When you start having lower back problems and associated sciatica pain, numbness or strange feelings down one or two legs, it is time to identify the cause of the pain before attempting to ease the pain with chiropractors, osteopaths, physiotherapists, hydrotherapy, acupuncture, massage or any other therapy (Therapies). For example if your pain is at its worse level when you stand up, sit down, lay in bed or doing certain exercises. You may not be aware but our body compensate for injuries, which can lead to secondary pain in other areas. For example, a lower back problem may result in stiffness in the upper body because our posture has changed to protect the injury. It is very important to communicate this to your doctor (GP) and ask to have MRI scans. Symptoms can often point to the source of the pain but it is always good to know the severity of the problem on MRI scans (CT scans provide less details).

A word of caution when going for MRI scans. If your pain eases when you lay down do not attempt to go to the most common horizontal MRI machine because it will show your problem at its best behaviour and your treating doctors will not regard your pain level as high as you experience it. Instead you should consider Multi-Positioning MRI (Positioning MRI), which can also take scans while sitting down or standing up. It is a different machine altogether and is relatively new on the market (see http://www.fonar.com). This MRI will show your problem at its worse condition and to dynamic moves.

After the MRI revealed the exact source of the problem you can discuss the appropriate treatments with your doctor. If the damage is not too bad you may benefit from Treatments but be aware that they need to be reasonably spaced otherwise you will never return to normal lifestyle. If treatments do not give you any reasonable relief you may want to try CT guided Peri-Radicular cortisone injection into the affected area. If the injection works for a few months or longer you may repeat the injection as you will experience better benefits. You can try managing your pain with pain killers but be aware that certain tablets are not good for you over lengthy periods.

If the Peri-Radicular cortisone injection does not improve your condition, you need to see a neurosurgeon specialising in low back surgery to provide you with a better assessment. The neurosurgeon would like to see recent MRI scans and by now you already know that everything else failed and you start running out of options. Surgery, such as Microdiscectomy (keyhole surgery) should be considered as the last resort if appropriate for your problem and only discuss surgery with an experienced neurosurgeon specialising in lower back surgery.

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