Health Essentials from Cleveland Clinic

If you experience a sharp, regular or recurring pain shooting or radiating down your leg (known as radiculopathy), you may suffer from a damaged nerve or herniated disc in your spine.

When you feel that type of back or leg pain, contact your primary care physician. He or she can estimate the level of damage – from mild to severe – and will help you decide how to tackle the problem.

Level one: anti-inflammatories

Typically, your physician will first perform an informal examination. As long as you don’t show any signs of significant muscle weakness, the physician will usually prescribe an anti-inflammatory medication or a steroid dose pack.

If a nerve root is inflamed by a disc herniation or irritated by normal degeneration from aging, then the pain will often calm down.

Level two: physical therapy

If, after several weeks, the pain is not improving, the next step would be to initiate physical therapy to help strengthen and stretch the muscles supplied by the nerve. Doctors often recommend:

• Stretching exercises
• Back-strengthening exercises
• McKenzie back program for a suspected disc herniation

These exercises may alleviate the symptoms over time.

“In approximately 80 percent of patients with radiating leg pain, the pain will subside on its own without surgery,” says spine surgeon Tiffany Perry, MD.

Level three: injection

However, if the pain and other symptoms persist for more than six to eight weeks in spite of these measures, your physician may order x-rays or an MRI and may refer you to a interventional pain specialist or a pain management specialist.

A lumbar X-ray and/or an MRI scan can often help reveal the cause of the problem.

Scans may reveal:

• A disc herniation causing nerve compression
• Nerve compression from age-related arthritic changes causing spinal canal or foraminal narrowing (stenosis).

If the scans reveal one of these conditions, the pain management physician may consider treatment with a spinal injection.

These injections are a focal steroid treatment targeted to the specific area of compression or inflammation to calm the nerve root, rather than a systemic anti-inflammatory steroid. This process may only require one injection or might require additional injections.

Level four: surgical evaluation

If spinal injections provide some relief but it is not long-lasting, a surgical evaluation would be the next step.

“At that point, we would examine the patient and review the imaging. Then we would discuss surgical options, including the risks and benefits, and most importantly, the anticipated outcome, says Dr. Perry.

Basic recommendations

Some general guidelines to addressing this issue include:

• Consult your primary care physician when you experience persistent pain radiating down your leg.
• Consider using an over-the-counter anti-inflammatory medication such as ibuprofen. These anti-inflammatory drugs can help relieve some of the pain. There are also other prescription medicines available. You should discuss them with your doctor.
• Continue to exercise and do back-strengthening exercises. Also continue with your normal activities as you are able. If your muscles become unused and atrophy, that will weaken the body’s structural support system for your spine and make recovery more difficult.