in some days and it's just okay in other days... But during pain I am almost unable to move a single step.it become bad after I slipped my steps during a hiking ..do u guys travel with ur pain? 
  • LizLiz Posts: 7,832
    hello zeko
    This is an old discussion created by a member no longer on the forum so I am closing it.
    I suggest you create a new discussion using the link below

    Please click on the link for useful information

    Liz, Spine-health Moderator

    Spinal stenosis since 1995
    Lumber decompression surgery S1 L5-L3[1996]
    Cervical stenosis, so far avoided surgery
This discussion has been closed.
Sign In or Register to comment.