Sciatic pain after car accident

Dear Ask The Doctor: I was recently in a car accident 18 Feb 11 and suffered initial dx whiplash and lumbar strain. After about a week the pain had increased and I went to a chiropractor and D.O. An x-ray showed a limbus fracture at L5. It was obvious to me when I viewed the x-ray, even as a layman. It was determined that it was an old fracture but aggravated by the accident which has greatly misaligned my spine. Over the last few years, I have experienced sciatica the day before my menstrual cycle and pain at L5 that is sharp and intense, relieved by putting pressure firmly on L5. Now, since the accident, the sciatica has not stopped, varying in pain from a 3 to an almost unbearable 9 on the standard pain scale. The stabbing sharp pain at L5 has also grown exponentially and has not gone away. My question is this: An MRI a few days ago stated no abnormalities at L5. The MRI machine did "go on the fritz" halfway through, causing them to stop it and resume a while later. My chiropractor believes the MRI was misread. What I want to know is, could the limbus fracture at L5 be the cause of the severe sciatica I have been experiencing, and how could it have not shown up on an MRI when it was very, very obvious on the x-ray? Is there treatment or a solution for this? Will chiropractic treatment and physical therapy stop this, or will I have to have surgery to stop the pain? Additionally, I now have a dx of Post Concussion Syndrome and am dealing with memory and cognitive issues. Could the pain be neurologically related? Thank you.

Dear Lisa: There are many causes of sciatic nerve inflammation: blunt injury, compression by the surrounding muscles, intervertebral disk degeneration ,fracture or lumbar disk disease, all of them can produce inflammation that results in pain along the sciatic nerve. The conventional treatment for Sciatica is aimed to relieve the pain and besides the use of anti-inflammatory medications ( “Motrin”, “Aleve”) and vitamin B complex, a physical therapy program definitely can benefit you,not only for the sciatic pain but for the whiplash too, with stretching of the hip , spine and neck muscles along with local heat or ultrasound application. It is very important also avoid activities that place stress on the lumbar/cervical spine, so if you feel like you can go to work after the session, you can try, but avoiding activities that can cause you discomfort or pain. Sometimes the pain and discomfort can persist for several weeks before to improve. The local corticosteroid injection may be considered if you show limited response to oral medication and physical therapy.