Nerve Pain

As I cannot currently do any new projects or work in the loft workshop at the moment which requires standing for very long, I thought I would write about what has been happening during the Covid 19 lockdown here in the UK for me. This is a very text-heavy post so the TLDR is: Damaged my spine and haven't been able to work much!

Normally in the summer months, I would be walking 20+ miles and cycling 50+ miles each week.

Since March 2020 I have been dealing with an ongoing problem with bad sciatica pain in my right leg and hip area with lower back pain on the right side.  This post details the things I have tried so far and the ones which have made it worse and better.

I hope this will be useful for anyone else dealing with the same symptoms and I would appreciate any comments if you have found exercises or treatments which have worked for you.

The Initial Cause of the Pain!

We have a family allotment where we grow fruit and vegetables and in early March I spent three days in a row digging the veg area by hand for several hours each day. after the third day, I had pain in the buttock on the right side and some pain behind the knee and calf muscle.

As I have had lower back pain problems in the past due to an old injury, I thought it was the same as before and took paracetamol which numbed the pain for a while, but I started to get very sharp pains and numbness down my leg to my foot when moving from sitting or lying down to standing which felt like electric shocks running down the leg.

I searched online and found information about sciatica and the symptoms seemed to match with the pain in the buttock and back of the knee/leg.

The recommended treatment was to see a physiotherapist, chiropractor or osteopath but as the country was locked down due to the Covid 19 pandemic, I was not able to get any professional help.

I looked on various websites and found a YouTube channel which was recommended  Yoga For Sciatica - Yoga With Adriene

I did the exercises once a day, but by the end of April the pain was getting worse and the leg was showing signs of weakness with a very strong ache in the buttock/glutes and the back of the knee when trying to extend the leg when sitting or moving the leg too far forward (stretching the hamstrings).

First visit to the Doctor

When the pain started keeping me awake at night, I was able to make an appointment with my doctor, he examined me and couldn’t find any obvious spine issues and said it could be piriformis syndrome after performing leg lift tests but there isn’t any treatment he can recommend at the current time apart from taking ibuprofen with Omeprazole Gastro Tablets to counteract the ibuprofen side effects to try to reduce the inflammation and also take paracetamol to help with pain control, continue with the exercises and it should resolve itself and do nerve flossing exercises.

Nerve Flossing Example

The doctor recommended seeing an NHS or private physiotherapist but due to the lockdown, none of the physiotherapists could see anyone.

I continued with the yoga exercises and was able to walk a mile or more each day outside but limped on the right side due to the pain which was much worse when walking up hills.

Online Support

I found a subreddit on reddit.com/r/Sciatica/ which had a lot of useful posts and I was recommended a book called Back Mechanic by Dr Stuart McGill, (amazon.co.uk/Back-Mechanic-Stuart-McGill to do core strengthening exercises from the book which I was doing throughout April and the start of May until my mobility decreased further.

Second visit to the Doctor

By the second week of May despite the exercises and stretches, the pain was getting worse and I went back to the doctor and was prescribed Naproxen 250mg one twice per day and Omeprazole Gastro Tablets 1 per day and to continue taking Paracetamol. I was referred to Poole Hospital's spinal unit for an MRI scan to see if they can locate the source of the pain and recommend suitable treatment.

I was also told to use hot and cold on the affected area. The hot treatment with a hot water bottle seems to help for a short time but ice packs cause more pain.

Spraining the Ankle

I was still going out twice a day walking with my dogs at the end of May and the start of June but on the 3rd of June, I was stepping off a kerb to avoid a group of tourists when I badly rolled my right ankle sideways and twisted it. It was painful the rest of the walk, but I got home without any problems over the following days the ankle started to swell up and I could not stand unaided without a lot of pain.

The pain was getting worse when standing and walking and I had a telephone appointment with the doctors to follow up on the sciatica tablets/pain and was prescribed Codeine 30mg tablets and to take one or two up to 4 times per day. These gave me bad dizziness and nausea with bad constipation and did not seem to help much with the pain.

Visiting Swanage Hospital

After a few more days I was unable to go out walking due to the ankle pain and swelling with very sharp glute/top of hamstring pain and ankle pain when standing which was getting worse every day.

I started using crutches to get around the house, but this was also very painful.

The pain was causing a strong ache / electric shock feeling down to my right foot when standing or lying with my leg straight. I called my local hospital which has a Minor Injuries Unit (MIU) and they told me to go to them and they would examine my ankle and X-ray it if needed to see if it was broken or sprained.  

The hospital staff checked the ankle and foot and could not find any symptoms which indicated a broken bone and told me they thought it was a Grade 2 level ankle sprain and that I should treat it with ice packs and use ankle support to help it heal.

They also told me that the hospital physiotherapist would be starting work again soon and to contact them online for a telephone appointment and they would send me suitable exercises to do.

Trying to Sleep

The pain was waking me up at night and taking paracetamol/codeine would only allow me to get 2-3 hours of sleep.

I tried different support pillows including Elevating Memory Foam Leg Rest Pillow but this caused a lot of pain in the low spine/glute area. The only way I have been able to get any rest is by sleeping on my side with a pillow between my knees after taking pain tablets.

Stronger Pain Relief

After another week I had extremely bad spasms and pain in the entire leg which made me collapse and my family called the out-of-hours doctors to see if they can give me a nerve-blocking injection or pain control. The doctor visited me at home and after examining me, he thought the ankle pain was also an Achilles tendon sprain which explained the pain in the back of the lower leg and why I could not put any weight on the area. He prescribed a much stronger liquid pain drug called Morphine Sulfate to take up to 5mg up to 4 times a day and to stop taking the codeine tablets.

I started to take a single dose of the Morphine Sulfate at night and it was giving me 2-3 hours of uninterrupted sleep before the effect wore off. It helped a lot with the ankle pain but not the nerve pain in the glutes and back of the leg.

The Physiotherapist Appointment

The local physiotherapist contacted me by phone and had a long discussion regarding everything I had been doing and my current pain problems. She told me that after reviewing the “Yoga With Adriene” video, she thought that I was pushing my hamstrings much too hard and that was not helping with any healing and I could have made the problem worse.

The physiotherapist sent me several pages of exercises and stretches to do and I am currently doing the first stage to get everything moving again.

Finally seeing an Osteopath

With the Covid 19 lockdown restrictions starting to lift I was able to make an appointment with a local Osteopath on 8th June and after examining me, he thought it is a problem with L4/L5 or L5/S1 in the spine causing the sciatic nerve to get impinged but the MRI would confirm this.

He did some gentle movements of my leg and hip joints and recommended that I stop trying all the other stretches for a week and just do some basic movements of the joints to settle things down.

On the second visit a week later, the Osteopath did additional joint manipulation which showed additional movement to the previous week and some deep tissue massage. The following couple of days were very painful but I started to get improved movement in the leg and less glute pain.

On the third visit, the session was spent with deep tissue massage and the following days were painful but not as bad as the previous weeks.

MRI Scan Delays

On the 11th of June, I received a letter from the spinal unit at Poole Hospital which I thought was regarding the MRI scan referral from my Doctor. The letter said that someone would be in contact within two weeks to book an appointment.

I waited two weeks and after not having any contact, I telephoned the spinal unit and was told that my doctor was not able to request an MRI scan and that I would have to see a consultant in the hospital which could be in weeks or months due to the current backlog and after this, if the consultant agreed, they would refer me for the MRI scan which could be weeks or months after that before they can possibly consider any other treatment.

Speaking to the Spinal Consultant

At the end of June, I had a letter from Poole Hospital with a telephone appointment with the spinal consultant I spoke with them in July and after discussing the pain and issues and the consultant agreed that I needed an MRI scan to confirm the cause of the pain and from the symptoms, it appeared likely to be an L5 / S1 disk problem.

I was told that I would receive a letter with the MRI date within 6 weeks, but I received a letter 2 weeks later with a date and time for the MRI scan on the first week of August. I also had an appointment with the spinal consultant 7 weeks after the scan to discuss the results.

I was also recommended to speak to my doctor to get a prescription for a nerve-blocking drug to ease the pain I spoke to my doctor a few days later and was given pregabalin tablets to take 75mg twice a day.

Having the MRI Scan

I had to complete risk assessments before I could go to the hospital for the scan due to the Covid 19 situation and I was nervous before the scan as I wasn’t sure how far I would have to walk in the hospital to get to the MRI unit and I wasn’t sure if my mobility would be good enough to get there on my own or need a wheelchair. The hospital is not allowing outpatients to have anyone else with them.

In the time before the scan, I worked hard at the exercises from the physiotherapist and the osteopath and I was gradually improving my walking distances by the time the MRI scan was due, I was able to walk up to 300m without needing to stop and rest which was enough to get to the MRI unit without any problems.

This was the first time I had an MRI scan and I was not sure if I would be able to lay still long enough in the scanner as I could not lie down flat. When I went into the scanner room the technician asked if I would like to have a leg support pillow and this allowed me to lay comfortably for the time of the scan. I was then told that I would have the results in a maximum of two weeks, and I should contact the hospital if I did not receive the results.

Waiting for the results

I waited for the results of the MRI to arrive but after two weeks, I had not had any contact from the hospital, and I waited an additional week before contacting the spinal unit. I called them and was told that the results would be sent when they are ready.

Four weeks after the scan, I had a telephone appointment with the hospital physiotherapist and she told me that they had not received the results and I should contact the hospital and ask for my records so I could have a copy of the scan images and results. I completed the hospital “Application for Access to Information” form and send it in the post with a copy of my passport, a few days later I had a call from the hospital's legal department to confirm they had received my request and it can take up to 8 weeks to get your data and there may be a charge involved.

The Results via Email

A few days later I had an email from the hospital with a secure link to download my data and there was a 300Mb file containing the scan images, scan result and an image viewer.
In the results was a text file with the following: “Isolated L5-SI disc disease: L5/S1: Reduced hydration with a right paracentral protrusion effacing the lateral recess and impinging on the traversing right S1 root.”

The image below shows the disk at the base of the spine with the protrusion into the spinal nerve area.

MRI scan

Now I had a confirmed diagnosis, I forwarded this to my osteopath, and it confirmed what he told me on my first visit as the most likely cause.

Speaking to the Spinal Consultant

In September, I spoke to the spinal consultant again and she explained the MRI results, and the disk was not a candidate for surgery so I should continue with the pregabalin tablets and the physio and osteopath exercises. I was told that normally this sort of disk problem goes away within 12 weeks for most people but for some, it can go on for much longer.

The pregabalin tablets

The nerve tablets made me very dizzy and nauseous the first few days but after a week the tingling and pain down the back of my leg decreased a lot and this allowed me to start to exercise and walk more each day.

My doctor asked me to have a monthly review of the tablets so I am given enough for 30 days each time. 

Since taking the pregabalin tablets, I have found that they have been a huge help to my recovery, and they allowed me to start walking more each day and gradually improve. They do have numerous side effects, but I was lucky not to have many issues with them.

At the start of October, my doctor decided that I should half my dosage to a single tablet each day in the evening and since reducing the dosage I have found that the tingling is back in my lower leg for most of the day and when walking I am not getting more hamstring and glute pain again but it is not as bad as before taking the tablets. I am now taking paracetamol again in the mornings when the pain is worse.

Going forward

As of today, the 17th of October I am walking around one mile in the morning and the same in the afternoon or evening. After each walk, I have to lie down and do knee hug exercises and side rolls as I get a lot of glute and hamstring pain when I sit after walking and everything seems to cramp and go into spasm. This is more of an issue if I walk out of town and must get back into the car. I have tried a few longer walks but the pain after has been a lot higher and longer recovery time.

Standing without walking for more than 20 minutes still causes a lot of lower back pain so my VR gaming has stopped. 

I am using a single crutch as support but some days I can walk nearly a mile without needing it and I use it mainly on rough ground and walking up hills.

I am also able to get into the loft workshop easier than before and am able to start working again but I have to stand and walk around every 10 minutes otherwise I get cramping issues if I sit for too long!

Looking back over the months, I wish I had not overdone the exercises initially which appears to have caused more damage overall. The ankle injury put me back with my recovery and I hope to be able to start cycling again this year once I am back on my feet fully!

Hopefully, by next year this will be behind me and I will be out walking and cycling every week again.

The following links are videos and equipment which I have purchased which have made life easier with sciatica.

Back Mechanic by Dr Stuart McGill

https://www.amazon.co.uk/Back-Mechanic-Stuart-McGill-2015-09-30/dp/B01FKSGJYC/

Percussion Muscle Massage Gun. Works well on tight muscles and hamstrings.

https://www.amazon.co.uk/gp/product/B082YX9SNB/

Adjustable Crutches

https://www.amazon.co.uk/gp/product/B00HXACI4Q/

Reusable Ice Packs

https://www.amazon.co.uk/gp/product/B07GH5TL35/

Tens Machine for pain relief. 30 minutes of use reduces the pain for up to 2 hours.

https://www.amazon.co.uk/gp/product/B0052607XW/

Shower and Bath Seat, never thought I would need one of these but makes taking a shower much less painful.

https://www.amazon.co.uk/gp/product/B001DUP0TC/

Squatty Potty Ecco - The Original Bathroom Toilet Stool. Makes using the toilet much less painful!

https://www.amazon.co.uk/gp/product/B007BISCT0/

Bob & Brad YouTube Channel.

A lot of useful videos on all different types of pain and exercises to help.

https://www.youtube.com/user/physicaltherapyvideo

Seated Nerve Flossing Video

https://www.youtube.com/watch?v=OMbKv94Bu_U

If anyone has any comments or feedback on this post please submit them below.

Top photo by wikipedia.org www.scientificanimations.com/