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#32960Topic: Back & hip pain 4 months after microdiscectomy in forum BACK PAIN |
Dear Dr. Corenman,
First of all, thanks very much for your kindness. I have already learnt so much about my condition from your website and hope to keep doing so in future. Really appreciate any advice you have for me.I am a 36y old male. I have had a minor discomfort in lower back for 4-5 years. Otherwise I was generally active and try to remain fit. With two severe episodes of pain in the back and shooting down the left leg 2 months apart this year (Feb and May) I underwent a L5-S1 microdiscectomy in early May. The MRI showed two herniations. One at L5-S1 (left side of spine) which was operated on and a 3cm protrusion extracted (it had become quite bad by then). Other one at L4-L5 which was not so bad, not yet touching on the nerve and doctor chose not to touch.
The surgery went well. I felt amazing after. Started recovery with walking at first, then brisk walking and starting physio, core exercises and Pilates along the way (2-3m). Had a good recovery path, was running at my pre-surgery speed by 3 1/2 months post surgery. Felt ok afterwards. Was feeling pretty normal except for some minor stiffness in the morning which went away 10-15min later. Was exercising and swimming almost every day (maybe that was too much in hindsight?). Also started doing some deadlifts and that also felt ok.
Now it’s 4 months since surgery and after a busy and unfortunate weekend, pain came back. Could be because of any of these things or a combination – continuous & long office chair sitting (9-10 hrs) on Friday just before the w/e, or intense flexion during Pilates combined with playing some football (with a kid) in eve on Sunday, or could be 3-4 hrs of sitting on hard floor playing a board game on Sat night.
I started feeling discomfort and pain (3-4) in the hip (deep and along the outside and going down but sometimes on the inside) and lower back along the waistline on Monday afternoon (more on the right side), and got worse on Tuesday. One specific motion that causes it is when I push my pelvis back – like further backward extension of the hip in a pelvic tilt. Accordingly i also feel the pain if I sit too long and stand up without doing pelvic tilts. I also feel a solid dull strain kind of pain (3-4) near backbone on right side (around L3 height) – comes and goes. The surgery was done on the left side. Leg raises also cause a pain but only in the hip (again not too severe, 3-4). The pain started around 55 degrees. Pain is manageable for now and only in the waist / hip area, but feels similar to how this whole issue started in the first place. I ignored it in the beginning thinking it was weak or tight muscles and will go away with time which I regretted later.
Visited my physio and she said it does not look serious. I have most likely strained my back by overloading during those 2-3 days. Should take it easy for a week and give some time to heal. She thinks it’s referred pain from the back to the hip, not necessarily a nerve issue. Asked me to keep doing extension exercises (pelvic titls standing and lying down, and cobra pose) and also avoid too much flexion movements in future, mix them up with extension (like swimming). This does help and extension exercises make the pain / discomfort go away. Swimming feels great.
I am obviously worried if it could be reherniation or herniation of L4-L5 (which was not operated on). If not then is it some inflammation, or is it mechanical compression as you suggested in another post? What exactly is causing this? Also if this does heal in a week, I also wonder what I can do and what to avoid in future. Can I please ask if you are able to say what this might be based on the symptoms? And if you have any advice for me.
Many thanks for your kindness helping so many people through this forum.
Warm regards
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 questionsI really appreciate your consideration,
Thank you,
AlexHi 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 sportsPain 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 caseThank you for your consideration,
Alex#32941 In reply to: Recent MRI REPORT …please interputate the |You report “I had a small fall walking outside I landed on my knees”. Then; “the original symptoms I being struggling with over the years had intensified steadily…sensations from burning to pins and needles to cutting feeling..its entire body head to toe”.
You then “spoke to a chriropracror today briefly she told me bone spurs or disc’s even if its not impiging can cause these symptoms from head to toe at same time including my mouth and throat”.
Your chiropractor is incorrect. Local bone spurs indicate degenerative changes of the spine which can cause local pain but if there is no compression of the spinal cord or nerve roots, the fall should not cause the symptoms you indicate. Since the face and mouth are supplied by cranial nerves which generally don’t leave the skull, the increased symptoms much have a different source other than the cervical vertebra.
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.#32934 In reply to: Recent MRI REPORT …please interputate the |Dr corenman , I was hoping you could please answer this question for me …I had a small fall walking outside I landed on my knees..that one knee actually ended up with a hole in it ..I caught my fall with my arms …landed sideways at the end ..No impact on my head or neck ..But after the fall the original symptoms I being struggling with over the years had intensified steadily with no breaks other then change in intensity as sensations from burning to pins and needles to cutting feeling..its entire body gead to toe as mentioned in previous posts ..with same intensity as well exact same symptom whatever it changes to at that time …its extremely severe in my mouth as well my throat..and steady …I spoke to a chriropracror today briefly she told me bone spurs or disc’s even if its not impiging can cause these symptoms from head to toe at same time including my mouth and throat as she said because the spinal cord has nerves throughout the spine..But when I ask my neurologist in the past he told me no …I had these symptoms for years and years …since I cold turkey off a medication given to me for wrong reasons ..But after my fall its been extremely intense ..I am going for another MRI in 3 weeks…Be greatly appreciate if you could share your thoughts …I started to get severe nerve pain in my head burning ..firing off nerves..pressure…soreness asif my head was bruised ..since the fall as well…but it wasn’t this steady or severe before my fall…ThaNk you for reading and looking forward to your reply..Stay safe
Sincerely Laura
#32921 In reply to: collapsing due to a level of my neck. |You might have instability at the C3-4 level. An MRI is important to look for spinal cord impingement and injury but you also need a 4 view cervical X-ray with flexion/extension film to look for instability. Other levels could also cause the symptoms you note.
Please publish the findings of the Radiologist report from the MRI (without your identifying information) and any reports of X-ray findings which should include flexion/extension views).
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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