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Ask Dr. Arun Phophalia Your Own Question
Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 35453
Experience:  MBBS, MS (General Surgery), Fellowship in Sports Medicine
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I have a herniated disc, 2 steroid shots helped thigh and

Customer Question

I have a herniated disc, 2 steroid shots helped thigh and calve pain immensely but still rough lower back pain is surgery required to eliminate this pain? Possible discectomy and would it help and how?
Submitted: 9 years ago.
Category: Health
Expert:  Dr. Arun Phophalia replied 9 years ago.


How old are you? Male or female?

Since when is this pain?

Have you tried physical therapy?

What are the other modalities you have tried?

Are you overweight, smoker or take alcohol?

Dr. Arun

Customer: replied 9 years ago.
Reply to Dr. Arun Phophalia's Post: female, 66 years old, January 6th of this year My doctor who gave me the shots suggest PT but limited due to needing a hip and knee replacement, it's up to me if I try it now and he strongly suggested getting the hip done first as it is the priority between the both replacements. I am 5'11" and weigh about 182 due to lack of exercise since injury. I have a drink once in awhile about once a week and unfortunately I smoke I have tried Chantrix but it upsets my stomach immensely and cannot deal with right now on top of my back hip and knee.
Expert:  Dr. Arun Phophalia replied 9 years ago.


The low back has the following comprehensive management principles:

1) Back care in the activities of daily living is one of the most significant part of the treatment. Back education and back school will tech you to handle your back: It teaches the patient basic body mechanics, such as the correct posture for standing, standing at a desk or drawing board, sitting, brushing teeth, washing the face, pushing and pulling a weight, lifting a weight, getting in and out of bed, sleeping, getting into a car, and sitting in a car. Back school also teaches patients the proper and improper behaviors when their back is painful in case they have to sit, bend forward, lie down, cough, or sneeze.

a) Avoid activities which increases the pain.

b) Rest

c) Avoid bending at 90 degrees

d) Pushing and pulling should be avoided till pain subsides

f) Avoid prolonged sitting and standing

g) Avoid sitting or sleeping on floor

2) Anti-inflammatory analgesics like ibuprofen, analgesics and muscle relaxants

3) Local analgesic gels or sprays

4) Hot fomentation

5) Electrotherapy like trans cutaneous electrical nerve stimulation: done by Physical therapist. Other thing are ice packs, heating pads, electrical stimulation, phonophoresis, iontophoresis, relaxation, and biofeedback.

6) Good supervised physiotherapy: Floor exercises consist of abdominal bracing, modified sit-ups, double-knee-to-chest or low back stretches, seat lifts, mountain and sag exercises, knee-to-elbow exercises, hamstring stretches, extension exercises, and extension flexibility exercises. Swimming exercises are some of the best activities for back pain.

7) Lumbosacral corset or support

8) Epidural steroid shots

9) Surgery last resort

10) If obese reduce weight

I can understand, with your age and associated knee and hip osteoarthritis, physical therapy is difficult. But all specialists agree that it is mainstay of the treatment.

Degenerative disc disease is not life threatening, however it can certainly impact the quality of one's life due to pain and changes in activity that may occur. This disease is increasingly common as we age. Obesity, heavy lifting and smoking also increase the rate of occurrence or difficulty in complete pain relief.

Of all connective tissues, the intervertebral disk undergoes the most serious age-related changes. This cascade of degenerative changes can be subdivided into 3 stages: dysfunction, instability, and restabilization. Dysfunction involves outer annular tears and separation of the endplate, cartilage destruction, and facet synovial reaction. The dysfunction stage is followed by the instability stage, in which disk resorption and loss of disk space height occur. In the stage of restabilization, the progressive degenerative changes lead to osteophyte formation and stenosis. The symptoms are low back pain of varying severity. The signs are muscle tenderness, stiffness, reduced movement, and scoliosis.

Transforaminal selective nerve root blocks have been used as both subjective diagnostic and therapeutic interventions for lumbar spinal stenotic levels. When MRIs show evidence of multilevel degenerative disk disease, Selective Nerve Root Block can be used as a tool to try to determine if a specific nerve root is affected. Surgery may be the other option, in which they remove the herniated disc. This relieves the pressure from the pinched nerves and thus pain.

Feel free for your follow up questions.

Dr. Arun

Dr. Arun Phophalia and other Health Specialists are ready to help you
Expert:  Dr. Arun Phophalia replied 9 years ago.


I forgot to mention;

1) A trial of another steroid shot can still be done for your this residual pain.

2) After that you can go for your hip replacement.

Post operatively you can have physical therapy for hips and back together.

Dr. Arun

Customer: replied 9 years ago.
Thank you for a quick reply. My problem is where to go from here. I also need to make a correction The rehab hospital I had my steroid shots in was Spalding Rehab not Shaunessy, it came to mind because I visit a friend there. They are excellent and as I stated the front thigh and calve pain has now gone onlyM lower back pain exists. I kind of would like to see a neuroligist at Mass. General Hospital to see what he suggests, back or hip first. I could probably start the PT at North Shore Medical Ctr. in Salem MA instead of going into Boston for it and they are part of MGH Partners unbrella as many other hospitals around here. My doctor who gave the shots is located at MGH and does the shots at Spaulding. I worked at MGH for 24 years and all my doctors are there, PCP, Oncologist, Orthopedic, Gyn, Derm and my wonderful "shot" doctor, God bless him. It's what to do first that weighs my mind down at this moment Back or hip. My shot doctor states as long as I don't walk correctly due to the hip and knee the back will still be the same as now and total PT for the disc can't be done on very limited. I've had my share of surgeries over the past years since 1990 and I really don't want anymore but know that's not realistic. Kind of like grin and bear it. Soooo I'd like to ask you as I would my PCP what would you do next/first? I even get her doctors names to see, so I've got good doctors and a great hip doctor to call back when I'm ready. But again what comes first>
Customer: replied 9 years ago.
I glanced at your addition to the first reply and you have given me the answer I was looking for.
Thank you for your time and sound advice Just kind of wanted another opinion.
Expert:  Dr. Arun Phophalia replied 9 years ago.

You are always welcome.

Dr. Arun