As a background, I’m familiar with your work re: back pain, and Tom Jesson’s work re: sciatica. Long story short, 3 month bout with sciatica (small amount of pins and needles in my left leg early on, and the rest was radicular pain), haven’t really been able to do squatting of any kind as using my glutes or hams whatsoever beyond mundane activities has flared it up. Ortho testing was positive. Have been doing some terribly basic, mundane upper body work in the meantime. Sciatica is/was bilateral, and accompanied by a history of “traveling” non-specific back pain (typically flexion-related), as well as highly localized pain at times (always came from extension).
In any case, doctor recommended an MRI (even though I didn’t think it would be extremely useful), and MRI came up “normal”. No bulges, herniations, nothing, at least by the radiologist’s interpretation of the scan.
This does fall in pattern with my history of pain, namely that I’ve had knee, shoulder, hand/finger, etc issues. I don’t put a label on it, but no scans have ever produced anything (including an MRI on my knee when I was 17) and I seem to be more prone than normal to tendinopathy or pain broadly. Sleep issues seem to be the most significant probable factor, as well as life stress, but difficult to say.
Anyway: have you run into this? Is there any sort of medical testing or intervention you’d recommend given the above history to rule out anything else, or is this better addressed with basic lifestyle interventions (prioritize sleep and stress)? I’ve been tested for RA twice and it’s been negative. Only consistent positive finding is higher than normal HS-CRP (2.5-8, depending on when the test was taken).
Sorry to hear you’ve been in some pain as of late. I’m not sure this fits the label of “sciatica” you’re working with, though there’s more to the story than just the imaging.
In any case, this is best handled via a consultation with one of our pain and rehab professionals. We would need more information and the ability to communicate regularly in order to help.
I appreciate it. Will try to be brief, but I did 2 months’ pain and rehab consultation with Dr. Miles about a year ago for other compounding issues and while his programming and advice were solid, I kept having the same steady lanes of no-progress maintenance with setbacks. He wisely advised that I should look at psychological stressors and that with multiple kids + baby + physical trades work I was likely trying to do too much. The “sciatica” I experienced some months later made me have to quit my work and move into a line of work I should have long ago. As a result I’ve addressed many of the issues he touched upon (stress, trying to address sleep disruptions, depression I had been ignoring for months, etc) and while I’m not lifting much, I’ve made significant progress in controlling and reducing pain, so I’m actually on a pretty good stretch currently. Admittedly advice I should have taken far more seriously far sooner.
TL;DR: I don’t think I really need management help at this stage, just wondering if I had a diagnosis wrong, or if there are other avenues for this type of experience, and whether or not there are any other medical routes worth looking into for having a seemingly very low threshold for “tendinopathy” or possibly “inflammatory” symptoms (very loose terms). I know you guys are extremely busy so if this isn’t a good use of your time, or if a medical consult would more likely be warranted, please let me know.
Re sciatica: I went through some ortho testing with my family doc and was positive (particularly SLR), and it seemed to follow a predictable dermatomal pattern. It was pain that started in my lumbar region and then gradually became leg pain, to the point that back pain was mostly absent. Sitting, especially with anything on my lap (i.e. a guitar) was intolerable and I didn’t sit down except in awkward passenger-seat positions for probably two and a half months.
Yea, I think you would likely benefit from both diagnostic and management help. Those are both things that would require a consultation from a professional. Unfortunately, we cannot diagnose you via our forum.
In the interim, would it be worthwhile getting another opinion on the MRI, or is the interpretation/consensus of radiologists as “normal” sufficient to point me in the direction away from sciatica and towards something else? Do you guys offer medical consults or would that best be pursued by my local GP/etc? If your suspicion is more the typical pain/load/activity management covered in your podcasts and articles I’d be open to another go with Dr. Miles, he was fantastic to work with.
Would definitely not expect diagnosis or thorough management help through the forum, mostly looking for avenues of investigation to pursue if they fall outside the typical scope of pain and rehab.
Sorry to hear about this persistent issue. I agree that it’s going to be challenging to make much more progress via the forum.
For your interest I’ve attached a paper discussing cases of “MRI-negative Cauda Equina Syndrome”. This is NOT in any way to suggest that you actually have CES, of course, but it does contain some discussion on mimics and other image-negative causes of this related syndrome. It may or may not be useful for you as you work with healthcare professionals in this area.