For a lower back injury causing pain that radiates down my buttocks and right leg, what treatment options can help to completely relief my symptoms?

Dr Dinesh has given you an excellent answer. Following an MRI scan, your treatment will depend on the degree of your nerve compression seen on your MRI scan (not visible on X-rays).

If mild compression, your sciatica leg pain is from a nerve irritation or inflammation and will slowly but gradually improve naturally after 1-2 months of back rest/care, pain medications and physical therapy. Radiofrequency/injection is optional as the effect, although immediate, is only short term temporarily and is reserved for severe pain despite the above treatment. Surgery, although helpful, may not only be unnecessary at this stage, it may cause you more harm if you have an unfortunate surgical or anaesthetic complication.

However, if your sciatica leg pain is caused by severe compression on your MRI, none of the above treatment will help in long term and surgery will now be needed to directly and permanently relieve the compressed nerve before you end up with permanent irreversible nerve damage when its too late to do anything helpful anymore at this later stage.

For a back injury to cause back pain with radiation down the leg, it most often involves the nerve root being irritated by a slipped disc or bone spur.

Conservative management consists of bed rest in the initial period, medications for your pain (NSAIDs, muscle relaxants). Physiotherapy with stretching, massage, heat, ultrasound will help.

These methods will alleviate about 70-80% of pain associated with slipped disc. The remaining 20% will have persistent pain (enough to affect their daily lives) or even show signs of nerve damage (weakness, loss of reflexes and even persistent tingling). This last group of patients may need more invasive treatment.

These treatments include the use of steroid injections, disc modulation therapy (nucleoplasty), radiofrequency neurotomy and a small group will need surgery to remove the offending disc fragment or bone spurs.

Hi there,

From what you describe, it sounds like you have sciatica - which is basically pain along the sciatic nerve at the back of your leg. This can be due to a problem in the back or from an injury or irritation of the nerve in the leg itself.

The first thing to do is to get this assessed, particularly if you are experiencing "red flag" symptoms. A Sports/MSK physician or physiotherapist can assess your back and determine where the pain might be coming from. They can then arrange appropriate investigations, such as an X-ray or MRI of the spine, before offering you treatments such as strengthening of the back, traction, massage, acupuncture, facet or nerve root injection and so on.

Sometimes, you may require surgical intervention if the condition is not improving or if you have the "red flag" symptoms.

BW

Dr Dinesh