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How can i tell if my pain is sciatic pain?

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Sciatic pain is from irritation - most often in your lower back - of the biggest nerve to your leg. Usually there is some low back pain, but mainly pain, tingling or burning in the butt-cheek and radiating down the back or side-back of the thigh. Sometimes the pain just goes to the knee, other times it goes down the calf or even to the toes.

The "irritation" may be from actual pinching of the nerve root as it exits the spinal canal, but more-often we find it is as much a chemical irritation by inflammatory chemicals that leak from damaged discs, angry facet (or "z") joints, and injured/scarred muscles or ligaments.

Physical tests - so-called 'nerve-stretch' tests are not very reliable, but resting postures, stretching and postural strengthening exercises can be very successful - and give fast-relief. Lumbar MRI is not necessary unless your numbness, tingling or muscle weakness is getting progressively worse-and-worse.

Why? MRI shows only abnormal anatomy - NOT the CAUSE of the pain. Even if a herniated disc showed up - no guarantee it was causing pain. 30-40% of herniated discs cause no pain.

If you're losing bowel or bladder control - or have numbness there - get to the doctor ASAP - it's a "Red Flag" of back pain - you may need emergency surgery.

Otherwise, new topical pain-relief medications can give fast-relief, but they are so new they're essentially secret. Cochrane Reviews found 35 studies showed "good" pain-relief with topical NSAIDs.

Also, consider an early Physical Therapy evaluation - in many states you can do this without an M.D. referral - P.T.s are trained specialists - Ask for the new "pattern-recognition" back pain therapy or the older Mckenzie protocol.

Best wishes,

drdanbullock (orthopedics)
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