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  • skjr
    Participant
    Post count: 2

    Hi Dr. I am a former patient of yours at Vail clinic~ 2015/16, I was living in Santa Fe then (you helped me avoid surgery)

    ~ 1.5 years ago started having pain in my left psoas after alot of running and xc skiing; PT helped a little and eventually I was running again, but having chronic pain in my low back. Seeing a PT again and his eval. indicates too much lordosis and when running the back muscles fire first and the hips don’t do their job, so back pain from overworked muscles.

    Makes sense and I can see it. Backpacked 100 miles over a week with pretty heavy pack and no pain, started again when finished. downhill skiing did not initiate pain either, nor does mountain biking.

    General living and running (I have not run in months) do make it hurt. Performing PT to address curve, retrain muscles etc. but I don’t seem to be getting anywhere. Just thought I’d ask for your thoughts

    Donald Corenman, MD, DC
    Moderator
    Post count: 8459

    Left psoas pain I interpret as anterior hip pain. This could be your hip joint as well as a nerve referral pain. Obviously, lower back pain is located in a different spot and is normally generated by the lumbar spine. Hyperlordosis doesn’t occur overnight so your earlier X-rays would be helpful to determine your current lordosis which I suspect is within normal limits.

    It sounds like flexion (bending forward) relieves your pain. Backpacking causes spine flexion to compensate for a heavy load posterior to your spine. Mountain biking and skiing are also flexion activities. You might have a facet disorder> See:
    https://neckandback.com/conditions/lumbar-degenerative-facet-disease/

    Dr. Corenman

    skjr
    Participant
    Post count: 2

    Hi Dr Corenman!

    You were correct, finally obtained MRI and there appears to be facet problems:

    “Primary lumbar osteoarthritis [M47.816 – Spondylosis without myelopathy or radiculopathy, lumbar region]
    Facet mediated low back pain” / “Sid has axial low back pain on the left greater than right localized over 4/5 and L5/1 lumbar facets. No radicular symptoms today. He has had 2+ years of pain without improvement conservative measures.”

    Considering steroid injection or Ablation… I am thinking start with the steroid. I understand this may help but need to be repeated, but apparently the ablation often needs to be repeated as well and it seems like a more involved procedure than the injection.

    Realizing you don’t have the MRI to review etc., in general, does that seem like an appropriate course of action or am I likely to end up having to have the ablation in any event? Any relevant data on outcomes I can review or look up?

    I’ll be 65 soon and very active and I’d like to get back to running, assuming that is reasonable.

    Thank you so much for being a great resource! I often think about you saving me from an unnecessary surgery

    Donald Corenman, MD, DC
    Moderator
    Post count: 8459

    It appears that you have facet disease and you need to go through the diagnostic blocks to prove this theory. The blocks themselves can provide treatment (months to a year of pain relief) and are necessary to diagnose the disorder if an RFA (ablation) is considered. Keep us informed of your progress.

    Dr. Corenman

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