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  • Total2k
    Post count: 2

    Hi Dr Corenman, I’ve been a long time lurker of this website thank you for all of the resources and information.

    I’m an athletic 20-year-old male, I compete in BMX and I also run, surf and golf.
    That being said 4 months ago, while riding my bike, I noticed my back was hurting more than normal, I tried to ride through the pain until it gradually became too painful to continue. I didn’t think much of it at the time, until days went by and I realized it wasn’t recovering.
    I’ve had on and off pain in my spine everyday since then, I’ve seen 2 back specialists who couldn’t provide a diagnosis or treatment plan. I’ve tried physical therapy with no improvement. I received an mri and xray that showed everything as normal and healthy.

    Pain location and type:
    Deep, dull, weak, ache in my upper lumbar spine that is worsened by actvity. Its central to my spine, although sometimes slightly worse on the right side. Its near my thoracolumbar junction, around L1-L2-L3 levels. Pain is never below L3.
    Characteristics are very much discogenic with no pain in any of my surrounding muscles.
    Spine feels fatigued, weak and unstable at the painful levels of l1-l2-l3.
    Very sensitive to slight forward flexion or weight away from my center of gravity.
    No pain with extension or side bending.

    On the VAS 1/10 scale:
    1 while resting
    3 overall throughout the day while resting
    5 if irritated throughout the day
    7 with sports

    Pain triggers
    While resting I’m aware of the dull ache but its very mild, almost non-existant. The pain is made much worse with slumping, forward flexion or any forward bend away from my center of gravity. Sitting with no lumbar support also irritates it.
    There isn’t one specific trigger for sharp pain, instead of the pain accumulates throughout the day, becoming more irritated and painful when I stress my spine. I can swim and walk for hours with no pain, but running, jumping, picking things up off the floor, brushing my teeth, sitting at a dinner table, all of these will progressively worsen the pain throughout the day. Sports like BMX, surfing, golfing are unbearable and will leave me in pain for a few days. I’ve stopped all athletics since the injury with no progress in my recovery.
    Sneezing is very painful.

    I received my MRI results expecting to find an upper lumbar disc herniation or an annular tear but I was surprised that my doctor found nothing. My Xrays also showing no abnormalities.
    My MRI says: “The thecal sac has a normal diameter. No evidence of disc bulge or protrusion. The neural foramina are patent bilaterally” for every level of my spine.

    So at this point I’m out of options for diagnosis or treatment. I’m at the point of just waiting hoping it’ll go away. Its been hurting for 4 months with mild improvement but many many setbacks on a day-to-day basis. Simple activities will re-irritate my spine right as I imagine its improving.

    Personal suspected diagnosis
    I found through the internet that some annular tears won’t show on an MRI, and that while most are asymptomatic, some can be very painful and toxic. With my pain characteristics being discogenic in nature (pain with forward flexion, sneezing, and sitting, sports), this leaves me to believe the only possibility is I have a toxic annular tear that was missed by the MRI.

    That being said I’m still left not knowing what my official diagnosis is, what my timeline for recovery looks like, or what I should expect for the future.
    I could find very little information on painful annular tears, especially in the upper lumbar region. I also heard that unlike disc herniations, where the pain-producing Nucleus Pulposule can retract and heal, a painful annular tear can take years to heal the outer layer, and will leave weak scar tissue that may hold me back from ever being athletic again. The inner layers, if painful, might never heal.
    My pain hasn’t improved in 4 months and I’m very depressed and anxious that this will affect the rest of my life. I’m very young and still want to work as a fight fighter and train as a BMX athlete.

    So I guess my questions are:
    1. Do painful annular tears ever fully recover in athletes?
    2. Could there be any other diagnostic explanation for my pain and clear MRI’s
    3. Could my young age play a role in the speed of the recovery of my disc?
    4. Is there any research on the timeline and effective recovery of annular tears
    I’d also just appreciate any other perspective on my case

    Thank you for your consideration,

    Donald Corenman, MD, DC
    Post count: 8455

    “I’ve had on and off pain in my spine everyday… VAS 1/10 scale: 7 with sports… Sports like BMX, surfing, golfing are unbearable and will leave me in pain for a few days”.

    “I received an mri and xray that showed everything as normal and healthy…some annular tears won’t show on an MRI…can be very painful and toxic”.

    There are disorders that are not mechanical (no obvious structural derangement on MRI) such as metabolic and rheumatological disorders. See

    There are disorders that can be missed by a radiologist such as and (not just in kids).

    See if any of those might fit. It is highly unlikely that you have a missed annular tear.

    Dr. Corenman

    Post count: 2

    Thanks for the reply,
    I’ve seen at most of these disorders when I was originally trying to find a diagnosis and I think I can rule most of them out based on symptoms and imaging.
    Autoimmune disorders: I have no morning stiffness and no pain improvement with exercise. My imaging shows no fusion, bone spurs, abnormalities, or sights of inflammation
    Degenerative Disc Disease: I show no fluid loss or disc height loss. Imaging shows very healthy discs.
    Spondylolysis and pars fracture: This was actually my initial guess, but I’ve begun to have more doubts. I have pain with weighted forward flexion, but I can side bend and extend backwards to my end range with no pain. If the pain was from facet or pars then I think I should be able to trigger pain by grinding and pressuring my spine by going into extension. I also have no pain from any palpation. Additionally, I’ve also had Xrays and Mri’s so if it were a fracture or a sight of inflammation its most likely shown up. I also show no signs of slippage or instability, although my imaging was taken while lying down. Can early instability be missed if the imaging wasn’t taken in a flexed or weighted position? I would love your input on this because I couldn’t find much information on fractures that only trigger pain with flexion, instead of extension.
    Thoraco-Lumbar Scheuermann’s Disorder: This was very interesting for me to read, and was the one condition I hadn’t considered previously. According to my imaging, I have a normal curvature with no humpback, no schorls nodes, no “visible” endplate fractures, no noticeable wedging vertebrae. Could an early stage of this disorder not be visible on imaging? Like an annular tear, could I have endplate damage that isn’t visible on an MRI?

    All that being said, these are all reasons that I’ve self-diagnosis an annular tear. All of these other disorders have symptoms that I can’t fully relate too.
    An annular tear is the only diagnosis I’ve found that matches my symptoms to a tee.
    Although I’ve heard it’s a controversial diagnosis because most cases are asymptomatic, I don’t know what options I have left considering I have a clear MRI but my pain symptoms seem very discogenic.
    This still leaves me with my previous questions

    I really appreciate your consideration,
    Thank you,

    Donald Corenman, MD, DC
    Post count: 8455

    Annular tears are generally visible on an MRI. An occult tear would be highly unlikely and even more unlikely at higher levels (L1-3) or thoracolumbar levels. There are conditions that cause local pain (myofascial pain syndromes) and conditions that mimic thoracolumbar pain such as visceral (organ specific like gall bladder) referral pain. If there are no endplate changes, no evidence of fracture such as pars or facet fractures, no malalignment issues or discal injuries and no tumors, this might be an unusual presentation of a myofascial pain syndrome. Make sure this is not referral pain from a higher spinal disorder like a thoracic disc herniation.

    Dr. Corenman

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