I was talking to a friend of mine the other day and we were swapping stories of back woes. (It passes for entertainment at my age). He's a bit younger than I am but his back doesn't seem to be. His pursuit of relief has led to more exercise, physical therapy, acupuncture and chiropractic adjustments with varying degrees of success. When a recent MRI showed what his physician described as "garden variety, age-related arthritis" of his spine, the comment seemed to strike a nerve with him and it got me to thinking about Tim Wakefield's recent uphill struggle to get back on the mound for the Red Sox.
Wakefield was placed on the 15 day disabled list with lower back pain back on July 20th and seemed to be on the mend until an episode of sciatica left him with pain and weakness of the calf. The weakness persisted even as the pain diminished which may be better than the opposite scenario. Sciatica can cause the kind of pain that has otherwise healthy folks knuckling under.
"I've had people come to the office in tears because they are in such terrible pain," says Dr. Kevin McGuire, co-director of the Spine Center at Beth Israel Deaconess Medical Center. "Women will tell me that delivering a child was nothing compared to this kind of pain."
This kind of pain is known as "referred pain" - pain that is perceived in one area of the body while the injury is actually occurring elsewhere. And Dr. McGuire also informed me that sciatica is not a term that he or his colleagues use to describe the condition. On a patient's chart doctors would use the term radiculopathy (for all you Latin fans that's "root harm"). Physicians would also be much more specific about the location of the origin for the pain.
"We know that most of these episodes are related to injuries to or the anatomy of the lower back in the area of the L4/L5 and L5/S1 disc. We can identify the source of the nerve root irritation by the location of the pain," notes Dr. McGuire. "For example, if a patient has pain on the side of their thigh and it radiates to the lateral thigh, that signals a problem in the area of the L5 nerve root. If the pain is posterior-in the back of their thigh and into the calf-its source is likely the S1 nerve root."
The most common causes of radicular pain are herniated or bulging discs, degenerative disc disease and spinal stenosis, a narrowing of the spinal canal and/or nerve openings. While about 85% of us will experience some form of back pain in our lifetime, the incidence of radicular pain is much lower, perhaps 8 percent. And though it can be debilitating initially, symptoms tend to diminish over time.
"Most patients are feeling better in 4-6 weeks. Physical therapy can help. Sometimes a person may need a narcotic to deal with the pain initially, but that doesn't address neuropathic pain very well so it deals with the symptom but not the cause," he says. "If the pain persists an injection of an anti-inflammatory can often provide relief. Using X-ray guidance we can deliver an ESI, or Epidural Steroid Injection with tremendous precision directly to the site of the nerve irritation."
At the age of 43, there's a chance that the cause of Tim Wakefield's back problem is a bit of that age-related arthritis that my buddy's doctor referred to. But Wakefield's knuckleball is anything but a garden-variety pitch and given his 11-3 record before his trip to the DL, his absence from the rotation has been more than an irritation. It's been a pain in the.....well, let's just say his return will be a real shot in the arm for the Sox.