Ask a doctor on the topic of Orthopedics

Extreme sciatic pain

January 11, 2015 | 20,00 EUR | answered by Dr. med. Frauke Gehring

Good morning.

I hope you can give me some advice. In November, I had a minor accident where I stubbed my right foot on a sidewalk slab. I had a painful bruise on my foot, which quickly healed. However, since then I have been experiencing constant severe back problems. My doctor, who is also experienced in chiropractic care, initially adjusted a spinal blockage, but afterwards I started experiencing extreme sciatica pain. Two weeks passed (due to Christmas holidays, etc.) before the treatment could resume. She then found a second blockage, which she also resolved. However, the sciatica pain persists. Nothing has improved despite treatments such as heat therapy, stretching exercises, an injection (anesthetic), painkillers, and now cortisone tablets. I can barely walk and I can't find relief even at night, as I also experience severe pain when lying down.

When I asked if an X-ray would be helpful, my doctor said it was unnecessary since the cause of the pain is already known. The prolonged presence of the second blockage has caused inflammation in the surrounding area, which is also triggering the sciatica pain. However, I am now afraid of a herniated disc.

How do you assess my situation? What do you think could be causing these sometimes unbearable sciatica pains? And what would be the next step for me to take? I am at a loss, and because nothing is helping, I am slowly becoming desperate. :-(

I am grateful for any help.
Kind regards

Dr. med. Frauke Gehring

Good morning,

In the X-ray, the intervertebral discs are not visible, so an MRI would need to be done. This is done when the pain is either unbearable and cannot be improved, or if paralysis occurs. In both cases, the consequence would be a surgical intervention.

However, if you are older (over 50) and there is a fear of a (possibly osteoporotic) vertebral fracture, an X-ray to rule out a fracture is absolutely necessary.

If the symptoms are not severe enough to consider surgery, then an MRI is also not necessary, as many people have disc herniations that cause no or minimal complaints, and the MRI would not provide any additional information.

Since your pain is unbearable, a quick X-ray at the orthopedist and possibly a consultation with a neurosurgeon with the question "MRI? Possibly surgery?" would be advisable.

In the meantime, you should be equipped not only with anti-inflammatory medications like cortisone, but also with sufficient pain medication (e.g. Tilidin). This can still be done by the emergency medical service.

All the best!

Sincerely, Dr. Höllering