Q: I had a slipped disc a few years back. Ever since I get backache every year especially in winters or at the change of season. This starts at the slightest pull of muscles either by forward bending or even without it. It is not clear whether it is only muscular spasm or related to the disc problem. Due to this I have to bend and walk. For the past one year I have been having pain in all my muscles even when with normal exertion. Further, it takes time to straighten my arms, legs, toes and back if these remain folded/bent for sometime. While walking I feel pain in my toes (especially thumb & heels). Can some old accident (I fell from my bike once) be its cause? Every night I sleep with my foot bent in order to prevent leg cramps. Stress increases all of the above. I try and do some exercise like jogging, Surya Namaskar. Please suggest the causes, tests, remedies and prevention.

A:A herniated disc occurs when the soft inner core of the disc (nucleus pulposus) extrudes or “herniates” through the fibrous outer core (annulus) of the disc, irritating the contiguous nerve root as it exits the spine. In general, it is thought that a sudden twisting motion or injury can lead to an eventual disc herniation and sciatica. However, most discs weaken due to repetitive stress and the final result is a herniation. A herniated disc is sometimes referred to as a slipped disk, ruptured disk, bulging disc, protruding disc, or a pinched nerve and sciatica is the most common symptom of a lumbar herniated disc. The term sciatica describes the symptoms of leg pain and possibly tingling, numbness or weakness that travels from the low back through the buttock and down the large sciatic nerve in the back of the leg. An important thing to understand is that sciatica is a symptom of a problem — of something compressing or irritating the nerve roots that comprise the sciatic nerve — rather than a medical diagnosis or medical disorder in and of itself. This is an important distinction because it is the underlying diagnosis (vs. the symptoms of sciatica) that often needs to be treated in order to relieve sciatic nerve pain. While sciatica can be very painful, it is rare that permanent nerve damage (tissue damage) will result. Most sciatica pain syndrome result from inflammation and will get better within two weeks to a few months. Also, because the spinal cord is not present in the lower (lumbar) spine, a herniated disc in this area of the anatomy does not present a danger of paralysis. For most people, sciatica responds well to self-care measures. These may include use of hot packs or cold packs, stretching, exercise and use of over-the-counter (OTC) medications: Physical therapy. If you have a herniated disk, physical therapy can play a vital role in your recovery. Once acute pain improves, your doctor or a physical therapist can design a rehabilitation program to help prevent recurrent injuries. Rehabilitation typically includes exercises to help correct your posture, strengthen the muscles supporting your back and improve your flexibility. Your doctor will have you start physical therapy, exercise or both as early as possible. Its the cornerstone of your treatment program and should become part of your permanent routine at home. Prescription drugs. Sometimes you might benefit from a course of anti-inflammatory medication along with a muscle relaxant. Tricyclic antidepressants and anticonvulsant drugs also can help ease chronic pain. They may help by blocking pain messages to the brain or by enhancing the production of endorphins, your bodys natural painkillers. More aggressive treatments When conservative measures don’t alleviate your pain within a few months, one of the following may be an option for sciatica treatment: Epidural steroid injections. In some when sciatica becomes chronic patients benefit from an injection of steroid into the affected area. Corticosteroids mimic the effects of the hormones cortisone and hydrocortisone, which are made by the outer layer (cortex) of your adrenal glands. Steroids suppress inflammation around the irritated nerve, thereby helping to relieve pain. Their usefulness in treating sciatica remains a matter of debate. Some research has found that corticosteroids can provide short-term symptom relief, but that these medications arent a long-term solution. In addition, corticosteroids can have side effects, so the number of injections you can receive is limited — usually no more than three in one year. Surgery. This is usually reserved for times when the compressed nerve causes significant weakness, bowel or bladder incontinence, or you have pain that gets progressively worse or doesnt improve with other therapies. I do not think currently you fall in this category. I think you should start with a structured course of physical therapy aimed specifically for your back and if the symptoms do not get better in 6-8 weeks get an MRI of the Lumbosacral area. At that point you might benefit from an epidural injection.