[ziotech]

#7494

History:
I had bent slightly while picking up a computer and suddenly felt a shooting pain originating in my lower right back and moving up the right side of my spine. This occurred over 4 years ago. The MRI at the time revealed a disc bulge at L4-5 with a superimposed left foraminal annular tear and fluid in the facet joints bilaterally.
At L5-S1 there is a disc bulge with a superimposed central posterior disc herniation with indentation of the ventral margin of the thecal sac.

For several years after the initial injury the pain was minor and tolerable as long as I stayed within reasonable limits of activity. It has increased over the past year and now that I am in a prescribed core exercise therapy routine it has gotten much worse. My primary physician can not explain why this is so.
My most recent MRI (March of 2012) was unrevealing according to him.

Location:
Primary pain is located in the lower right back area and begins to extend first downward into the right buttock and thigh, then upward just to the right of the spine after extended upright sitting or increased physical activity.

Percentage of pain is 70/30 on average.

Quality and Intensity:
The quality is a constant ache with movement at level 2 on the VAS (10 months ago). This is the pain level with minimal activity. During increased activity such as core exercise therapy (Current) this pain level rises to a constant 3-5 and becomes more of a stabbing type of strong discomfort and a cramping type of pain occurs in the upper part of the right buttock as well. Then there is a crippling failure (crises) at level 9 (Crippling failure happened on Oct. 30th after crouching and has happened approx every 2 months before that for the past year) after increased activity which occurs after bending, lifting, kneeling or crouching following the 3-5 VAS pain level.
Skin at the location is hypersensitive to touch and heat.

Weakness:
There is some weakness associated with the condition and exists in the right leg. Climbing stairs and extended walking are negatively effected. There is a pronounced limp after increased activity or sitting upright for extended periods.

Activities:
The most painful are lifting, bending (both shallow and deep), kneeling and crouching. Sitting upright in a standard type of moderately padded office chair begins to become difficult after 1 hour and pain spreads down the right leg and up the right spine. Intolerable at the 2 hour mark. Reclining in a more padded chair provides some relief. Standing also temporarily reduces the pain from sitting upright provided that I favor my left side. Standing becomes difficult after 2 hours due to increased back and leg pain.
Walking is limited to 1/2 mile before rest is required. Pain increases over time while standing, walking or sitting upright. Pain increases sharply with repeated kneeling, bending, twisting, lifting or crouching. Jumping and running are out of the question. Both of these activities cause extreme pain instantly. Biking on an actual mobile bicycle is out of the question due to impact issues but stationary biking is tolerable for up to 1/2 hour.
There is instability pain as described above, after increased activity and increased pain levels leading to crises mode which cripples me for weeks.
Daily function varies with activity and pain levels. I try to greatly limit my bending, crouching and anything described above that causes sharp increases in pain levels.

Occupational restrictions:
I was effectively released from my position due to these back issues and they have made it impossible for me to keep a job. At any moment I can suffer crippling back failure and can barely stand, walk or sit. I was an IT consultant which required me to move a lot of equipment weighing up to 50 lbs. Now any repeated lifting, bending, twisting, kneeling or crouching is out of the question. After inactivity and healing over the course of months I can lift a 40Lb object and move it 100 ft once with tolerable discomfort but not repeatedly. Since I can not sit upright for any length of time or stand for very long this leaves me in a permanently disabled and effectively unemployable state.

Treatment:
Initial physical therapy failed and caused more pain. Secondary therapy was slightly better. Now enduring a 3rd round of therapy that is proving largely unsuccessful. My primary physician claims that core exercises and medication will alleviate the condition. He is incorrect. Core exercises may strengthen the surrounding muscles but cause the actual injury to weaken and fail at crises levels. Currently in low impact hydrotherapy which helps the muscles become stronger but also increases the pain and discomfort in the injured area.
Years ago a spine specialist told me that I was not a good candidate for surgery and that I would have to live with the discomfort and would probably never work again. At that time I thought I could continue to heal and be capable of most of the things I did before the injury. Now I know that is not going to happen.

Here’s the immediate issue….My primary physician tells me that I should not be experiencing the problems I am experiencing based on my latest MRI. He continues to prescribe medication and core exercise therapy and admits he has no idea why I would be in so much pain. I need to know what is going on here and why I keep experiencing crippling back trauma over and over again. Why the exercise therapy seems to be aggravating the injury instead of strengthening and stabilizing the area. Any insight you may have would be most appreciated.

[Author]

Posts