Back Pain

[Donjman]

Hi,

Yes, on a good day this wont cause pain, on a bad day or a day loaded with activitys such as running or swimming, this will.



And this next one, will cause pain on the best of days:



Sorry they arnt the clearest of pictures...

I dont have any pins and needles, no numbness, no areas of increased decrease sensation that i can tell, and obviously the underactive muscles are much softer the overactive much tougher.

So you think the underactive muscles and the hip pain could all be linked?

[alophysio]

Thanks very much for the photos. They are definitely helpful.

1. The first lot of pictures i assume is you going from slouched sitting to sitting up straight. Does the pain after activity come on while slouched or when you sit up straight?

2. The second lot of pictures is very instructive. A further question would be - does the pain change (more/less/same) if you lift your leg up STRAIGHT then slouch over and put your chin on your chest? If so, it is nearly certain it is a neurological problem to do with the spinal cord having some scarring or tethering.

I don't think the muscle thing is causing the pain. I think it might merely be a victim of what is going on which is probably a mechanically sensitive nerve.

Is it possible for you to sit slouched without pain? If so, then are you able to S L O W L Y straighten your leg or lift your knee to a point where it stretches but doesn't give pain? If so, then this is probably a good exercise to do to try get the nerve moving again. If it is painful, stop doing it!!!! If it flares your symptoms up, stop it. If you are at all unsure about it, don't do it. But if it works...

Let us know how you are getting on. Please remember that the exercise just listed is not to be painful at all. Don't overdo it - just do 5 or 10 reps slowly without holding - maybe take 4 secs to go through the range up and then 4 secs to bring it back down again.

How cool would it be if you got fixed over the internet???

[Donjman]

1. The first lot of pictures i assume is you going from slouched sitting to sitting up straight. Does the pain after activity come on while slouched or when you sit up straight?

The pain comes from slouching TO sitting up, during the movement.


2. The second lot of pictures is very instructive. A further question would be - does the pain change (more/less/same) if you lift your leg up STRAIGHT then slouch over and put your chin on your chest? If so, it is nearly certain it is a neurological problem to do with the spinal cord having some scarring or tethering.

Pain is felt when i lift my leg straight then slouch and chin to chest yes.

And i would be so so cool if i got fixed over the internet.

If this was a spinal cord issue, would this be the reason i have over and under firing muscles?

Also is there anything more i can do to fix this?

[alophysio]

Hi - sorry to get narrow here...

When you straighten your leg then tuck your chin down onto your chest, is this worse than doing it with your leg bent.

In other words, it is the angle of the hip that makes the difference?

IF SO then whether you have the knee bent or not, the pain should be the same - to test this, sit with your feet out straight in front with your knees together, straight and at the same level as ezach other. Tuck your chin down. Note the pain. Now KEEP THE RIGHT LEG STILL and then bend the left knee so the foot is under the chair and the knees level. Now do the chin thing again. Note the pain

Does the pain feel more or less or the same with the leg straight compared to the leg bent. I need more/less/same, not just yes or no please.

I won't put the implications for positive and negative because i don't want to bias the result.

The other things i need you to do is have someone test your reflexes and babinski and clonus. Your chiro can do it, your doctor, physio or knowledgeable friend.

Also a sensation test. This is where you close your eyes and they use something light like cotton wool and touch you in the legs to see if there is a difference more/less/same that the other side.

Thanks!

I promise to answer!

[Donjman]

Hi,

I did both knee bent and knee straight tests, i felt literally next to nothing...

I dont understand there is just no pain

Positive babinski is fanning of the toes and negative is jolting the whole foot out of the way?

Oh and the reflex tests, would they be knee and elbow with the hammer?

And Clonus is done on the anke wrist and leg?

I'll get those done tonight, i have a knowladgeable friend

Im worried now that i dont feel any pain

[alophysio]

Hi,

You are assuming something is wrong...

What happens if all this testing has started to free up the spinal cord and nerves and you are starting to get better?

It would be an internet fix! Assuming the chiro and physios haven't tried this before etc!

[Donjman]

Yes your right, i worry too much

Oh and to awnser your Q, the pain is pretty much the same with leg straight or leg bent in, its come back down, i couldnt for the life of me get a sign of it this morning though.

Yeah so about the same, im gonna get those tests done now and i'll report back on the forum.

I notice that the first time i test for the pain, its there, the second time it might be there but by the 3-4-5th time, is really not, like you say maybe moving the nerve is the key

I cant thankyou enough for spending your own time to look over my problems.

[alophysio]

No problem.

If it feels better with successive testing, then i would continue along that line.

To answer an earlier question that i think i left unanswered, i think this can help explain some of the muscle imbalances because it is well known that pain inhibits the muscles - maybe you are hitting the right spots to inhibit some muscles. This then leads to a pattern developing etc.

[edit - added later - the fact that the pain is the same no matter the position is interesting. It means that it is independent of the "length" of the nerve but your nerves could be caught in your hip - maybe piriformis (about 12% of people have the sciatic nerve pass directly through this muscle). The next logical thing to do is to repeat the experiement but now change the hip angles:

1. Sit down with knees bent, feet flat on floor.
2. Chin to chest
3. Note pain
4. Put left foot on a telephone book (this increases hip position slightly)
5. Chin to chest
6. Note pain.

Now because you have improvements with each repetition, you will have to do the procedure the reverse way to ensure the improvement/increase in pain is not due to repeated testing.

Another experiment you might like to do is to do 5 repetitions of whatever position - just keep it the same. Then when the pain is gone, see if you can bring it on by increasing the hip flexion - if you can, then the hip is almost definitely implicated.]

Let us know how you go. From what you say, i think sensation, reflexes and Babinski and clonus will be negative. I think you have a "neurodynamics" problem - BUT I AM GUESSING. I have not done a proper assessment on you. Please don't go around saying that other people are wrong and i am right - even if you get better! nothing beats seeing the person in person (if you know what i mean!).

let us know how it goes!

[Donjman]

Sensation, babinski and reflexes all normal, and i will book an appointment at my GP for a colunus if you wish, or its probably not worth doing?

The pain is so tempremental, i did both legs infront while sitting on a chair this time slouch and chin to chest and got reasonable pain.

I then bent my leg and didnt really get that much pain...

So i waited about 3 hours and did it again but the other way round, and got more pain with the leg stretched out than with it in.

I know i said this morning they are about the same, but i think that was a mistake, i was faffing around for quite some time and i could have make the condition better...

Going off these last 2 times, i would say im worse off with a straight leg.

I repeated the experiment reverse with the hip angles and about 5 phone books, pain was minimal but didnt in decrease with the less phonebooks

So maybe it is to do with the nerve length after all....

If it was the nerves getting snagged in the hip what could be done?

[Donjman]

So, where to from here captain?

[alophysio]

Hi,

Sorry, i thought i had replied last week but obviously i didn't!

I have had exams and my family come for easter so i apologise...

If it didn't decrease with less phone books then it may not be hip angle if all other angles are the same.

But it could be nerve mobility still, just not snagging at the hip.

How do you feel overall?

I would ordinarily give you the nerve mobility exercises as we have done with testing but short of pain. Especially since you respond well to repeated testing - this means that it seems to decrease your symptoms with more testing - a good prognostic sign for the exercise in itself.

If you try some of the nerve length testing as exercises, PLEASE DO NOT HAVE PAIN AT ALL during the exercises. Only a stretch, no pain or pins and needles or numbness etc.

No need for clonus testing i think but if you still want to get it done, by all means go ahead (can you see me covering my butt??? )

You could also try a piriformis stretch...
1. Sit on a chair upright.
2. Cross your leg like you are reading the paper (like a guy, not like a girl) - it should be like a figure 4.
3. Keep your back straight and GENTLY bring your knee to the opposite shoulder - YOU WILL NOT GET FAR. This is ok.
4. Feel the stretch in the buttock
5. Hold for at least 30 seconds by a clock (the research says 18-20secs but most people count too fast and longer isn't going to hurt you!)
6. No pins and needles or numbness please - if so, you are going too hard. No pain as well.

I am still away from a computer until the start of next week so i will try when i can to get online...

Thanks

[Donjman]

Well after a number of weeks the nerve flossing has really helped.

Ive seen someone in my area who said i have scolisois slightly which is why one side of my back is soft vs hard, which is also why im prone to straining more areas than others. Also i had some triggerpoints, got rid of those myself

The nerve/hip issue has virtually gone, but I cant seem to 100% get rid of the pain, but youve helped so much i cant thankyou enough.