Lower back pain: Muscle or Sciatica?

Dear Ask The Doctor: Recently I walked two mile stretches, twice a day (from the train to the hospital, and then back), carrying a small messangers type bag which contained pens, pads, couple of bottles of water, not too heavy. I also shoveled snow the other day. I have some history with sciatica the other night, after one of the days I walked the 4 miles, I woke up to pee in the middle of the night and noticed my back was hurting on the lower right hand side. Not sure if its the sciatic nerve or my lower back. I take alieve for arthritis in my big toes (which I wrote to you about previously) what do you think it is? And what can I do about it? It has beenbothering me for a few days now.

Dear Alan: From what you are describing your pain seems to be related to a lower back muscle strain which may have been caused by excessive exertion or bending down in the wrong manner while shovelling. Sciatica which you say you have experinced before usually accompanies lower back muscular pain and is characterised by pain which is radiating down into the buttock area and also down the back of the leg. This occurs when the nerve involved is getting compressed by some structure (usually the intervertebral disc).

A Muscular back pain should improve over time .Simple measures like local heat compress  (helps releive the spasm), analgesics and topical antiflamatory like Voltaren gel applied to the area can help hasten the recovery process. However if you currently are / or in the near future do experience some pain radiating down your legs, any numbness or weakness in your legs or any bowel/ bladder problems this could indicate a more serious cause of spinal stenosis and I would recommend you to see your physician for further investigations.