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.
Common Symptoms of Pinched Nerves in the Back
Big Toe Numbness
Believe it or not, one of those significant issues that can present as numbness stems from the low back. In the lumbar spine, the nerve that exits the spine at the L5 level branches down through the hip, thigh, knee, lower leg, and, yes, all the way into the foot and toes. So a pinched or irritated nerve at that L5 level in the back can create problems, such as pain, numbness, tingling, and so on, anywhere along the nerve branch. So what can irritate the L5 spinal nerve? The list is long, but it includes disc issues, such as herniated…
Throwing this question out to the social-media masses is sure to bring out the cyber “comedians” among us, but the truth is when you really do have butt pain, it’s no laughing matter. So we’re glad you came here to ask because we actually do see many patients in our clinic with this problem. There are a number of issues that can cause butt pain, but the root causes we most often discover are hamstrings tendinopathy, a pinched low-back nerve, or sacroiliac joint syndrome. Let’s take a look at each of these individually. – Hamstrings Tendinopathy: The hamstrings are actually a collection of large muscles…
A twitching calf muscle may seem like no big deal, and if it’s just a temporary annoyance that lasts a couple of days and then goes away, it may be. However, it can also be a warning sign of something bigger, especially if it continues. So, today, we’re going to explain a little about the calf and why it’s not a good idea to ignore calf muscle twitching. If there’s one muscle you’re likely familiar with, it’s the calf muscle. If you reach around and grab your calf and flex it, the muscle you are actually feeling just under the surface is called the gastrocnemius muscle.
Treatment depends upon the underlying cause of the arm numbness. Left-arm numbness is a warning sign that requires attention. As noted above unexplained numbness requires immediate attention. At the Centeno-Schultz Clinic, we are experts in the treatment of left-arm numbness due to cervical nerve irritation, cervical stenosis, thoracic outlet syndrome, and peripheral nerve injuries. When appropriate first-line treatment should involve conservative care including physical therapy and stretching. Steroid injections should be avoided as they are toxic to orthopedic tissue and can accelerate damage. Surgery for Cervical Stenosis and Thoracic Outlet Syndrome is major surgery and associated with significant risks. These risks…
So what exactly causes the leg to feel disconnected? The hip joint is the connection point between the leg and the rest of the body. The femur in the leg and the acetabulum in the pelvis create the hip joint. So if the left SI joint, for example, in the back and the symphysis pubis joint in the front becomes unstable due to loose supporting ligaments, then the left leg, which is connected between the two joints, is likely to also feel a bit disconnected. Likewise, if the right SI joint were unstable, then the right leg might feel disconnected. How This Patient’s “Disconnected” Leg Was Fixed Despite “leg feels…
Have you ever been walking and your leg gives out? It can be both surprising and alarming What would cause your leg to give out? Can sciatica cause your leg to give out? How do you treat weak legs? Let’s dig in.Weakness in the leg can arise from three principal sources: nerve problems, muscle weakness, and SI joint dysfunction. Weakness in the legs may indicate a significant nerve problem. In many cases, it may be the first indication of a nerve problem. There are three common causes of nerve injury: low back disorders, nerve compression as it descends down into the hip, thigh, and shin and medical conditions such as diabetes…
There are 26 bones in the foot. The Navicular Bone is a small C-shaped bone located on the inside portion of the midfoot. It is nestled between the talus, the three cuneiform bones, and is a structural link between the midfoot and forefoot. It provides important support of the foot and arch during movement.
The Tibialis Posterior is the only muscle that attaches to the Navicular Bone and is also important in supporting the arch.
Ligaments are thick bands of connective tissue that connect one bone to another. The 26 bones in the foot are held together by ligaments and muscles. The spring ligament spans between the heel bone and the Navicular Bone and is an important ligament as it provides support for the arch and foot.
The ischial tuberosity, also called your Sitz bone, sis a pair of rounded bones that extends from the bottom of the pelvis. They are the bones that we sit on. The pelvis consists of three strong bones fused together: the ilium, ischium and pubis. The ilium are the tall, thin bones that create the iliac crest aka the waist bone. The pubis bones are the small anterior bones that are joined together by the pubic symphysis. The ischium forms the lower and back part of the pelvis. It is situated between the ilium and pubis A tuberosity is defined as a large prominence…
Conventional wisdom states that stiff neck symptoms can be treatable with nonsurgical remedies. However, not all stiff neck symptoms are benign, and leaving the stiff neck untreated can lead to a limited range of motion that can affect your overall health and quality of life. A stiff neck can cause pain, tightness, popping, and clicking noises and sensations and affect daily activities. A detailed examination of stiff neck symptoms can determine the exact condition affecting the stiffness of one’s neck. Where does the neck hurt? Neck stiffness can occur at the base of the head, down to the shoulders. This can be associated with pain, crunching noises, or popping sensations and may…
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,
adjacent segment disease,
stress from repetitive work,
bone spur formation (osteophytosis)
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:
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…
My passion and specialization are in the evaluation and treatment of cervical disc, facet, ligament and nerve pain, including the non-surgical treatment of Craniocervical instability (CCI). I quit a successful career in anesthesia and traditional pain management to pursue and advance the use of PRP and bone marrow concentrate for common orthopedic conditions. I have been a patient with severe pain and know firsthand the limitations of traditional orthopedic surgery. I am a co-founder of the Centeno-Schultz Clinic which was established in 2005. Being active is a central part of my life as I enjoy time skiing, biking, hiking, sailing with my family and 9 grandchildren.
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.
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.
Doctor Hyzy is Board Certified in Physical Medicine and Rehabilitation (Physiatry) and fellowship-trained in Interventional Orthopedics and Spine. Dr. Hyzy is also clinical faculty at the University of Colorado School of Medicine in the Department of Physical Medicine and Rehabilitation; In addition, Dr. Hyzy is an Adjunct Clinical Assistant Professor at The Rocky Vista University College of Osteopathic Medicine. Dr. Hyzy also maintains an active hospital-based practice at Swedish Medical Center and Sky Ridge Medical Center. He is also recognized and qualified as an expert physician witness for medical-legal cases and Life Care Planning. He is published in the use of autologous solutions including…
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…
Dr. Mairin Jerome is a physiatrist with subspecialty fellowship training in Interventional Orthopedics and Regenerative Medicine. This subspecialty serves to fill the gap for patients who are interested in therapeutic options that lie between conservative treatment and surgery. Dr. Jerome uses regenerative medicine techniques, including prolotherapy and orthobiologics, via X-ray or ultrasound guidance to precisely deliver injections to areas of musculoskeletal injury or degeneration. Orthobiologics refers to tissue harvested typically from a person’s own body, such as platelets (platelet-rich plasma, PRP) or bone marrow, for use in treating painful musculoskeletal conditions. The goal is to stimulate the body’s healing mechanisms to improve pain, function, and decrease inflammation.
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.
Lumbar Discography is a pre-surgical procedure to identify whether one of more of the lumbar discs is a “pain generator’. It is a procedure that should only be undertaken if all other possible sources of pain have been excluded and the patient is prepared to undergone surgery. Other sources of lower back pain include lumbar … Continued
Chronic lower back pain can arise from many sources. Unfortunately many patients are not provided a thorough examination and evaluation by a physician specializing in pain management. Often times patients are reflexively placed on muscle relaxants and narcotics with no effort to identify the source of back pain. If the pain does not resolve some … Continued
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This book is full of tests and exercises to understand what is happening to cause your orthopedic pain.