I am not a doctor so obviously you need to see a doctor as your issues are bothering you and better to deal with it sooner than later.

Given you are having sciatica pain and some numbness this should be more than enough reason for you to see a GP and than a spine specialist. The issue of running to relieve pain are things I went through initially but instead I rode my bike, Mine eventually turned into a mild herniation in my L4/L5.

I was also told I had pirformis syndrome which later proved to be false. I would talk to the docs, maybe get an MRI if they concur and see what plan of recovery they recommend. Unfortunately as many can tell you hear it can be a long time and many different procedures or opinions before they find out what exactly is the issue.

-js

I have seen osteopaths, physios and am now under the care of an orthapedic surgeon. I know the best people in this field work in the private sector but I'm loathe to start spending money until I get a diagnosis that makes sense. I also do a lot of cycling and have lost 3 stone (42lbs) but this hasn't helped my back.

So did you find running got rid of your pain too? This seems to be the single point that baffles everyone.

I'm having an epidural injection in a month's time, but I have to tell you, I'm not holding out much hope that it will be a success.

Have you had a flexion X-ray and been checked for spondylolisthesis? Usually when pain goes away when you sit or lie down, but is bad when you are weightbearing, it is a class sign of stenosis. The lumbar nerve is being compressed, but when you lean forward or change position, the pressure moves off the nerve just enough to provide a little relief.

This compression can be caused by a problem with a disc, or degenerative changes that cause the spinal openings to narrow. With spondylolisthesis, there is a slippage of one vertebra over the top of the vertebra beneath it. This too can result in a nerve being compressed in certain positions.

Of course the curious aspect of your situation is that the pain goes away when you run. I cannot imagine why that would be.

It is very frustrating to have a problem that is perplexing to the medical community. You'll just have to keep at it until you find the right person who will know how to help you.

Good luck.

Gwennie

Not sure what a flexion x-ray is but think I've only had a normal one. As for spondylolisthesis, would this not have been apparent on the MRI? The MRI shows what looks like a herniated disc, but they weren't 100% sure. I guess this epidural they're giving me is as much to help confirm the diagnosis as to actually give me pain relief.

The running thing is weird and is what is making me think it's not as simple as a herniated disc. Is it just that the muscles are warmed up and stretched, or is it that I'm not load bearing in one position? Or could it even be to do with endorphins giving pain relief. I have no idea.

KevinT glad to hear you loss the weight as that should definitely help with your plight for obvious reasons but back to your issue and my experience.

Based upon your post you are giving me the idea that like me you may be a fairly athletic and active person. in my experience this helped me alot on the early stages. Infact it took about March thru July of a slow loss of power till end of July/August when the pain really kicked in and by end of September I was using a cane. Honestly it was me stopping all exercises and a bad chiro experience that got me to the cane. I would also guess that your docs look at you and say, you are pretty strong 5/5 which also throws them off.

I would suggest the best test to do would be a nerve conduction test and that could give them a better idea where the pain is coming from. I am also going to guess that what they believe is not much of a herniation probably is more than they think.

I would do the esi and go to a PT program that involves lots of exercises for a herniated disc that are illustrated here. I would stop running, go to walking but add in the prone exercises and see if you have relief. In my experience cause I was mis-diagnoised with pirformis my PM doc explained I spent months with my nerve just stewing and doing the wrong PT. The chiro just pushed it over the edge into pain!

If I am right I can save you alot of time and not be a almost a year in with this with now finally getting on the right track. I also know of another person who has what gweenie explains and he loves to ride his bike as is the only time he feels good...he does 200-300 miles a week. Unfortunately I do not think we will out run it that way. Your MRI should have shown narrowing also.

-js

I'm not so up on all the technical terms as you guys but I'll explain what the MRI showed as best I can.

It showed a big white circle on all but one of my discs, which was explained to me as the channel that the nerves run through. On one disc, this white circle was little more than a dot. Is this what you mean by narrowing?

As for being athletic, I am now, but I haven't been. In fact through my teens, twenties and early 30's I was pretty much a fat useless git. I didn't do any sports, so there is no trauma type injury to explain where this comes from. It is more likely to be bad posture. It's only this year that I decided to get myself in shape and I love it. It hasn't made my back problem either better or worse though.

The nerve conduction test sounds interesting? How does this work?

I'm not so up on all the technical terms as you guys but I'll explain what the MRI showed as best I can.

It showed a big white circle on all but one of my discs, which was explained to me as the channel that the nerves run through. On one disc, this white circle was little more than a dot. Is this what you mean by narrowing?

As for being athletic, I am now, but I haven't been. In fact through my teens, twenties and early 30's I was pretty much a fat useless git. I didn't do any sports, so there is no trauma type injury to explain where this comes from. It is more likely to be bad posture. It's only this year that I decided to get myself in shape and I love it. It hasn't made my back problem either better or worse though.

My condition doesn't prevent me from exercising at all. I'm pretty much either in the gym or cycling every day of the week. Where it hinders me is that I can't go anywhere where I can't guarantee a seat. So no more golf (which I used to love), I have to avoid traveling on trains in rush hour (which isn't always possible), no busy bars, no drinks reception type events, that kind of thing. My surgeon angered me the last time I saw him by implying that "it can't be that bad if I can run" - He clearly doesn't realise its much more convenient in life to be able to stand up for more than 2 minutes but not be able to run rather than vice versa.

The nerve conduction test sounds interesting? How does this work?

When I first injured my lower back L5-S1, I found that exercise was the best and only pain relief I could get. About 15 minutes into running, cycling or speed walking, I would get an endorphin boost that would provide me the only temporary pain relief I could get. Within a few minutes of stopping the exercise the pain would return. A good Pain Management doc was the one to point that out and understand what was occurring.

I still find this to be the case no matter where and how much I hurt. Some of us have a good capability to produce natural endorphin release, whereas others don't. Also taking narcotic pain medications over a period of time will suppress the body's ability to produce endorphins, hence exercise while medicated with narcotics won't produce the same effect. Once the narcotics are removed the body can return to producing natural endorphin release.

That's my experience.

"C"

Spondy does not always show up on a MRI. With the flexion X-rays, they have you bend backward, and then bend forward while the X-rays are taken. This will show if there is one bone slipping forward or backward over another.

I think you'll find that the only way to figure out your issues is by ruling out problems one at a time.

The nerve conduction study is part of an MEG -- you can read about it here:

http://www.spine-health.com/conditions/back-pain/electromyography-emg You'll note in the last paragraph the article says:

"There are no major risks, although the tests are not highly reliable in determining which nerve is compressed."

I had the same problem with standing prior to my surgery. I had gotten to the point where I could only stand about a minute or a two and I was driving to the mailbox at the end of the driveway to collect my mail. I never tried running, but I can't imagine that I could have done it.

You might want to try laying off all exercise except for gentle walking for several weeks just to see what happens. If there is a tear in a disc that is not showing up on MRI, maybe it would give it enough time to begin to repair. You could do this in conjection with the ESI. It would give the injection the best chance of having an effect.

If I understand your description of the image from the MRI, you should be able to see an opening as that is what the nerve passes through. When you cannot see any daylight, you know the nerve doesn't have enough room.

Did you get a copy of the MRI report?

It was done on the NHS so MRI report I'm afraid, but it sounds like you describe. As for gentle walking, I'd be in agony. That is the only exercise I can't do because of the pain! And for the first 9 months of having this condition I did no exercise at all. Doing all this exercise and neither helped nor hindered any progress. The only way to rest it so that I don't get symptoms is never to stand up, which clearly is not practical in day-to-day life.

I would go with what gweenie17 similar to me posted but wait till after you have your esi...the esi has a pretty much a-bomb effect so should produce some comfort for sure. Than try and slow down and do some simpler exercises and let the body heal.

Obviously the running/cycling is not helping you overall and just masking an underlying issue.

Does your doctor have any course of action after the ESI? I understand why he would be perplexed by the running but like someone else posted I had in the past been able to "work through it" atleast that is what I used to call it. It does not mean though it is working.

Have you noticed any difference in your running/cycling? Can you run faster or longer which each run/ride? I noticed over time that my ability went down over time.

-js

On a side note the doctor's scale of 5/5 is really not all that much and given your current activity level I am pretty sure you would be pretty high on the spectrum. Unfortunately my experience has been unless you come with crutches or a cane, the doctor will tend to believe you are not that bad. Till I came in with the cane did he send me for an esi otherwise do more PT and meds were the answer. I understand your frustration with your doctor lack of concern but given what he sees you are so much better than most of the others out there with these type of issues...

I would say the running and cycling is definitely helping me 'over all' - it just has no bearing on my back. I don't do a great deal of running - I'm not very good at it, but I'm loving cycling. I don't want to quit exercising but I will if the Doctor thinks it will help my back to sort itself out. As well as all the cardio work (which I'm doing for weight loss and general fitness - not as a tool to try and fix my back), I'm also doing lots of stretching and core stability exercises.

My ability to run or cycle has never been hindered by my back, so my ability is getting better, as I do more of it, as you would expect.

You kind of sound like me several months ago but the one thing I have learned here is that no two cases are ever the same. In the end if your doc does not tell you what is wrong than for sure your body will. Meaning that if the running/cycling are making things worse than eventually you will no longer be able to cycle/run. But if the cycling/running are a form of therapy than your back will get better.

I think it is hard for everyone to see them as separate issues including your doctors so something will have to give eventually and show the real culprit.

-js

I don't really feel like the exercise is either hurting me or providing any therapy. The fact that I can run is just a bonus. Means I can play football etc. I don't for a second imagine it's helping me. Nor do I need to run to provide relief. I'm really only in any sort of pain when standing up. The issue is more what I can and can't do in my day to day life, rather than being in constant unmanageable pain.

Been told today that if I get some relief from bending forwards this pretty much rules out a herniated disc as that would intensify the pain, not relieve it.

Does that sound right? If it's the case, this epidural is going to be a complete waste of time.

I do not think you can rule out anything at this point. But I was thinking of your story while in the gym and wondering does anything give you relief, hot baths, ice packs and meds. Also when you are in pain is it just a general pain or in any area of the legs. I would think your doctor would try to get to more of the specifics.

-js

You know what the NHS is like. If diagnosis isn't immediately apparent, they get bored and move you from pillar to post. And you end up seeing a different person every time. I think I need to spend some money and see a good osteopath and get another opinion.

I use voltarol tablets and gel which give some relief but nothing major. Deep Heat also gives some relief, although it's hard to guage how much and how much is placebo. It gets worse throughout the day and a night in bed helps it settle down again. The urge is to stretch forward which seems to loosen things up a bit.

I never get any kind of sharp pain, it's always a progressive aching and tightening. Likewise, no doctor has ever been able to re-create the pain by applying direct pressure to anywhere. It simply comes on from standing up. I had to take my son for an operation this morning and had to do a fair bit of standing, taking him to theatre etc, so today has been pretty bad. After sitting down, now I am in no pain, but I feel where it's coming from if I move about and stretch. It seems to stem from the area just a few inches above the base of my spine, about an inch or two from centre.

After I made that last post, seeing as I was off work today, I phoned around and got an appointment with an osteopath. I'm so dubious about the NHS's latest line of enquiry that I thought I'd get another opinion.

After a thorough exam and listening to all my sympoms and experiences, she thinks it's my Lumbosacro joint that's the problem, not the SI joint which was an earlier diagnosis.

She gave me a good massage and pushed and pulled me in all directions and told me to use hot and cold compresses until I see her next, as well as giving me a couple of new stretches to get to the muscles in this region. She also told me to work on strengthening my side abs as these will pull my pelvis into the correct position and take the strain off my lower back.

I'm gonna swallow the cost and go with her advice and continue to see her weekly in the weeks leading up to this epidural and see what happens.

She said the full range of running would stretch these muscles out so explains the mystery of pain standing but no pain running. Anybody know anything about the LS joint?

Kevin, I also get varying symptoms which have baffled physios because they contradicted each other.
An x-ray showed spondylolisthesis (slipped vertebra) L4/L5. Then, 6 months later, an MRI showed that I had stenosis caused by the spondylolisthesis and bulging/protruding discs which were also degenerated. At the level of the slip, the disc is almost worn away and bone on bone.

I now think that my contradicting symptoms are due to the different problems I have. Sometimes bending forward causes pain - due to disc problems.
Other times bending forward helps. I have sciatica which is caused both by my spinal canal being compressed (stenosis) and also my L5 nerve root is being squashed by the spondylolisthesis.

I just couldn't understand why standing and slow walking (especially shopping) are soooo painful quite quickly (5 to 10 minutes), while if I walk briskly, I can walk for about 30-40 minutes without pain, and it even seems to help get rid of pain. I asked a surgeon and he said that when I walk briskly, I engage my muscles which support my spine and stabilize it, where as slow walking the muscles relax and don't support it properly.

I have also been doing lots of core stability exercises to strengthen my muscles, and I have definately improved a lot on how I was at the beginning of the year. I have also been visiting a Chiropractor (over 50 sessions!)

I do hope that you manage to get some relief. It sounds like exercising is helping, or at least not doing any harm. Let us know how you get on.

I too have the shopping pain. That was the first time I noticed it, before it got so bad that I decided I have to do something about it.

Right now though, I've come down with flu so everything is hurting. At least I'm not standing up much so the back will be getting a rest.

I hope that you make a quick recovery and get back your strength quickly.
Take care