Sciatica: When to See an Orthopedic Specialist

For leg issues, lumbar problems, and sciatica, you should consult a specialist in orthopedics or a neurologist?

Hello Doctor: I apologize for the lengthy message.
I am a 39-year-old woman who needs to stand and lift things for work.
Since the end of September, I have been experiencing pain starting from the left side of my lower back, extending to my hip, thigh, knee, and the back of my calf.
The pain begins after standing for about 15-20 minutes, and even walking less than five minutes to buy lunch causes discomfort.
However, sitting down provides significant relief.
I visited an orthopedic clinic where I had an X-ray taken.
The doctor mentioned some mild degenerative changes and recommended physical therapy, prescribing pain medication as well.
I began my first round of physical therapy, which included electrical stimulation and stretching exercises, along with taking the medication.
While my lower back felt some relief, the pain in other areas did not improve.
The pain persists, and I feel discomfort after standing for just over ten minutes, and sitting for too long also causes pain.
After completing six sessions of physical therapy, I reported that the medication had no effect.
When I returned for a follow-up, the doctor asked if my lower back felt better.
I replied that it had improved, but my hip and legs still hurt.
The doctor inquired again about any discomfort in my lower back, and I said it was not too bad, but my hip and legs were very painful.
The doctor then advised me to continue with physical therapy, but this time did not prescribe any medication.

The following days were incredibly frustrating; the pain would come and go, making it uncomfortable to stand or sit.
Even bending over caused pain, not in my lower back but starting from the left side of my coccyx, radiating down to my calf.
Sometimes, after sitting or squatting for about ten minutes, I found it difficult to get up.
I walked hunched over like an elderly person, and forcing myself to stand straight caused pain in my hip and the entire back of my leg, although my lower back did not hurt.
During this time, I also consulted a traditional Chinese medicine practitioner, who did not provide much insight but performed acupuncture, which also did not lead to improvement.
Whether through physical therapy or acupuncture, I experienced temporary relief during the sessions, but the pain returned after walking home for about eight minutes.
At times, the pain was so intense that I felt numbness.
As soon as I got home, lying down helped alleviate the discomfort.
After completing the second round of six therapy sessions, I switched to another rehabilitation clinic.
They also took X-rays, and the new doctor confirmed degenerative changes but noted that the space between the fifth lumbar vertebra and the coccyx was too narrow.
I was given medication again and started physical therapy, but again, I only felt relief during the sessions, and the pain returned afterward.
The medication did not seem effective, and now I even experience pain while riding a bike.
Eventually, I had to go to a pharmacy to get stronger medication, which has reduced the pain to intermittent discomfort rather than constant pain.
However, I now experience occasional numbness in my hip and legs.
Whether at work or home, I find myself alternating between standing for a few minutes and sitting for a few minutes, constantly changing my posture.
Unless the pain becomes unbearable, I look for a place to lie down, and about five minutes of lying down usually provides relief.
My question is: Is this sciatica? Is there a connection? Should I continue with physical therapy or go back to the hospital for further evaluation? If I go to the hospital, should I see an orthopedic or rehabilitation specialist, or is there another specialty I should consider? Thank you! ^o^

Miss Yu, 30~39 year old female. Ask Date: 2016/11/29

Dr. Shi Guozheng reply Orthopedics

It could be sciatica, so it's best to consult an orthopedic specialist to determine if further evaluation is necessary.

Reply Date: 2016/11/29

More Info

Sciatica, commonly referred to as sciatic nerve pain, is a condition that arises when the sciatic nerve, which runs from the lower back down through the hips and buttocks and into each leg, becomes compressed or irritated. This can lead to pain that radiates along the path of the nerve, often affecting the lower back, buttocks, and legs. Given your symptoms and the history you've shared, it is indeed possible that you are experiencing sciatica, especially considering the pain radiates from your lower back to your legs and is exacerbated by prolonged standing or certain movements.

Your description of the pain—specifically, that it worsens with standing and improves when sitting—aligns with typical sciatica symptoms. The fact that you also experience numbness or tingling in your legs can further indicate nerve involvement. The underlying causes of sciatica can vary, including herniated discs, spinal stenosis, or degenerative disc disease, which may explain the "mild degenerative changes" noted in your X-ray results.

In terms of treatment, it seems you've already undergone a series of physical therapy sessions, which is a common first-line treatment for sciatica. Physical therapy can help strengthen the muscles supporting your spine, improve flexibility, and reduce pressure on the sciatic nerve. However, if you are not experiencing significant relief after multiple rounds of therapy, it may be time to consider further evaluation.

Here are some steps you might consider:
1. Re-evaluation by an Orthopedic Specialist: Since you have already seen an orthopedic doctor, it may be beneficial to return for a follow-up. They can assess your progress and possibly recommend further imaging studies, such as an MRI, to get a clearer picture of the structures in your lower back and identify any issues that may not have been visible on X-ray.

2. Consultation with a Pain Specialist: If the orthopedic evaluation does not yield a clear path forward, you might consider seeing a pain management specialist. They can offer additional treatment options, including injections (such as epidural steroid injections) that can help reduce inflammation and pain.

3. Consider a Neurologist: If your symptoms include significant numbness or weakness, a neurologist may provide insights into whether there is a more complex nerve issue at play. They can conduct nerve conduction studies or electromyography (EMG) to assess nerve function.

4. Alternative Therapies: While traditional physical therapy has not provided the relief you hoped for, exploring alternative therapies such as chiropractic care, acupuncture, or massage therapy might offer some benefit. However, ensure that any alternative treatments are coordinated with your primary care or orthopedic physician.

5. Lifestyle Modifications: In addition to medical treatments, consider lifestyle changes that can help manage your symptoms. This includes maintaining a healthy weight, practicing good posture, and incorporating gentle stretching or low-impact exercises into your routine.

In conclusion, your symptoms do suggest a potential case of sciatica, and it is advisable to continue seeking medical attention until you find a treatment plan that effectively alleviates your pain. It may be beneficial to revisit an orthopedic specialist or consider consulting with a pain management or neurologist for further evaluation and tailored treatment options. Remember, persistent pain should not be ignored, and finding the right specialist can make a significant difference in your recovery journey.

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