michaelMemberMay 26, 2011 at 11:47 pmPost count: 7
Hello Dr. Corenman. First of all, thank you for all the information on this site, I have learned more from your site than all the visits to any of the doctors I have seen for my back pain/leg pain.
This may be a bit long but I want to give you the most detailed information. I am 38 in good shape and have no health issues other than my back. 4.5 years ago I was working out doing back extentions when I felt a pain all the way down the back of my left leg into the foot. I immediately stopped working out and went home. The pain increased and was pretty moderate and mostly when I sat. Standing was much better. From that point on I saw a chiro, an othopedic surgeon, and nuerologist. I had an MRI done, but not one doctor went over the results with me. But I did get the radiolists report so I was able to read that I had a bulge at L4/L5. But that’s about all I understood since I’m no doctor. I found these doctors to be of zero help so I just quit going.
The pain in my leg when I sat seemed to improve over time and eventually after a year or so it either subsided enough to not really bother me or I was just so used to it that it didn’t really bother me. I would still notice it, but it didn’t affect any of my activities too much.
So I got back into working out (didn’t do any back extentions again or anything else that really used the lower back) and did fine up until this February when I took my neice bowling. Bowling 3 games really made my back tight and hurt badly and both legs began to hurt. I noticed a lot of very low/central back pain, pins and needles in legs, pain, numbness, or what I like to describe as “circulation being cut off” to the lower legs (kinda like how your arm feels when they put a blood pressure pump on). I also have a tad bit of weakness in my right calf and hamstring. (feels more like I have worked my leg out and it’s tired). All of these syptoms are felt in the bottom of my feet, toes, outside of feet, lower legs, lower thighs. The syptoms come and go in intesity depending on what I’m doing.
I am an airline pilot and now these new symptoms were affecting my job. I had a new MRI and for the first time I am able to see the images and there’s an obvious bulge at L4/L5 (it’s obvious to anybody with eyes!). I went to a nuerosurgeon (took 6 weeks to get an appt.)and while he didn’t go over the images with me, he looked at them and also stated that my L5 has slid forward over S1 a few millimeters and that is affecting me also. (I’m no doctor but I have looked at the images ad nauseum and I cannot see this spondylolisthesis he’s talking about). He didn’t recommend anything other than some back exercises he gave me.
I’m frustrated! I have improved some from the bowling day, but I still have lots of lower back pain and pain and all the symptoms (in varying intesities) described above when I sit . Any type of strenuous activity just makes my back knot up and hurt and the symptoms get worse. Walking makes it feel better. But as a pilot I cannot get up and walk around in the plane! I am going to see another nuerosurgeon on June 6th.
What’s your opinion given what I have told you and not seeing the images? I have been very tempted to get myself to your office as you have come highly recommened by a USAF General friend of mine who says the USAF flight surgeons speak very highly of you. There’s gotta be something that can be done to improve my quality of life.
Thanks for taking time to read this.michaelMemberMay 29, 2011 at 12:31 amPost count: 7
I should also mention that when I sit, the symptoms are very light in intensity and then gradually increase the longer I sit. They will almost go completely away if I stand up and walk around. I can also sit in one chair and have very light symptoms and get up, move to another chair and have much worse symptoms. Some chairs are great, others are not! So it’s constantly changing all day.
The bulge at L4/L5 is also centrally located.Donald Corenman, MD, DCModeratorMay 29, 2011 at 12:40 amPost count: 8436
It appears that you suffered a disc herniation at L4-5 when doing back extensions so many years ago. The L5 root was compressed and you developed radiculopathy. You don’t mention any foot weakness (the L5 nerve could cause foot drop, weakness of ankle inverters and a trendelenberg gait)- see web site for these conditions.
Normally with a disc herniation, the symptoms will slowly decrease over time. The tear in the back wall of the disc however does not heal. Since the process of degeneration does not stop, the nucleus (inside jelly) can disrupt and become another free fragment. A recurrent (repeat) disc herniation occurs in about 10% of patients. This is what probably happened after the bowling incident.
The comment by the neurosurgeon about one vertebra slipping on the other sounds like a spondylolysthesis. There are two types that might affect you- isthmic and degenerative. These should be obvious on x-ray and MRI. Look at the radiology report to confirm this slip.
If you have back pain and leg pain- what is the percentage of back vs. leg? This makes a difference as back pain is generally caused by the spinal column itself (instability, degenerative disc disease or spondylolysthesis) and leg pain which includes buttocks pain is caused by nerve compression.
The fact that sitting causes more pain is somewhat encouraging as this may indicate that the disc herniation is causing much of the pain. However, the percentage of back vs. leg pain will help to understand the correct diagnosis. Please feel free to send your films into the office.
Dr. CorenmanDonald Corenman, MD, DCModeratorMay 29, 2011 at 12:47 amPost count: 8436
The fact that standing and walking do not aggravate your symptoms is helpful. Central spine pain with standing normally stems from instability or discogenic pain so absence of this pain makes the prognosis much better. The “central bulge” at L4-5 does not really describe how large the herniation is or if it lateralizes to one side or the other. Please send in your films.
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