Question
I am going in this AM to probably receive an epidermal shot in my lowest spine area by recommendation of my chiropractor and my physical therapist and they both recommended this Doctor. I have pain that shoots from my tail bone sacroiliac area, down my left hip & leg and will wrap around into my groin area. I cannot lift my leg at times and cannot put pressure on it at times it hurts so bad. Standing for a period of time makes it worse, sitting seems to help, cannot sleep on my left side, mostly only on my back. My physical therapist gave me ultra sound and electric shock and some stretching to do but recommended the shots. My Chiropractor has given me a treatment but said with the pain wrapping around into my groin at times he said it was probably a degenerative disc and recommended the shots. I have a numbness & tingling in my left foot, mostly in the base of the heel but some in my toes but mainly in the big toe. When I try to lift my leg it is the worst but at times if I can get through the shooting pain then I lift my knee clear up but will have pain lowering it and again only in a certain spot of lowering it then once I am past that point it is fine to finish lowering it. Sorry this is lengthy but I don't know how to shorten the explanation. I have always been an advocate of don't mask the problem, find the root of it and fix it. The shots are very expensive and I have a high deductable on my insurance.

Answer
Dear JD,

Well, I am not sure what the chiropractor has done for you thus far (mentioned one treatment), but most chiropractors would treat you for at least 2 weeks to see if the care will be effective first.  If the initial examination indicated disk pathology, I would have definitely taken low back x-rays to see if the disc was degenerated, if there was spurring into the nerve roots, or if anything indicate that I should not be adjusting the spine.  If the chiropractor suspects a disk lesion that is compressing into the cord or nerve root, then he should have ordered and MRI to confirm the extent of the problem. I would expect the L5 and S1 nerve roots to be involved from the pain distribution you have described.

Now, conservative care can often reduce or eliminate the radicular pain you have described.  Techniques that would be specific to target the disc and nerve root would be flexion/distraction (cox technique), and intervertebral disc decompression, Spinal adjustments can be very effective as well.  If this does not help to reduce pain levels in 6-8 visits, then a pain management procedure would be appropriate. Moreover, if you have any changes in your bowel or bladder function, you should go to the ER and get an immediate MRI, not CT, to evaluate the condition, as this can be a medical emergency called Cauda equina syndrome.  However, the pain management physician will want the MRI as well to look at the area.  Further, the technique should be performed under flouroscopic guidance (like a motion x-ray) so that the injection can be placed accurately and safely.  

Hope this helps your understanding JD.  Good Luck.

Respectfully,
Dr. J. Shawn Leatherman
www.suncoasthealthcare.net