For Queen guitarist Brian May, the month of May was not a particularly good month. May recently took to to tell fans about a recent health scare. Earlier in the month, May was taken to a hospital after injuring his buttocks during an "overenthusiastic gardening incident." An MRI revealed that he had torn his gluteus maximus muscle. The pain from the injury seemed intense and was described by May as "agony." When there was no improvement a week later, a second MRI was done, this time of his low back. The MRI showed a severely compressed sciatic nerve. "That's why I had this feeling that someone was putting a screwdriver in my back," quipped May.
But May adds that the story then takes a "bizarre and somewhat scary" twist. Although May thought himself a "pretty healthy guy" with normal blood pressure and heart rate, who exercised regularly and ate a healthy diet, in the middle of his diagnosing his sciatica problem, he had a "small heart attack." He experienced a 40-minute episode of chest pain and tightness, radiating down his arm and feeling diaphoretic. His physician (who was there at the time) personally drove him to the emergency room in his own car. An angiogram revealed severe coronary disease in three arteries, and he decided to have three stents placed.
May says his recovery from the procedure was a bit trying, not because of the stent procedure itself, but from the still excruciating pain in his leg. Currently, he says he is OK, having made slow but steady progress with the sciatica pain.
Fun Fact: Did you know Brian May has a PhD in astrophysics? His thesis was entitled: "."
Sciatica
Sciatica is a symptom of a problem with the sciatic nerve. Made up of the nerve roots of L4 to S2, which join together in the pelvis, it is the largest nerve in the body (at up to 2 cm). It controls the hamstring muscles, lower extremity adductors and indirect motor function to the calf muscles, and anterior lower leg muscles. It provides sensation to the back of the thigh, part of the lower leg, and the sole of the foot.
The symptoms of sciatica include pain, weakness, numbness, or tingling. These symptoms can start in the lower back and extend down the leg to the calf, foot, or toes. It's usually on only one side of your body. Sciatica pain often is worsened with flexion of the lumbar spine, twisting, bending, or coughing.
Any condition that may structurally impact or compress the sciatic nerve may cause sciatica symptoms. This can include:
- A ruptured or herniated intervertebral disk
- Narrowing of the spinal canal that puts pressure on the nerve, i.e., spinal stenosis ( a common cause in the elderly)
- Spondylolisthesis or a relative misalignment of one vertebra relative to another
- Lumbar or pelvic muscular spasm and/or inflammation that impinges on a lumbar or sacral nerve root
- An injury such as a pelvic fracture
- A spinal or paraspinal mass including malignancy, epidural hematoma, or epidural abscess
Treatment/Management
Advice for patients usually includes:
- Use of hot or cold packs for comfort and to decrease inflammation
- Avoidance of inciting activities or prolonged sitting/standing
- Practicing good, erect posture
- Engaging in exercises to increase core strength
- Gentle stretching of the lumbar spine and hamstrings
- Regular light exercises such as walking, swimming, or aqua-therapy
- Use of proper lifting techniques
- Deep tissue massage may be helpful
Drugs can also help:
- A short course of oral NSAIDs
- Opioid and non-opioid analgesics
- Muscle relaxants
- In the event oral NSAIDs are insufficient, a course of oral corticosteroids may be beneficial
- Localized corticosteroid injections
Other approaches can include physical therapy consultation and surgical evaluation and correction of any structural abnormalities such as disc herniation, epidural hematoma, epidural abscess, or tumor.
The prognosis of sciatica is typically good. Resolution often occurs within 4 to 6 weeks and long-term complications are rare. In more severe cases, or in those that require surgical intervention, a more prolonged course of recovery may be necessary.
Michele R. Berman, MD, and Mark S. Boguski, MD, PhD, are a wife and husband team of physicians who have trained and taught at some of the top medical schools in the country, including Harvard, Johns Hopkins, and Washington University in St. Louis. Their mission is both a journalistic and educational one: to report on common diseases affecting uncommon people and summarize the evidence-based medicine behind the headlines.