<s>[INST] 8 years ago I sprained my back and received a shot to alleviate the pain. The pain finally went away but I muscle knot appeared within a few days of trauma. Over the years the knot was never painful but did get larger. Now this knot (lower left side of back) is causing pain in my back, left side of buttocks, and left leg. Every once in a while I will get tingling in the toes of my left foot. I have been to the chiropractor for 7years now and have seen 3 different massage therapist. I suspect a pinched nerve. What is the next step? [/INST] Hello, Thanks for your query. According to your history it looks like swelling compressing your spinal nerves leading to pins and needle sensation in your legs. I will advise you to do x-ray spine and MRI spine. You may need muscle relaxant with analgesic, and neurotrophic medicine. Lumbar corset and hot fomentation will give faster relief. Physiotherapy like USG and SWD will give quick relief. Spine exercises done regularly will prevent endurance of such episodes. If all conservative management fails then operative decompression can be considered do hope that you have found something helpful, and I will be glad to answer any further query. Take care </s>