Sciatica and Disc Herniation: A Patient's Journey

Sciatica, herniated disc?

I would like to ask a question.
Last month, I went to a large hospital to see a doctor for an X-ray, and it was found that I have a bone fracture on the left side of my hip.
However, I did not undergo an MRI.
The doctor advised me to wear a brace for three months but did not provide further information.
Since I was not reassured, I consulted a second doctor.
When I mentioned that it has been almost three months, the second doctor referred me to a physical therapist for rehabilitation.
The physical therapist taught me core strengthening exercises to stabilize the area and reduce pain.
They also indicated that I do not have sciatica, but I am still worried about potential nerve issues because the pain persists after such a long time.
The pain is localized to a small area on the left side of my hip and does not radiate to my thigh or calf.
I would appreciate your insights on this matter.
Thank you.

Mr. Li, 20~29 year old female. Ask Date: 2017/06/13

Dr. Shi Guozheng reply Orthopedics

Your symptoms do not seem to resemble sciatica.
If you have further concerns, you should consult a physician for evaluation.

Reply Date: 2017/06/13

More Info

Sciatica and disc herniation are common conditions that can significantly impact a patient's quality of life. Understanding these conditions, their symptoms, and treatment options is crucial for effective management. Based on your description, it seems you are experiencing persistent pain in your left buttock, which has raised concerns about potential nerve involvement.

Understanding Sciatica and Disc Herniation
Sciatica refers to pain that radiates along the path of the sciatic nerve, which branches from the lower back through the hips and buttocks and down each leg. Typically, sciatica affects only one side of the body. The pain can vary widely, from a mild ache to a sharp, burning sensation. It may also cause weakness, numbness, or difficulty moving the leg or foot.

Disc herniation, on the other hand, occurs when the soft inner gel of a spinal disc bulges out through a tear in the tougher exterior. This can compress nearby nerves, leading to pain, numbness, or weakness in the affected areas. The most common sites for herniation are the lumbar (lower back) and cervical (neck) regions of the spine.

Your Situation
From your account, it appears that you have been diagnosed with a bone fracture in your left buttock area and have been advised to wear a brace for three months. After this period, you were referred to physical therapy, which is a standard approach to rehabilitation. Physical therapists often focus on strengthening the core muscles, which support the spine and pelvis, thereby reducing pain and preventing further injury.

Despite these interventions, your ongoing pain raises valid concerns about potential nerve involvement, especially since you mentioned that the pain is localized to the left buttock and does not extend to the thigh or calf. This localized pain could be due to several factors:
1. Muscle Strain: The muscles around the fracture site may still be healing, leading to discomfort.

2. Nerve Irritation: Even if you do not have classic sciatica symptoms, there could be irritation of the sciatic nerve or other nearby nerves due to inflammation or muscle tension.

3. Referred Pain: Sometimes, pain can be referred from other areas, such as the lower back or pelvis, even if the source is not directly in the leg.

Recommendations
1. Follow-Up Imaging: Since you have concerns about nerve involvement, it may be beneficial to discuss the possibility of an MRI with your healthcare provider. An MRI can provide detailed images of the soft tissues, including discs and nerves, and help rule out any significant issues that may not be visible on X-rays.

2. Continued Physical Therapy: Continue with physical therapy as prescribed. It is essential to communicate with your therapist about your pain levels and any changes you experience. They can adjust your treatment plan accordingly.

3. Pain Management: If the pain persists, discuss pain management options with your doctor. This could include medications, injections, or alternative therapies like acupuncture.

4. Activity Modification: Avoid activities that exacerbate your pain. Gradually increase your activity level as tolerated, focusing on low-impact exercises that do not strain your back or buttock.

5. Monitor Symptoms: Keep a log of your symptoms, noting any changes in pain intensity, location, or associated symptoms like numbness or weakness. This information can be valuable for your healthcare provider in assessing your condition.

6. Seek a Second Opinion: If you continue to feel uncertain or if your symptoms worsen, seeking a second opinion from another orthopedic specialist or a neurologist may provide additional insights and treatment options.

Conclusion
Your journey through sciatica and potential disc herniation can be challenging, but with the right approach and support, many patients find relief and regain their quality of life. It is essential to remain proactive in your care, communicate openly with your healthcare team, and advocate for further evaluation if your concerns persist. Remember, recovery can take time, and patience is key.

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