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  • Brian W
    Participant
    Post count: 2

    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
    Post count: 8468

    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

    Brian W
    Participant
    Post count: 2

    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
    Post count: 8468

    “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

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