Discitis Rehab

[Elvster]

Hi everyone,

I'm a year post qualified but unfortunately I have spent the last 2 months off work recovering from L4/5 Discitis. Following a week in hospital, 3 MRI's, numerous x-rays, 10 weeks of very strong antibiotics and countless pints of blood given in blood tests, i am on the mend!

My consultant isn't the most proactive of clinicians and with regard to my ongoing rehab, his professional advice was to "take things easy" I want to progress but thought I would try and gain some advice from those more senior than myself.

My main problem is lumbar flexion together with general back pain and sharper sacral symptoms. I originally presented with severe neuro symptoms (L4 dermatomal pattern pain and weakness together with a huge right sided lateral shift and pain through the roof, I can honestly say I was crying with the pain, no medication besides high dose diazepam would help) I am much better now, very occasional shooting ant thigh pain, but lots of VAS 3-4 back pain, almost constant and sharper VAS 5-6 sacral pain when sneezing or posteriorly rotating my pelvis.

I can now just about put my socks on, right foot much worse than left and I can reach the tops of my knees when flexing forwards - this is a big improvement as before I could hardly even drop my chin to my chest. However, things have stagnated.

Infection and inflammatory markers in my blood have now returned to normal (they were 15 times what they should have been). X-rays show no destructive changes to vertebra, but narrowed disc space at L4/5 and L5/S1 (pre-existing).

Consultant has now discharged me as I am no longer medically unfit but as an Muscukoskeletal physio used to training in the gym 4-5 days a week and being very active, my lifestyle has completely changed.

Does anyone have any ideas on how to start getting myself back to somewhere near normal? Do I try and force the flexion? MRI shows a small prolapse at L4/5 and the level below. When do I start stability work and what do I start with? At the moment I'm a little scared to do anything because I can still remember the 10 out of 10 pain when I was really ill!

Any advice greatly received.

Mike

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[Dr Damien]

Dear Elvster (Mike)

Recovery from Discitis generally can take up to year or more, so the advice from your consultant is sensible. However, if you are clear of the initial infection and inflammation has subsided significantly my guess is that you have several structures in your spine area that are suffering from multiple adhesion sites. It is not uncommon to have stenosis occurring on several sites post a disc infection. This can present with chronic pain for a very long time.

You may want to visit an MSk physio such as yourself for a detailed assessment to start gentle exercises to improve range and improve core stability. because of the herniated disc that you have, I might want to improve extension first. I might also want to improve lumbopelvic ryhthm. Knee rocks within pain limits maaybe helpful..this will help open up the stenotic areas . BUt this has to be done gradually.

You should be able to start your stability exercises in neutral first. Lying on your back, maintaining a good core(flattening spine) and perhaps adding heel slides and upper limb elevation. and or lower limb abductions...
this can be progresses graduallyin sitting, standing...use of light weights

if your pelvis is not moving effectively anymore due to these multiple adhesive sites, then the strain would be on your spine when you flex, for good forward flexion, at least half of the movement shoulde be coming from the hips first before the back takes over...this is something you can work on with your physio...

hip flexion in supine lying, maintaining a pelvic tilt and gradually stretching on a gym ball may be helpful...

when you start your exercises, you may be feel an increase of symptoms( by which I mean pain alone) this does not mean anything is significantly wrong as your infection has been controlled...however this pain should gradually lessen...you may want to consider pain control in addition with any vexercises you start...

As you know, any neuro symptoms seen would be the concern...not necessarily pain...if you are not experiencing any neuro signs (bladder issues, gross muscle weakness, parasthesia etc) i wont be concerned and should think you can start your physiotherapy...

The reality is even without any physiotherapy as you continue with your regular daily actvities your pain should generally subside...

My advice is visit a physiotherapist, get assessed and start an exercise program that is aimed at improving range and corestability...

Good luck



lots of soft tissue work will be helpful...

some soft

[Elvster]

Dr Damien,

Firstly many thanks for Taking the time to leave me such a detailed response to my initial ramblings. You have certainly given me lots of ideas to work with and more than anything, your positive words have encouraged me to push on......gradually (as you say this could take a year or more so I guess patience is the key)

I have loads to work with and ithink have been lucky, I have since read of some horrendous outcomes following Discitis and I have to bear this in mind when I feel frustrated at not being able to play cricket this summer!

I would say that as a junior physio, I will certainly be making sure that when I assess new back pain patients that I clear any systemic causes - I'm embarrassed to say that I had never even heard of Discitis before I was diagnosed with it.

Thanks again

Mike

[mike addi]

Dr Damien,

Firstly many thanks for Taking the time to leave me such a detailed response to my initial ramblings. You have certainly given me lots of ideas to work with and more than anything, your positive words have encouraged me to push on......gradually (as you say this could take a year or more so I guess patience is the key)

I have loads to work with and ithink have been lucky, I have since read of some horrendous outcomes following Discitis and I have to bear this in mind when I feel frustrated at not being able to play cricket this summer!

I would say that as a junior physio, I will certainly be making sure that when I assess new back pain patients that I clear any systemic causes - I'm embarrassed to say that I had never even heard of Discitis before I was diagnosed with it.

Thanks again

Mike

Hi I know this is an old post, but can you tell me how you are doing today?