Back/Leg Pain

U

Unregistered

Guest
I currently hold a 3rd class medical and recently have been experience some minor lower back pain and pain in the front of my thigh. The pain in my thigh feels like a numbness and is more pronounced when I am laying on my back. This leads me to think that this is something to do with my back.

Here is my question, what documentation should I get from my back doctor to demonstrate I can still perform airman duties so that when I declare on my renewal, I don't get referred. Any thoughts would be much appreciated.
 
Unreg, you need to figure out (with the help of a neurosurgeon) what the problem is, fix it (before it gets worse - if it's your back , it will get worse), then deal with your FAA stuff. :)

It's not "referred", it's "deferred".
 
It sounds like Sciatica to me. but you know how accurate internet diagnoses are, right?

A good physical therapist can give you some exercises to minimize this condition.

-Skip
 
Without a history or an examination, you could have any number of things, including spinal stenosis and radicular symptoms, hip arthritis, or meralgia parasthetica. It could also be something worse, but you can look these up online.

If the pain has persisted or worsened over time, say several weeks to a month, you should probably seek some help in figuring out what's going on, probably starting my your family practice doc.
 
Any AME worth his salt is going to put you through some basic maneuvers, while trying to get you certified. If you indded have L4 sciatica, you will have some difficulty.

Need to get it addressed, first. How much time do you have until you're due? 60% of these get better in 6 weeks if you don't stress it....
 
All, thank you for the tips.

I'm not due for another 10 months. The pain just started last week out of nowhere (woke up one day suddenly to pain in my thigh). It comes and goes but find it is worst during the night when I am laying on my back.

Sure hope it is in the percentage that goes away after 6 weeks. Any thoughts on whether I should try to go to a massage therapist to see if that does the trick.

The pain is not restrictive and I have full range of motion in my thigh, leg, hip, etc. All full strength in my thigh as I lift weights with it.

In worst case scenario of L4 sciatica, what would I need to demonstrate to keep medical?
 
No one can answer your questions without a history and physical exam. L4 would typically be further down your leg. You could also have trochanteric bursitis.
 
Not quite true, Jim (many orthos think this). Where he describes it can come from the L4 disc itself (haveing done many provocative disocographies); the nerve referral pattern for L4 is a tad lateral to where he describes, and the L3 nerve referral pattern runs just below the groin. It is a "network wired" zone, as it were.

I took care of these things for 20 years full time, doing many many nerve root specific blocks for diagnosis.

And to the O.P: there is no way to describe the paces you go through. Get it better and get good advice from a doc.
 
Last edited:
Yes, he can have sclerotomal pain in the area described, but radicular symptoms of L4 would be in the L4 dermatome. Of course, he could also have troch bursitis, meralgia, hip arthritis, or something worse.
 
Fix the L4-L5 disc and get on with your life without the bloody pain. I've had 2 done, no issues at all with getting my medical even with one before my first medical and one while holding a second class.
 
rotorhead1026 said:
Unreg, you need to figure out (with the help of a neurosurgeon) what the problem is, fix it (before it gets worse - if it's your back , it will get worse), then deal with your FAA stuff. :)

It's not "referred", it's "deferred".
Click to expand...
I would not run to a neurosurgeon for an initial evaluation. When you are a hammer everything looks like a nail.
 
Gary F said:
I would not run to a neurosurgeon for an initial evaluation. When you are a hammer everything looks like a nail.
Click to expand...

I wouldn't exclude them either, no reason you can't consult with more than one specialist. When it comes time to 'drive the nail' so to speak, I'll take the neurosurgeon wielding the scalpel, they tend to be more delicate. It's the ortho guys that like to swing the hammer...literally.:eek::rofl::rofl::rofl:
 
The problem could also be relatively simple. For example, if you've been wearing 36's, try some 38's.:tongue:
 
Gary F said:
I would not run to a neurosurgeon for an initial evaluation. When you are a hammer everything looks like a nail.
Click to expand...

I've had good results, Gary, although Chein's advice for rest should be tried first. We can agree that any doctor that consults you while holding a hammer should be avoided. :D
 
Unregistered said:
All, thank you for the tips.

I'm not due for another 10 months. The pain just started last week out of nowhere (woke up one day suddenly to pain in my thigh).
Click to expand...

This was actually near end stage for me (down the side of my left leg), but I had years of milder problems. I vote for the "rest and see what happens for now" approach as well. Naproxen sodium helped with this type of discomfort.
 
Last edited by a moderator:
Without checking your MRI (You should get one..) it seems like a L4-L5 radiculopathy (Probably a disc herniation). If you are lucky (50 % are lucky), with medication and therapy you should be fine.

But never trust an Internet Aviation Forum for your health problems!! Check with a Spine surgeon and he will tell you what you should do. I dont think you will loose your medical on this condition.
 
Unregistered said:
I currently hold a 3rd class medical and recently have been experience some minor lower back pain and pain in the front of my thigh. The pain in my thigh feels like a numbness and is more pronounced when I am laying on my back. This leads me to think that this is something to do with my back.

Here is my question, what documentation should I get from my back doctor to demonstrate I can still perform airman duties so that when I declare on my renewal, I don't get referred. Any thoughts would be much appreciated.
Click to expand...


I have this from time to time. There really isnt much they can do for sciatica. Howver, there are exercises that was recommended and I found them by googling sciatica exercises. Since doing the exercises I have not had an issue flying or riding my motorcycle long distances.
 
DaytonaLynn said:
I have this from time to time. There really isnt much they can do for sciatica. Howver, there are exercises that was recommended and I found them by googling sciatica exercises. Since doing the exercises I have not had an issue flying or riding my motorcycle long distances.
Click to expand...

Sure there is, they remove the material impinging on the nerve and the pain miraculously disappears, I've been through it twice and have my last surgeons number on speed dial if it happens again.
 
jsstevens said:
That would be the anesthesiologist. :D

John
Click to expand...

Lol, they scare me the most. My ex girlfriend in Aus did anesthesiology on the side of his PCP practice (all house calls BTW, Aussies have a Locum system that works great for everybody involved). He related to me a story of his biggest mistake where he had a guy paralyzed for abdominal surgery but not asleep.:hairraise: He said the patient related to him, "That bloody surgeon was rough as guts" which he admitted was a correct observation. He was amazed he didn't get sued over it.
 
Frankly, I'm surprised at all the repair work being quoted for what was described as minor lower back and thigh pain and numbness. I've been living with these symptoms for the last 30 years with very minor consequences. My pain responds well to getting off my feet and an 800mg Ibuprofen and my doctor says not to worry as long as the numbness is transient. No X-ray, no MRI. I'd much rather do that than have someone sticking knives and needles a fraction of an inch from my spinal cord.
 
Old Geek said:
Frankly, I'm surprised at all the repair work being quoted
Click to expand...

Yup. You don't want them cutting if they're not sure what they're looking for. I had some relatively minor pain for years. The docs looked at the MRI and said "Hmmmm ... unremarkable". Too many people have let docs cut on them in this situation (mine wasn't inclined - not a "hammer" guy :)) and come out poorly. Wait until several docs say "AHA" when they see the MRI (and the pain will be bad enough then); your result will likely be good. Don't suffer needlessly, to be sure, but if ibuprofen and rest fix the issue, that's fine. OP appears to be at this stage.
 
Dr. C is correct.

I would not order an MRI at this point. It appears to be an acute injury. Give it 4-6 weeks with rest, mild stretching, Ice and NSAIDs such as ibuprofen or naproxen.

90% non-radicular back pain will recover within 2 weeks.

With your symptoms of radiculopathy, usually due to a herniated disc has a slower recovery time. About 30% are improved in 2 weeks and 75% after 3 months.

As always, it is difficult to diagnosis via forums and I'd recommend seeing your provider.




bbchien said:
Not quite true, Jim (many orthos think this). Where he describes it can come from the L4 disc itself (haveing done many provocative disocographies); the nerve referral pattern for L4 is a tad lateral to where he describes, and the L3 nerve referral pattern runs just below the groin. It is a "network wired" zone, as it were.

I took care of these things for 20 years full time, doing many many nerve root specific blocks for diagnosis.

And to the O.P: there is no way to describe the paces you go through. Get it better and get good advice from a doc.
Click to expand...
 
*NOT THE UNREG OP*

I lost my medical due to a similar situation. Lower back pain leading to numbness in the thighs. Turned out to be degenerative disc disease. My daily regimen controls the pain until it's time for surgery. Unfortunately the diagnosis and regimen don't fit withing the FAA guidelines. I don't want to create undue concern but take care of you first. It sucked to lose the medical but it feels great to wake up relatively pain free and be able to get through most days without gasping for breath from pain.
 
Unregistered said:
*NOT THE UNREG OP*

I lost my medical due to a similar situation. Lower back pain leading to numbness in the thighs. Turned out to be degenerative disc disease. My daily regimen controls the pain until it's time for surgery. Unfortunately the diagnosis and regimen don't fit withing the FAA guidelines. I don't want to create undue concern but take care of you first. It sucked to lose the medical but it feels great to wake up relatively pain free and be able to get through most days without gasping for breath from pain.
Click to expand...

I was where you are when I was 20 with the pain and I tried it all trying to avoid surgery, boy what a mistake. I woke up from surgery with what felt like a paper cut on my back. When I was there 15 years later with another disc blown, I didn't wait, again, woke up with a mild case of suture discomfort, I was home that evening.

I agree that if you aren't having nerve pain to do nothing dramatic, but a dic causing a mild problem is typically a disc waiting for the first opportunity to be a major problem. In my bit of research I came to this conclusion, if the nerve pain doesn't make it past 1/2 way down its path, you have a chance of recovery if you are very careful and remain so for the rest of your life. If the pain makes it full run, go see the best neurosurgeon you can find. My method of finding them is to walk the surgical floor at the hospital and ask 10 of the nurses if they had to send their loved ones to someone for this surgery, who would it be. You'll find they will all give the same name with maybe one saying someone else because there is a personality conflict. You may also get "nobody here" from several which is a good indicator you may want to find another hospital.:D

The greatest piece of advice on backs I can give is always turn at the hips when bent over or with a load in your hands. Both times I had a blow out it was in the middle of a twisted motion.
 
You need to make a distinction between personal anecdotes and sound medical advice.
 
AcroBoy said:
You need to make a distinction between personal anecdotes and sound medical advice.
Click to expand...
I agree. Jim is an orthopedic surgeon, if I recall.

In a career of Interventional Pain medicine, we sort out the pain generator(s) carefully. Is it limited to the segmental nerve root (a selective root only block settles that). Is the pain generator intradiscal (we hate that, discography is painful and has a 1/300 chance of really awful disciitis), then you really need Acroboy's knife...so we save that for when the investigation really requires it, and at the last at that. But before we do an artificial disc replacement, we "gotta" know. It's a HUGE deal coming in the front, moving the Cava aside, and putting in the prosthesis. We lose lots of blood (though it's getting better with the learning curve).

Is the pain generator physical intrusion?
If it's all sensory is the pattern electronically suppressable?


Is there an motor loss or is the apparent weakness entirely secondary to pain?

Have we left out "network pain". The sacroiliac joint has the capacity to refer to L3, L4, L5 and S1 dermatomes. That's easily dealt with with specific block, but only if stretching the joint on exam really plainly generates the pain....there is no good fusion or prosthesis for that joint. Prelminary percutaneous fusion data really really stink.

Lastly, DO THE FEWEST procedures possible- epidurals, etc.

Bottom line is get to a guy who knows all the tools and DOESN'T WANT TO USE THEM. BUT there is benefit to wiating six weeks before you do much of anything.

****

Jim, it's a great irony. Henning, not being a physician, is able to offer medical advice. Neither you nor I really can. For Henning's benefit, the OLD SCHOOL Ortho Spine thinking was, "if you fuse all the pain generators, the pain stops". True, but if you fuse soemthing the next joint up form the fusion takes a beating and fails much more quickly.

So the "lifecycle" has to be considered. A 24 year old is differnt from a 58 year old.
 
Last edited:
Henning said:
Life is nothing but a series of observed anecdotes.
Click to expand...

Thankfully, most physicians and scientists rely on data rather than anecdotes. Surgery, especially elective procedures, should always be the last resort, even if Henning's diagnosis was actually correct, without benefit of a history, physical exam, knowledge, training, or experience.
 
Lumbar spine fusion is a big operation. If the surgeon goes in front and back, it involves a big flank incision along with essentially a second operation in back. In front the current trend is to insert cages between adjacent vertebral bodies after scraping out the degenerated disk(s). This helps the fusion rate. In back generally large screws are inserted into the adjacent levels, which are then linked by rods. Neurosurgeons and orthopaedic spine surgeons use the same approach toward these fusions.

Complications can include infections, major bleeding, impotence, or death.

However, the OP could have any number of causes of his symptoms, many completely unrelated to his back.
 
Let's stop the insanity. Whether or not you have a radiculopathy or a bursitis or sacroiliitis or whatever is not important.

1. It is not 60% but 90% of all back issues from degenerative or minor traumatic issues improve within 6-8 weeks no matter what you do.
2. Unless the pain is intractable(whatever that means) or you develop motor weakness, or bowel or bladder dysfunction there is probably no need to see a physician. If on the other hand you develop motor weakness or bowel or bladder dysfunction then you need to see a spine physician(I am partial to one that knows his/her stuff) or your local emergency room immediately as you may need emergent surgery.
3. Bedrest, and decreased activity has actually been shown to be worse than activity as tolerated by your level of pain. Muscular deconditioning can happen quite quickly and the vast majority of back pain, sciatica, etc etc etc are caused not by degenerative disk problems, or degenerative joint problems but by muscular injury. Exercise as tolerated including walking, swimming, or biking, and back stretching and mild strengthening exercises are imperative.
4. OTC antiinflammatories(Aspirin is probably the best) is the only medication you should need. Narcotic pain medications, muscle relaxants(either of the addictive typr or non addictive type), steroids(injected or ingested), and neuromodulators typically are not indicated in the vast majority of patients.
5. Studies including MRI's and CAT scans with or with intrathecal dye(for those who cannot get MRI's) are typically not necessary in the first 6-8 weeks. There are some exceptions see above #2. No offense to Dr. Bruce but pain provocative studies(eg discograms) are voodoo medicine at their best and dangerous at their worse in my not so humble opinion. If your doctor recommends injecting saline or someother substance in your disk space to diagnose your condition, tell him to have a nice day and find someone who can diagnose you without resorting to what I consider dark ages torture. EMG/NCV is rarely helpful and again I would avoid it. Thermograms, surface EMG's and the sort are about as useful as discograms but at least they are not painful.
6. If you are a smoker QUIT. If you are overweight, do not think if you lose weight by just dieting you will get better. You will not and will probably get worse, as dieting without exercise causes you to become dehydrated first and lose muscle mass prior to losing fat mass. Your body goes into starvation mode as well. This all leads to a relative muscular deconditioning state and see #3 above.
7. There are multiple causes of "sciatica"-a terrible term if I do say so myself- and if you are worsening despite doing the right things then you need to seek medical help. If you are not better in 6-8 weeks you need to seek medical help. If there are associated symptoms such as unexplained weight loss, abdominal symptoms, urinary burning, fevers, etc then you need to seek medical advice. Medical advice or help means seeing a physician and not researching it on the internet, forum boards, speaking to aunt Suszy the nurse in the family, or reading a self help book.
8. As to the pros and cons of further surgical and nonsurgical treatment I do not have the time or space to discuss it here. Please remember however surgery is typically a last resort not a first treatment except for rare patients, and there is absolutely no consensus as to what is the best treatment for back problems. It's the wild west out here.
9. Everything I have posted here is my opinion and should not be misconstrued as being an offer of medical advice, treatment, or recommendations. If you are uncertain you need to seek a physician's advice who can examine you, and correctly diagnose you. This cannot be done on the internet.

Okay now I will get off my soap box, and wait for the angry replies.

Doug
 
Last edited:
Old Geek said:
If that works for you, fine.

Scientists, engineers and doctors aren't ashamed to stand on the shoulders of the giants before us.
Click to expand...
Cap Henning may be closer to the truth than he thinks. I do not know about the engineering literature, nor the non medical science literature aas I have not read it critically since my days in college and post graduate studies, but the medical literature is full of studies that are just reproductions of things that were shown years ago, studies based on limited patient numbers not enough to make reliable conclusions, studies with poor designs, and studies that come to conclusions not supported by the data. There is truth behind the saying show a back patient to ten back specialists and you will get eleven ways to treat it all supported by the literature. In spine there are specialists relearning the lessons of years ago, and often it is the patient who suffers. Unfortunately, often is the case in medicine where we like to eat our young and tell our old they are behind the times.

Doug
 
AcroBoy said:
Thankfully, most physicians and scientists rely on data rather than anecdotes. Surgery, especially elective procedures, should always be the last resort, even if Henning's diagnosis was actually correct, without benefit of a history, physical exam, knowledge, training, or experience.
Click to expand...


Why would you want to exclude my data from the pool? I actually have 2 positive long term results.
 
Henning said:
Why would you want to exclude my data from the pool? I actually have 2 positive long term results.
Click to expand...
I do not think anyone is trying to exclude you from anything, but believe me all because you got better with surgery twice does not mean you will be as lucky on your third outing(and statistically you have a pretty good chance of that occurring) and all because you got better with surgery does not mean you would have not gotten better without surgery(which is more often than not).

Furthermore, I hope no one is going to extrapolate your personal experience to the population and say that surgery is the answer for the treatment of back problems, because believe me when I say surgery(especially the so called anterior posterior fusion for degenerative disk disease which I hold in the same regard as the lowly discogram) is the last resort for the vast majority of degenerative back issues.

Doug
 
douglas393 said:
Let's stop the insanity. Whether or not you have a radiculopathy or a bursitis or sacroiliitis or whatever is not important.

1. It is not 60% but 90% of all back issues from degenerative or minor traumatic issues improve within 6-8 weeks no matter what you do.
2. Unless the pain is intractable(whatever that means) or you develop motor weakness, or bowel or bladder dysfunction there is probably no need to see a physician. If on the other hand you develop motor weakness or bowel or bladder dysfunction then you need to see a spine physician(I am partial to one that knows his/her stuff) or your local emergency room immediately as you may need emergent surgery.
3. Bedrest, and decreased activity has actually been shown to be worse than activity as tolerated by your level of pain. Muscular deconditioning can happen quite quickly and the vast majority of back pain, sciatica, etc etc etc are caused not by degenerative disk problems, or degenerative joint problems but by muscular injury. Exercise as tolerated including walking, swimming, or biking, and back stretching and mild strengthening exercises are imperative.
4. OTC antiinflammatories(Aspirin is probably the best) is the only medication you should need. Narcotic pain medications, muscle relaxants(either of the addictive typr or non addictive type), steroids(injected or ingested), and neuromodulators typically are not indicated in the vast majority of patients.
5. Studies including MRI's and CAT scans with or with intrathecal dye(for those who cannot get MRI's) are typically not necessary in the first 6-8 weeks. There are some exceptions see above #2. No offense to Dr. Bruce but pain provocative studies(eg discograms) are voodoo medicine at their best and dangerous at their worse in my not so humble opinion. If your doctor recommends injecting saline or someother substance in your disk space to diagnose your condition, tell him to have a nice day and find someone who can diagnose you without resorting to what I consider dark ages torture. EMG/NCV is rarely helpful and again I would avoid it. Thermograms, surface EMG's and the sort are about as useful as discograms but at least they are not painful.
6. If you are a smoker QUIT. If you are overweight, do not think if you lose weight by just dieting you will get better. You will not and will probably get worse, as dieting without exercise causes you to become dehydrated first and lose muscle mass prior to losing fat mass. Your body goes into starvation mode as well. This all leads to a relative muscular deconditioning state and see #3 above.
7. There are multiple causes of "sciatica"-a terrible term if I do say so myself- and if you are worsening despite doing the right things then you need to seek medical help. If you are not better in 6-8 weeks you need to seek medical help. If there are associated symptoms such as unexplained weight loss, abdominal symptoms, urinary burning, fevers, etc then you need to seek medical advice. Medical advice or help means seeing a physician and not researching it on the internet, forum boards, speaking to aunt Suszy the nurse in the family, or reading a self help book.
8. As to the pros and cons of further surgical and nonsurgical treatment I do not have the time or space to discuss it here. Please remember however surgery is typically a last resort not a first treatment except for rare patients, and there is absolutely no consensus as to what is the best treatment for back problems. It's the wild west out here.
9. Everything I have posted here is my opinion and should not be misconstrued as being an offer of medical advice, treatment, or recommendations. If you are uncertain you need to seek a physician's advice who can examine you, and correctly diagnose you. This cannot be done on the internet.

Okay now I will get off my soap box, and wait for the angry replies.

Doug
Click to expand...
I agree with almost everything above except I don't recommend aspirin as an analgesic. All pain medications have side effect issues but for most people but I prefer OTC naproxen or ibuprofen used judiciously. People who have heart failure or take various medications including antiplatlet drugs (Plavix and Effient) or blood thinners (Coumadin, Pradaxa) should probably avoid nonsteroidal pain medications.
 
Last edited:
Gary F said:
I agree with almost everything above except I don't recommend aspirin as an analgesic. All pain medications have side effect issues but for most people but I prefer OTC naproxen or ibuprofen used judiciously. People who have heart failure or take various medications including antiplatlet drugs (Plavix and Effient) or blood thinners (Coumadin, Pradaxa) should probably avoid nonsteroidal pain medications.
Click to expand...
There are some contraindications to NSAID's including taking a anticoagulant or antiplatelet drug, previous history of ulcer or GERD, kidney problems, history of heart disease(though Aspirin is okay while most other NSAID's may not be), and allergies to NSAID's, but most people can take them safely. As to the relative pros and cons of the various NSAID's aspirin is for most people probably the best, but most people do not want to hear their doctor tell them to take two aspirin and they will be better, thus the marketing campaigns for all the others.

Doug
 
Last edited:
douglas393 said:
There are some contraindications to NSAID's including taking a anticoagulant or antiplatelet drug, previous history of ulcer or GERD, kidney problems, history of heart disease(though Aspirin is okay while most other NSAID's may not be), and allergies to NSAID's, but most people can take them safely. As to the relative pros and cons of the various NSAID's aspirin is for most people probably the best, but most people do not want to hear their doctor tell them to take two aspirin and they will be better, thus the marketing campaigns for all the others.

Doug
Click to expand...
I think that aspirin in doses high enough for analgesic effect probably has a higher risk of GI bleeding than many nonsteroidals such as naproxen and ibuprofen. The generic NSAIDS are relatively safe compared to the more potent prescription NSAIDS. All of these meds have issues so it is probably better to have them prescribed by your primary physician who understands all of somebody's medical issues.
 
Old Thread: Hello . There have been no replies in this thread for 365 days.
Content in this thread may no longer be relevant.
Perhaps it would be better to start a new thread instead.
Back
Top