Pinched Nerves in the Back

We talk a lot about leg pain stemming from a pinched or irritated nerve in the lower back. And, indeed, that’s what our physicians are traditionally taught in medical school—a pinched nerve in the lumbar spine typically presents as a symptom in the leg. However, what if you have some butt pain but no pain or other symptoms in the leg? Does this mean it couldn’t be a pinched nerve? Not so fast. Turns out a pinched low back nerve doesn’t always have to be accompanied by leg symptoms.

Let’s start by taking a look at how the back is structured.

How the Back Is Structured

The supporting structure of the back is the spinal column, an intricate part of the musculoskeletal system made up of 24 vertebrae (backbones) placed one atop the other. The spinal column stretches from the base of the skull all the way down to the tailbone. Between each vertebral level at the front of the spinal column rests an intervertebral disc intended to provide cushioning so the bones don’t rub together and absorb shock during movement and activity. Along the back of the spine, each vertebra meets the next at the facet joints, which have to cushion cartilage and provide flexibility and allow for a variety of movements.

Protected inside the spinal column is a large nerve bundle called the spinal cord. Nerves branch off the spinal cord all along the spinal column through openings called foramina around the facet joints. These nerves transmit signals to and from the brain and every part of our body. The low back nerves, for example, exit the lumbar and sacral regions of the spinal column and supply our lower limbs, sending signals back and forth between our brain and as far out as the tips of our toes.

What Causes a Pinched Nerve in the Back?

A pinched low back nerve really is exactly what it sounds like: something has caused the nerve to become constricted. There are, however, many different things that can cause a pinched low back nerve. A foramen, one of those holes at the back of the spinal column that the nerves travel through, can become narrowed. This is called foraminal stenosis and is a common cause of pinched nerves. You can learn more about it by watching Dr. Centeno’s video below:

Pinched nerves can also result from arthritis in the facet joints, which can narrow the space, constricting those nearby nerves. In addition, bulging or herniated discs can also irritate and put pressure on the nerve. Regardless of the reason for the pinched nerve, the key to treating it is to treat what’s causing it, which can include:

• instability stemming from an injury in the knee or ankle,
• degenerative issues,
• adjacent segment disease,
• injury,
• arthritis,
• stress from repetitive work,
• bulging disc
• spinal stenosis
• bone spur formation (osteophytosis)
• spondylolisthesis
• foraminal stenosis
• degeneration
• rheumatoid arthritis
• obesity.

Note: The factors can be numerous for any given patient.

In any case, when there is a pinched low back nerve, the traditional indicator has been leg pain or some other symptom in the leg. However, one study seems to suggest what we’ve observed for many years: this isn’t always the case.

Treatment for Nerve Compression in The Spine

You may start to consider therapy once your doctor establishes that you have a pinched nerve in your lower back. A mix of therapies might be used, including:

• over-the-counter (OTC) pain relievers
• physical therapy
• other lifestyle adjustments
• platelet-rich plasma injections
• cortisone injections
• spinal decompression surgery

Your doctor may prescribe medications or nerve blocks to relieve the pain, numbness, tingling, and weakness in your hand. More invasive techniques such as spinal injections or surgery might be required in some situations.

Low Back Pinched Nerves and the Distribution of Pain

One study investigated the distribution of pain (e.g., low back, legs, butt) in over 1,800 patients with chronic low back disorders. Where it was determined that nerve pain was the primary issue, whether patients had leg symptoms or not, most with butt pain did have low back nerve issues. This study suggests that old-school thinking that you must have leg symptoms if you have a pinched nerve simply isn’t true.

What does this tell us exactly? That many patients with pinched nerves aren’t being diagnosed as such because they don’t have the textbook leg symptoms to go along with it. Many of these patients have butt pain, but no leg pain, and when an MRI clearly shows a pinched low back nerve but there’s no leg pain, the pinched nerve isn’t being diagnosed as a reason for the butt pain. A pinched nerve is particularly likely if you have some low back pain that reaches into your butt area. If you have butt pain, with or without leg symptoms, make sure your doctor is checking for a pinched nerve.

Doctors Who Assist with Pinched Nerves in the Back

Christopher J. Centeno, MD

Christopher J. Centeno, M.D. is an international expert and specialist in Interventional Orthopedics and the clinical use of bone marrow concentrate in orthopedics. He is board-certified in physical medicine and rehabilitation with a subspecialty of pain medicine through The American Board of Physical Medicine and Rehabilitation. Dr. Centeno is one of the few physicians in the world with extensive experience in the culture expansion of and clinical use of adult bone marrow concentrate to treat orthopedic injuries. His clinic incorporates a variety of revolutionary pain management techniques to bring its broad patient base relief and results. Dr. Centeno treats patients from all over the US who…

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John Schultz, MD

John R. Schultz M.D. is a national expert and specialist in Interventional Orthopedics and the clinical use of bone marrow concentrate for orthopedic injuries. He is board certified in Anesthesiology and Pain Medicine and underwent fellowship training in both. Dr. Schultz has extensive experience with same day as well as culture expanded bone marrow concentrate and sees patients at the CSC Broomfield, Colorado Clinic, as well the Regenexx Clinic in Grand Cayman. Dr. Schultz emphasis is on the evaluation and treatment of thoracic and cervical disc, facet, nerve, and ligament injuries including the non-surgical treatment of Craniocervical instability (CCI). Dr. Schultz trained at George Washington School of…

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John Pitts, M.D.

Dr. Pitts is originally from Chicago, IL but is a medical graduate of Vanderbilt School of Medicine in Nashville, TN. After Vanderbilt, he completed a residency in Physical Medicine and Rehabilitation (PM&R) at Emory University in Atlanta, GA. The focus of PM&R is the restoration of function and quality of life. In residency, he gained much experience in musculoskeletal medicine, rehabilitation, spine, and sports medicine along with some regenerative medicine. He also gained significant experience in fluoroscopically guided spinal procedures and peripheral injections. However, Dr. Pitts wanted to broaden his skills and treatment options beyond the current typical standards of care.

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Jason Markle, D.O.

Post-residency, Dr. Markle was selected to the Interventional Orthopedic Fellowship program at the Centeno-Schultz Clinic. During his fellowship, he gained significant experience in the new field of Interventional Orthopedics and regenerative medicine, honing his skills in advanced injection techniques into the spine and joints treating patients with autologous, bone marrow concentrate and platelet solutions. Dr. Markle then accepted a full-time attending physician position at the Centeno-Schultz Clinic, where he both treats patients and trains Interventional Orthopedics fellows. Dr. Markle is an active member of the Interventional Orthopedic Foundation and serves as a course instructor, where he trains physicians from around the world.

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Brandon T. Money, D.O., M.S.

Dr. Money is an Indiana native who now proudly calls Colorado home. He attended medical school at Kansas City University and then returned to Indiana to complete a Physical Medicine and Rehabilitation residency program at Indiana University, where he was trained on non-surgical methods to improve health and function as well as rehabilitative care following trauma, stroke, spinal cord injury, brain injury, etc. Dr. Money has been following the ideology behind Centeno-Schultz Clinic and Regenexx since he was in medical school, as he believed there had to be a better way to care for patients than the status quo. The human body has incredible healing capabilities…

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Other Resources for Nerve Compression in the Spine

The Spine Owner’s Manual: How to Avoid Back Pain & Life-Altering Surgery

This e-book from Dr. Chris Centeno focuses on the spine and how it functions within the human musculoskeletal system and the body as a whole. Everything in our bodies works together like a well-tuned symphony to support our well-being, and a strong spine (including all of its component parts, such as spinal nerves, ligaments, muscles, etc.) is critical to complete health.

Using the Regenexx SANS approach, The Spine Owner’s Manual provides a series of tests and clearly defined exercises that you can do on your own to measure and monitor your own spinal health. These musculoskeletal tests will allow you to monitor where your own body might be struggling to maintain proper stability, articulation, symmetry, and neuromuscular function.

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