OPINION – Many people suffer with pain in their hips and their legs, preventing them from enjoying their favorite activities, and enjoying an active life pain-free.
Dr. Court Empey is a St. George native who graduated from both Dixie High School and Dixie College. Empey, who has the highest level of training in interventional pain medicine which includes training at the world famous Mayo Clinic, believes individuals can fully return to their normal active life pain-free.
“Every day I have new patients come to me with symptoms of pain in their hips and legs,” Empey said. “Commonly, these patients have been to orthopedic surgeons or other specialists thinking the pain is stemming from their hip or knee when the problem is really coming from the spine.”
Empey said there are two common conditions in the back that cause pain in the hip and leg: spinal stenosis and a herniated disc causing sciatica.
Spinal stenosis is very common. It is not a matter of if you are going to develop spinal stenosis but when. It is not uncommon for individuals to have spinal stenosis by age 40 but usually doesn’t develop until into people’s 60s or 70s.
Stenosis is a medical term for narrowing. In order for your spinal nerves to reach your legs they must travel through the spinal canal via the spinal cord. Bulging disks, bone spurs and thickened ligaments around the spinal canal can cause the canal to narrow. This most commonly happens in the lower lumbar spine.
“Symptoms of spinal stenosis include low back pain, hip and leg pain,” Empey said. “This pain can be on the left or right only but is most often felt on both hips or legs. Pain usually worsens the longer a patient stands or walks and commonly subsides soon after sitting down.”
Empey said when a person is standing or walking, the narrowed central canal narrows even more. Patients suffering from spinal stenosis commonly give a history of “the Shopping Cart Sign.” Leaning over a shopping cart usually relieves their symptoms. That narrowing tends to open more widely when sitting down or leaning over a cart.
Another common symptom Dr Empey hears about in his clinic at Desert Pain Specialists is a herniated disc causing sciatic pain.
“This pain radiates down the back into the buttock, knee and occasionally the foot,” Empey said. “Whereas spinal stenosis is typically felt in both legs, herniated discs are commonly felt in one leg.”
Herniated disc sciatic pain typically worsens when sitting for extended periods of time. Sitting puts increased pressure on the disc and causes the disc protrusion to get bigger. The larger protrusion then further narrows the tiny nerve openings on the side of the spinal canal called neuroforamen and irritates the spinal nerve causing sciatic pain.
Ultimately both the pain from the spinal stenosis and herniated discs are treated similarly. A primary care physician or interventional spine specialist help diagnose both conditions. A full history and physical exam should be performed. Sometimes further testing such as X-rays, CT scans, MRIs and nerve conduction studies are needed to confirm the diagnosis.
Surgery is usually not required to treat these conditions, unless a significant amount of numbness or weakness is noted on the physical exam. Successful conservative treatments include physical therapy, medications, and X-ray guided (fluoroscopic) epidural steroid injections.
Physical therapists can typically teach patients certain postural changes or other core strengthening exercises that help prevent and minimize the symptoms of spinal stenosis and herniated discs. Anti-inflammatories, opiates and nonopiate pain medications can treat these symptoms. Epidural steroid injections are also very successful at alleviating spinal stenosis and sciatic pain.
Ultimately, if conservative treatment fails minor surgical treatment is sometimes necessary to relieve the pain.
“My goal is to get patients out of pain without surgery,” Empey said. “If you are having pain that radiates in your back, hip, leg or foot that worsens with extended standing, walking or sitting, you may have spinal stenosis or a herniated disc. With medications, therapy or epidural injections, our goal is to help you return to your normal active life style pain free.”
Written by Dr. Court Empey.
Empey is fellowship trained in interventional pain medicine, completing this training at the world famous Mayo Clinic. A native to St. George, he graduated from both Dixie High School and Dixie College, then completed his bachelor’s degree at the University of Utah in biochemistry with honors.
He was also an honor graduate of the George Washington University where he obtained his medical doctorate degree. He then returned to the University of Utah to complete an internship in internal medicine and a medical residency in anesthesiology. Lastly, he completed his training in interventional pain medicine at the Mayo Clinic in both Scottsdale, Arizona, and Rochester, Minnesota.
With the highest level of training available for a pain specialist, he has had extensive training in medical management, physical medicine/physical therapy, cancer pain therapy, psychology and lifestyle modification. He believes in a multi-disciplinary approach to pain treatment.
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Ed. note: This report was incorrectly attributed to St. George Health & Wellness Magazine on initial publish; corrected to sponsored content April 20.
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I have Tarlov cysts disease in my spine they erode my sacrum bone and nerves in my spine. I could barely walk I was in a lot of pain. It started with sciatic pain had MRI showed 3 tarlov cysts growing in sacrum area I also have them in my pelvis area. The Dr told me not to worry about them now I’m disabled. Luckily there’s a Dr in Dallas tx that can slow the progression down in the meantime I have horrible nerve damage I deal with spine fluid leaks.