Chronic Low Back Pain for an Active Adult

Tagged: Chronic Low Back Active Adult

Viewing 4 posts - 1 through 4 (of 4 total)

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Brian W
Participant

November 11, 2019 at 11:47 am

Post count: 2

#31444

Hello,

Found your website while trying to do some better research on back pain. Have had steady chronic low back pain for 3-4yrs. With off and on bouts of pain from as far back as 10yrs ago. Had an MRI in fall of 2017. Lived with the pain for 2yrs, without reducing activity levels. Recently have felt that I’m either more focused/aware of the pain or it has gotten worse. I’m hoping you might provide a general opinion, which would allow me to further determine treatment course, or continue to deal with my situation. I’m 6′-3″ 185lbs 38yrs old male.

MRI 8.16.17
Examination: MRI lumbar spine without contrast
Clinical Indication: Spondylosis without myelopathy or radiculopathy
Comparison: 9.16.16 radiographs of the lumbar spine
Procedure: Multiplanar, multisequence MRI obtained of the lumbar spine without intravenous contrast.
Findings: Lordotic curvature and alignment are normal. The conus medullaris and bone marrow demonstrates normal signal. There is no acute fracture. Vertebral body heights are well maintained. There is mild loss of disc height at L5-S1. The perivertebral soft tissues are unremarkable.

L1-L2:Normal
L2-L3:Normal
L3-L4:Normal
L4-L5: Mild degenerative facet arthropathy. There is a shallow midline disc protrusion without significant stenosis or nerve root impingement.
L5-S1: Midline disc protrusion without stenosis or nerve root impingement. Mild degenerative facet arthropathy.

Impression: L4-5 and L5-S1 small midline disc protrusion and mild degenerative facet arthropathy. No stenosis or nerve root impingement.

My Symptoms as of Nov 2019.
1. In mornings when exiting bed, back starts to tighten when standing at sink. Typically centrally located. If I sit in a chair and bend forward arching low back with stomach onto thighs, or get down into child’s pose feels like a very tight muscle stretch. 4/10 pain, but feels like a muscle stretch.
2. Days of work. Office work. Sitting at my desk. Sometimes a little achy but usually not bothersome. Possible minor sciatica symptoms when sitting, in the left leg. Sometimes ache on outside of thigh in area of IT band. Sometimes tingling bottom of foot or big toe. Usually no pain in buttocks. No shooting pain.
3. Days of activity (weekends, or other). Typically minor discomfort with most activities. I’m hyper aware of the back pain now, so feel every little twinge. Hiking, running, both cause tightness and soreness generally central to low back.
4. Standing. I visit work sites and stand for meetings. Or standing during social events. More than about 15minutes of standing seems to be worse for pain. probably 4 to 5 out of ten in some situations. Strong aching pain. Sometimes is more of a burning across tops of hips, but that isn’t common. Sometimes favors right side over left. Bending forward and toward the left seems to feel like a deep stretch and seems to help. Also pushing on low back and bending backward seems to feel like a stretch. Pain doesn’t really resolve until sitting down. Sitting down slouched seems to relax everything
5. Lying on stomach and arching back like McKenzie excercises. Initially sharp pain, that subsides if I hold the position.

My Activity Level and Treatment:
1. Occasional chriopractor. Doesn’t do much. Pilates 1x a week. Feels good during and after pilates, but doesn’t last until next day. Occasional advil or alleve. Home stretching. Foam roller. Lying on foam roller, various yoga poses.
2. I’m very active. Office job but most free time I’m doing home improvement projects (flooring, tile, painting, etc) or working out. I used to do crossfit one or two days a week (conservatively). Run, swim laps, mountain bike, lift weights.
3. I’ve quit crossfit, cut way back on weight lifting. mostly quit running, and have found that swimming actually aggravates my pack pain. I was a competitive swimmer and swimming actually has a lot of flexion to extension during laps. I’m also becoming more reluctant on home improvement projects. I’m afraid I’m making things worse. I’m afraid to continue with rigorous exercise for fear of ruining my back. It’s causing me to stop activities I used to enjoy and feel are important for mental and physical health. The pain is limiting me, but I know I’m pushing through pain to stay active and will have more next day pain from these activities.

Sorry for long detailed info but hoping for advice on seeking further treatment or continuing conservative care. The Dr who ordered the MRI suggested nerve blocks next, to try to diagnose or rule out facet generated pain.

Thanks so much for the opportunity to ask you a question.

Brian

Donald Corenman, MD, DC
Moderator

November 12, 2019 at 5:51 am

Post count: 8660

#31455

You have CBS (“crappy back syndrome”) like most of my patients do. The side wall of the disc (the annulus) will tear after years of use due to its design or the facets will develop arthritis (or both). Disc pain generally will increase with flexion and loading (lifting) and facet pain will increase with extension (swimming).

You can go thru core strengthening (Pilates is my favorite) which will help somewhat but you have to understand the biomechanics of the spine to prevent positions that can increase more damage. See https://neckandback.com/treatments/conservative-treatment-mechanical-lower-back-disorders/.

The next step would be diagnostic blocks like facet blocks to see if you have facet-mediated pain. If so, the radio-frequency ablations could be valuable and if not, epidural steroid injections can be helpful. See https://neckandback.com/treatments/facet-blocks-and-rhizotomies/, https://neckandback.com/treatments/diagnostic-vs-therapeutic-injections/, https://neckandback.com/treatments/epidural-injections-and-selective-nerve-root-blocks-diagnostic-and-therapeutic/ and https://neckandback.com/treatments/pain-diary-instructions-for-spinal-injections/.

If those don’t work, then it is possible that a small surgical procedure like a microdisectomy could relieve some of your lower back pain (I tell patients its 50/50). Finally if nothing else works and you are incapacitated with your back pain, consider a fusion, the “last straw”.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.

Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

Brian W
Participant

November 13, 2019 at 10:15 am

Post count: 2

#31470

Your response is appreciated, not too mention you taking your valuable time to offer this service. I have one follow up question if you have the time to offer an opinion. What is your opinion on chronic muscle tightness or soreness? So much of my discomfort and especially morning pain feels like cramped or tight muscles in the very low back below tops of hips and at what I think is the sacrum. I’ve never found any information on this and wonder if it’s a response both mentally and physically to the degenerative changes occurring in the low back. Just curious as I try to continue to hone on on the actual pain generator(s). The information I’ve read always talks about acute muscle or ligament issues, but never any real mention of chronic issues.

Thanks again for your time.

Brian

Donald Corenman, MD, DC
Moderator

November 13, 2019 at 10:33 am

Post count: 8660

#31471

“Chronic muscle tightness” is typically referral pain from a spinal disorder. While muscles can be pain generators, more likely the spinal disorder is referring pain or the muscles are reacting to protect the spine.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.

Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.
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Donald Corenman, MD, DC

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Eric S

Sep 26, 2021

by Eric S on Donald Corenman, MD, DC

Successful pars repair at 46 years old

Back in November of 2018 (at 46 years old) I came from Vancouver BC to have a pars repair done with Dr. Donald Corenman at the Steadman Clinic in Vail Colorado. I'm finally posting this review nearly three years later in late 2021. The reason I waited so long was I wanted to know the final result before I posted my review. Unfortunately in that time Dr. Corenman has retired. Nevertheless, I want to post this review of Dr. Corenman and his staff at the Steadman Clinic in their excellent treatment of my L5 pars interarticularis.

I fractured my pars at age 42 back in 2014 when rolling on the gym floor, and was denied treatment by the Canadian healthcare system, probably due to my age. First my GP told me there was no surgical option for a pars defect, which was quite incorrect! I tried to live with it, but the symptoms worsened (periodic random spine slippage and weeks of resultant pain after just bending over to tie my shoe, so I eventually learned to mostly squat and hardly bend). When I finally consulted with Canadian spine surgeons, I was told they believed my pars defect had been congenital (since birth). This was absurd, considering I had done extreme martial arts (including jiu jitsu) for years prior, as well as 5 years of reinforcing steel full time in my 20s, probably the hardest job on the back you can find. No pars defect like mine would possibly have allowed this--ergo it was impossible that I had had the defect since birth. I did however have an asymptomatic congenital spina bifida occulta that made me more susceptible to a pars fracture. In 2014 in one instant, I went from having the strongest back people I knew said they'd ever seen, to being unable to safely bend over and tie my shoe without a non-negligible risk of my spine slipping randomly (which would lead to weeks of pain after each occurrence). This was due to the unilateral L5 pars defect, otherwise known as spondylolysis. It was when lying in pain on the floor 4 years later after maybe the 6th spine slippage event post injury, that I had had enough, and resolved to have surgery. If Canada's "universal health care" said no, I would make lemonade from lemons, and find the very best surgeon in the world at pars repairs. That was Dr. Donald Corenman. Dr. Corenman back in 2018 ran a website https://neckandback.com/ that dedicated many pages to the science of every aspect of pars repairs, from eligibility (good discs on MRI), to best surgical techniques (minimal open compared to minimally invasive), best imaging to use (i.e., O-Arm with Stealth imaging vs. older fluoroscopy), the ideal amount of BMP to use and why not use too much or too little, and much more, all to do with pars repairs, pages upon pages of his site just on the pars, with scientific references and his own extensive expert opinion. As a health research statistician, I was very impressed with this. It was in stark contrast to the websites of other spine surgeons which barely gave the pars a word or two, focusing almost exclusively on fusions. I had found the best surgeon in the world for pars repairs, and so after Dr. Corenman personally screened my MRI to ensure my discs were healthy, I booked the surgery.

Being 46 years old at the time of surgery in 2018, with a 4-year-old pars fracture from 2014 combined with a congenital SBO meant my pars fragment was somewhat atrophied, but it was "very solid", said Dr. Corenman in the operative report. Nevertheless, it was challenging with two things to fix, the pars and SBO, and OR time was around 4 hours. Recovery over the following months was guided by a very clear "Spine binder" from the Steadman Clinic with strict rules of "no BLT" (no bending, lifting or twisting), and illustrated physiotherapy guidelines. They even warned patients to avoid fish oil supplements, which could excessively dampen inflammation and hence slow bone healing. They answered many questions I had during months of recovery, with responses coming from the very supportive Lori Fugate (then director of Dr. Corenman's practice), and Ehrich Bean (then physician's assistant at the practice), as well as a couple calls with Dr. Corenman himself after two of the CT scans. Ehrich Bean offered great advice for taking the spine binder conservatively due to the nature of pars repairs vs. fusions. The final post-op CT scan I had was a couple weeks ago at 34 months post-op, and Dr. Corenman had retired, but I got a very positive and informative call from Eric Strauch (current PA at the Steadman Clinic under Dr. Corenman's replacement there, and who had also worked with Dr. Corenman previously). The staff at the Steadman Clinic were extremely supportive all the way through the process. I should mention, the local Canadian spine surgeon did offer me very good post-operative support including antibiotics as needed to deal with a mild surface incision-site infection early on, booking numerous x-rays when I felt something was amiss, as well as booking all four of my post-op CT scans. I am very grateful for that support also.

My final result shows plenty of solid bone across the pars and a healed SBO, with my vertebral body now a solid bone ring instead of being broken at two places as it was pre-op. Does my spine hold up in the real world? You bet! I have recently dug and moved several yards of dirt and sand and gravel by myself (shovel and wheelbarrow!) to fix our water main, pulled roots from the yard, moved several "portable" (these are HUGE) air conditioners up several flights of stairs my myself, and lifted weights. I now run 2 miles (3.2 KM) several times weekly with a hard 100 meter dash in the middle. I bend deeply before each run I go on, with no spine slippage. My spine feels amazing. I can bend over to do exercise, or real word tasks, with no risk of spine slippage.

My sincere thanks to God, Dr. Donald Corenman, Lori Fugate, Ehrich Bean, Eric Strauch, and the Steadman Clinic, as well as the Canadian spine surgeon who offered me excellent post-operative care back in Canada. You have all given me a new lease on life.

Sincerely,
Eric S

Robert S

May 11, 2021

by Robert S on Donald Corenman, MD, DC

Back Fusion Surgery

I had my entire lumbar spine fused in November of 2018. I had scoliosis , with pinched nerves that were so painful I could hardly walk - and standing for more than a few minutes was impossible. Even sitting was painful.
The fusion surgery produced immediate relief! And the recovery was much easier than I expected.
To this day I can do all the activities I love from hiking, to standing in a stream fly fishing to riding my bike long distances - or just walking down the street with my wife.
Kudos to Dr. Corenman and his staff, (including the two Erics) for taking such good care of me!

Leslie R

Jul 9, 2020

by Leslie R on Donald Corenman, MD, DC

TLIF

I had my TLIF surgery on 6/24/2020 by Dr. Corenman, I can not say enough good things about the Dr or his staff. I was always treated with respect and explained everything throughly, that made it easy for everyone to understand. I highly recommend Dr. Corenman and the Steadman Clinic.

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