The pain started in June 2024. It wasn’t bad at first, more of a discomfort radiating across the top of my right butt cheek, but it got worse with each passing week. I’d been to my doctor, who’d prescribed a narcotic for the pain. As time passed, the pain radiated down my right leg to the calf, which began to cramp painfully.

We all thought it was Piriformis Syndrome, a condition in which the piriformis muscle in the buttock spasms and irritates the nearby sciatic nerve, causing deep buttock pain, numbness, or tingling that can travel down the back of the leg, like sciatica, but that disappears with stretching and rest. I bombed it with ibuprofen, saw a physical therapist, and started a rehabilitation program. But it got worse, not better. Thankfully, the only time I wasn’t in pain was when I was hiking. I was grateful for that.

What I couldn’t do was sit down for more than a few minutes at a time, because I experienced excruciating calf cramps and tingling every time I stood up again. This was problematic because I have to sit while writing and working on my computer. I tried switching to a standing desk, but I couldn’t make the transition. It got to the point where I never sat down unless it was unavoidable, like when I was driving. I took to lying on my stomach when writing on my laptop. All this while I was taking the maximum daily dose of regular Tylenol per day (to avoid getting addicted to narcotics). My doctor subsequently prescribed a powerful muscle relaxant, which helped relieve the cramps, and scheduled me for an MRI.

Now, 18 months later, I’ve almost fully recovered.  But it was a terrifying time for me, not knowing if I’d ever be healthy again. I’m writing about my experience so that others may benefit from what I learned about low back pain, how poorly it’s understood, and the ways in which the medical establishment is predisposed to address it.

Once the MRI was scheduled, I had to endure another two months of pain and uncertainty before my MRI appointment, even though it was scheduled at New Hampshire’s Dartmouth Hitchcock, which is a medical center on par with the best hospitals in Boston. There is so much demand for MRIs at Dartmouth Hitchcock that they’re run around the clock, 24 hours a day, 7 days a week.

I found it difficult to adapt to a standing desk

I was afraid of getting an MRI. I don’t like being confined in small spaces, and the thought of being inserted into its donut-shaped cavity for hours made me very uncomfortable. Still, I knew that this was the only way I’d find out what was wrong. The medical techs were understanding, and I meditated during the procedure, calming myself to get through it.

Structural Evidence

The MRI results were sobering. I had a large spinal cyst (a fluid-filled sac) pressing down on my spine and the nerves running down my leg. The resulting pressure was judged to be the cause of the calf cramping and tingling I’d felt for the past 6 months. The root cause was attributed to natural degeneration associated with aging, but clearly, the cyst did not grow there overnight. It was probably growing inside me for years, a ticking time bomb.

Once the MRI results were available, the pace of my care at Dartmouth Hitchcock picked up. In order to avoid major spinal surgery, an attempt was made to puncture the cyst by inserting a needle into it. Some cysts have an exterior wall with a liquid center that can be drained and reduced in size to alleviate pressure on the spinal cord and nerve. While not a complete cure, the resulting pressure reduction can be enough to alleviate the symptoms causing distress, sometimes permanently. The procedure is performed while the patient is awake, but medically relaxed, and guided by a Cat scan. Unfortunately, the procedure, which had only a 50/50 chance of succeeding (which I was only told later), failed because the cyst’s exterior had calcified and was too hard to penetrate.

The Race for a Cure

My next step was to consult with a neurosurgeon about a more invasive procedure, involving the extraction of the cyst altogether. But the neurosurgery group at Dartmouth Hitchcock was short-staffed, and I had to wait before I could get an appointment. It was such a long wait that my primary care doctor referred me to another spine clinic, this time at the University of Vermont Spine Center outside of Burlington. By this point, I was getting increasingly desperate and was prepared to favor the doctor and institution that could provide me with the fastest relief. I likened the choice between them to a horse race.

I met both surgeons at Dartmouth Hitchcock and UVM in May of 2026. The Dartmouth Hitchcock surgeon is a well-known specialist in minimally invasive spinal surgery. He recommended surgery to completely remove the cyst, followed by a 6-month recovery period, during which I’d be limited to carrying 10 pounds. Despite that,  I readily agreed. But the surgery was scheduled for August, still months away, so I decided to visit the orthopedic spine surgeon at UVM to get his take on the situation.

Physical therapy helped accelerate my recovery.

An Unexpected Treatment Plan

The surgeon at UMV recommended a completely different treatment plan. Rather than surgery, he recommended getting an epidural injection of an anti-inflammatory steroid to calm the area around the cyst and the nerves running down my leg. He also prescribed a course of physical therapy in a swimming pool to strengthen my core muscles and help offload pressure on my spine and lower back. He explained that most patients recovered within 2 years of the epidural injection, and his goal was to keep me comfortable during that time to see if a non-surgical approach would pan out.

Despite the uncertainty of a cure, I decided to get the epidural injection because it could provide relief in the short term, while leaving the option of surgery by the Dartmouth Hitchcock surgeon open. Its effect took a few weeks to become noticeable, but it significantly reduced calf cramping to the point where I could stop taking high doses of Tylenol and muscle relaxants. I still had to medicate, but intermittently, as the need arose. I cancelled the surgery at Dartmouth Hitchcock, hopeful that this new approach would bear fruit, and knowing that I could get several epidurals a year if I had a relapse. That’s apparently not uncommon, as their effects can last 3-6 months.

I subsequently began physical therapy in the pool, with tremendous results.  The buoyancy of the water helped offload pressure on my spine, providing complete relief after 10 minutes in the pool. After 10 weeks of pool therapy, I started another 10-week round of dry exercises in the gym, with stretching and elastic bands. As my core strength improved, my symptoms abated.

Long Trail Physical Therapy offers pool therapy

I had a follow-up appointment with my UVM surgeon in October, who was pleased to hear of my progress and reduced symptoms. I asked whether it would be possible to have another MRI to see if the cyst had shrunk in size to explain the symptomatic relief I was experiencing. He said there was no need. I found this frustrating, but I think I understand why.

An Alternative Pain Model

There is a body of thought in the medical community (see the books by Sarno, Schechter, and Hanscom) that discounts the relationship between structural defects, such as my cyst, and lower back pain, favoring a neurophysiological explanation. When exposed to chronic or elevated stress, your body experiences a prolonged elevation of stress hormones, adrenaline, and cortisol, resulting in a myriad of possible symptoms and ailments. Why, for instance, did I experience a flare-up of leg pain symptoms in May of 2024 when it’s clear that I’d been carrying around a sizable cyst on my spine for years beforehand without any symptoms or warning flags at all?

In hindsight, I think my condition was triggered by several events that caused a tsunami of stress: I was in the midst of a protracted divorce, which, while reasonably amicable as divorces go, was repeatedly delayed by procedural issues for close to two years. In addition, I’d moved my residency from one state to another; sold one home and bought another. I downsized and moved my possessions twice, and wrote and published a book (Hiking Over 60). Any one of these events could have triggered a stress reaction, but experiencing them all within the same year probably overwhelmed by body’s ability to cope. Once these events had resolved themselves and my life had returned to normal, my symptoms began to abate.

I moved from New Hampshire to Vermont

That’s not to diminish the role that physical therapy has played in my recovery. It gave me a sense of empowerment after months of uncertainty and helped direct my energies in a constructive way. While the physical therapy sessions are over, I’ve continued to perform the exercises daily and increasingly challenge myself with harder variants. I’ve always been a gym rat since graduating from college, but I slacked off when I lived in the White Mountains in New Hampshire, and there were no gyms around. But I  have good workout facilities near my new home now, and I’m back at it.

Transactional Biases in Medical Care

When I got my MRI back and read that I had a large cyst on my spine, it’s no wonder that I thought it was the root cause of my leg pain. That cyst gave me a villain to blame, and I’d been programmed to attribute physical ailments to structural causes.

I’m not unique in this respect. Modern medicine, insurance billing, and privatized hospital conglomerates owned by hedge funds are all incentivized to pursue a model of care that identifies a cause and prescribes a cure. A patient presents with a complaint; tests are ordered, results are evaluated, a remedy is prescribed, and a procedure is performed. It’s a highly transactional model.

When it comes to low back pain or related spinal and nerve issues, this can result in unnecessary surgical procedures without regard for the other factors (such as neurophysiological ones) that might be identified by taking a more detailed personal history. Spinal surgery has a highly variable success rate. In the case of spinal fusions (which is one of the procedures my UVM doctor offered me if the epidural/physical therapy tract failed), 80% of patients require a follow-up surgical procedure, and only 15% return to work within a year (Hanscom, 2017). Those are bad outcomes and odds. You should do everything in your power to avoid spinal surgery.

Takeaways

If you’re suffering from an ailment classified under the umbrella of lower back pain, spinal, or nerve pain, and are considering care options, I hope you’ll find my story helpful. I understand the fear and desperation that you may be feeling and the desire to do something, anything to make the pain stop. Try to find a practitioner who offers a more conservative approach without surgery, particularly if you’ve experienced a stressful event or episode in your life.

In my case, the delay was the cure, not surgery. When my stressful events diminished, my pain dissipated. I’m almost completely back to my old self again. But I’m also wise to the potential for stressful circumstances to disrupt my life again, and I’m taking steps to mitigate their effects through exercise and meditation.

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