Back Pain

[Donjman]

Hi,

Im just after some advice about an injury of mine, any thoughts suggestions anything it could possibly be, anything would be greatly appreciated.

Let me tell you about the history of my injury to put you in the picture a little.

3 Years ago, i used to do karate, during training I felt a very serious strain when doing punch that requires a twisting of the torso, the pain i felt is here:



I had to stop training, and went straight to hospital, they said its a bad bad strain after Xraying lots to check there was no breaks or fractures, they sent me home with a box of ibroprofen.

I did no rehab, and rested for 3 months. I went back to karate, 2 months later same thing, same strain, i rested for 3 months and went back again to karate.

6 Months down the line, same strain, maybe a little worse, required 3 months of rest, I stopped karate at this point.

I then started my sport, and only during the strength traiing pullups chinups did i feel a pain in my back. I would rest for 2-3 days and continute, i just accepted something wasnt right and that was that.

I eventually saw a physio, this was about 18 months ago, he didnt seem to interested and said i had a weak back on my left side and i needed to sort my posture out. He gave me some strengthening exercises.

I wasnt making to much progress and i just gave up with the physio after 2 months it felt like he wasnt listening.

Went back to my sport, just ignoring the pains resting for a few days/

6 months ago, i saw a physio about my hamstring, he sorted me out with a nice program, and i mentioned my rib/back injury. He found a nice lump which i can clearly feel, he told me to work with it on a daily basis and said i need to strengthen my back. I couldnt afford to keep seeing him, a shame cause he was a good physio.

At this point, my left hip started hurting, worse and worse, my hamstring was better, and i realised i had to sort this scar tissue out, and get a strong back!

SO i saw an NHS physio, she assesed me 3 weeks ago, found the scar tissue, said my back was weak and sent me for a course of physio.

Which brings me to today!

I have hip pain and back pain after light swimming, running, and leg strengthening, and proglonded sitting.

Heres where i get the pain:



On a daily basis im really going at the scar tissue, after 2 months i feel there is a little less, its got less of a grip. But i do need some help with that.

Sorry that was a long history.

Currently, i am waiting for an NHS physio and am really strengthening my abs, leaving my back well alone.

Any advice, strengthening, stretching, scar tissue tips, thoughts, anything, is very appreciated cause i dont see this NHS phyiso coming through for months....

Thankyou very much in advice.

Justin

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[raafox]

Hi

just read your post,

are you still in pain?

[thomking]

Iam professionally a physiology lecturer.I want to dicuss about Fibromyalgia Syndrome.I gathered some information that deals with muscle pain.I want someone to explain briefly about the topic.those interested can reply me.

thanks for those who reply.

[Donjman]

Hi,

Yes I am, i've been to a private physio since jan, he said i had an unstable left SI joint and gave me stability and strengthening exercises for the left side of my back, he saw progress and in terms of exercises i was completing 30 repetitions of the superman exercise with good form still though the pain continued.

Ive also been to a chiropractor, who's thought it was a genetic brain imbalance, ive stopped seeing him but he did say i have a short leg on my right side due to a tight psoas muscle and the right side of my back is hypertonic

The pain in my hip seems to be over the TFL.

Currently im seeing noone

[raafox]

Hi

can you give me a current breakdown of your symptoms, starting with the most troubelsome first, please include area of pain, aggravating and easing factors, pattern through the day, ant abnormal sensations like pins and needles and other fiindings from therapists who have assessed you clinically.

regards

Raafox

[Donjman]

Of course,

My main problem is hip pain, over the ITB/TFL, not very painfull but is a dull pain very irritating, it came when i was resting a hamstring injury almost 1 year ago. 1-10 the hip pain is probably a 4.

The next problem is the frequency I injury the left side of my back, the pain marked on the diagram running almost in the midline of my body, this is muscular pain it comes from over exertion eg pullups.

Physios have found the left side of my lower back is soft, the right side is very tense, and also a chiropractor has found a short leg, my right leg is short due to my right psoas being tight.

So right psoas is tight and right lower back is hypertonic

Left hip pain and left side of back is soft.

If i go running, sprinting swimming or walking the pain comes on, ONLY when i sit down. Prolonged sitting makes the pain come back, i never get the pain standing up or while actually running sprinting, only when i come home, I sit down and its there again.

No pins and needles, its also been said i have tight hamstrings and a very tight thoracic spine, i am currently stretching my hamstrings and laying on a rolled up towel to get some mobility in my thoracic spine.

Sounds like a nightmare :|

Thankyou in advance for looking over my symptoms

[alophysio]

Sounds interesting.

What treatment have you had - precisely if possible.

Does the stretching help?

Has someone assessed your SIJ using the Gillet / Stork test? Results?

Does it hurt to cough or sneeze - in particular pain in the ribs?

How did the physio decide you have an unstable Left SIJ?

Is your SIJ now stable?

How is your "scar tissue" that you have been rubbing?

In general, would you say you are a motivated-type of person or are you really laid back?

How do you know the right psoas is tight? Did they do a Thomas test? Is it tight or overactive?

Same with hamstrings - are they tight or overactive?

Have you had a CT scan?

You may not be able to answer all these questions but i think they would be helpful for us.

Lastly, this has obviously been going on for some time. The "pain" can often be made worse by chemical changes in the brain - this is a really cutting edge side of the research coming out about persistent pain (often called chronic pain).

Hang in there and we will lick this thing!

[Donjman]

In January, i went to see a private physio he said that my left SIJ was unstable i had atrophy on the left side of my back and was reffering pain to my hip, also my thoacic spine was tight, lumbar spine was very flexbile on extension and my glutes were underfiring

My glute exercises were:

Glute Bridge, making a point of tensing the glutes for 10 seconds X 30
Shallow squats against a wall, again tensing glutes X 30

My Hamstrings were tight and overworking due to my poor glute activation, i did some static stretching for them

My Back Exercises were:

"Mule" Or "Superman" Exercise, kneel on all fours left leg out right arm out and visa versa X 30

Forward leans, simply bending 10-20 degrees forward

These exercises all progressed over a 9 week period, eg glute bridge turning to single leg, then single leg on a swiss ball.

The hip pain never decreased with the help of these exercises, while the physio said he saw a nice progression in my stability and the left side of my back was building up.

So i gave up, and went to see a chiropractor, who told me i had a genetic brain imbalance he said rather than there being atrophy on the left side of my back, that is was underfiring and the right side was overfiring and that some other muscles are overactive some are underactive, we proceeded with some strange treatment methods in his clinic and he sent me home with static stretching of specific muscles, my right psoas, my right side/lower back. All the time when in his clinic he looked for my leg length, and he said my right leg was short due to the right tight psoas. He would proceed to stimulate various muscles in my body by appling a small push to an area.

I beilive he was wrong with his diagnosis, it sounds whacky to be honest, however i did notice a reduction in pain, and i saw with my own two eyes a short right leg when he pointed it out to me in his clinic.


Has someone assessed your SIJ using the Gillet / Stork test? Results?
I dont know, to be perfectly honest if i have been tested, i underwent various tests with my physio, im unaware of the names, sorry.


Does it hurt to cough or sneeze - in particular pain in the ribs?
No never.

How did the physio decide you have an unstable Left SIJ?

He saw atrophy on the left side of my lower back and tagged the hip pain to a lack of stability and strength in the area. Im guessing to him it all fit nicley.

Is your SIJ now stable?
I dont know if it ever was unstable


How is your "scar tissue" that you have been rubbing?
I left it to be honest, i found a dynamic warmup with some stretches to the sides of my body really stopped it twinging when i exercise, so i leave it.


In general, would you say you are a motivated-type of person or are you really laid back?
Very motivated, and still after a year distressed about this injury

How do you know the right psoas is tight? Did they do a Thomas test? Is it tight or overactive?
Chiropractor said overfiring.

Same with hamstrings - are they tight or overactive?
Overworking due to poor glute activation and tight probably due to working so much.

Have you had a CT scan?
Never No.

This thread does indeed look a mess, and i apologise, theres just so much information and i really do give my thankyou to anyone that looks over it and gives me there thoughts, and thankyou alophysio for taking time to read my previous posts, i hope my awnsers can help you. If there are any more questions or anything you wish for me to explain for you any further or anything ive not explained properly ive no problem explaining in more depth, thankyou again.

Justin

[alophysio]

Hi Justin,

Ok, i don't have long so i might post more later...

Basically it seems you have a lot of different and conflicting opinions. The back exercises sounded like they helped your back but not your pain - it is not good us fixing things if it doesn't solve your problem, right!?

No what the chiro said sounds plausible in that your right sided muscles may be overactive. I am not sure if this is from the genetic thing. However, i do see a lot of people who have overactivity as a problem and it gives them pain.

The most interesting thing you mentioned in the post was that you only get the pain after exercise when you sit.

You see, I am thinking that you have what is classified as Non-specific low back pain (judging by your pictures) with a classification of motor control impairment - active extension. What this al means is that your muscles are way overactive and squashing your ribs, spine, pelvis and hip.

Think of it this way, when you squeeze your hand, especially the knuckles like in a handshake, it doesn't hurt that much right? But if kept squeezing and squeezing all day, by the end of the day, that hand is going to be very sore [sorry - it works better when i am with you in person!!]

The same thing is happening in your back (I am only guessing ok). The muscles that are overactive are putting extra load onto the joints and bones and then the weakest areas start to hurt first.

I asked the questions about motivation because people who are highly motivated tend to have this problem more in my experience because they persist with exercises, even when it hurts whereas people who give up easily have a different type of classification of back pain (again in my experience).

I wonder what happens when you lounge around being like a slob - do you ever do it? How does it feel?

Are you conscious of your posture? When you try to stand up straight, do you feel tired from holding the position? Do you feel good when you slouch? Do you feel bad when you catch yourself slouching?

It will be interesting to see what is wrong...Are you able to post pictures of your posture from side on, the back and the front please?

Thanks!

[Donjman]

I have been a slob for 2-3 weeks, just to try the total rest approach, the pain really was the same when it came to sitting down.

Since the physio back in Jan told me to sort my posture out i have done, when sitting and standing, but i am also carefull to not sit for a great deal of time taking regular standing/walking breaks. Im careful not to stand to straight, not overdo it. I do feel a little bad when i see ive slouched

Chiro said it was an imbalance pattern, imagine looking at me from the back.

Left Glute Overactive, Right Glute Under (Explains why i pull my right ham alot)

Left Lower Back Under, Right Lower Back Over (Explains why i pull my lower back slightly at the drop of a hat)

Right Psoas Over, Left Psoas Under (I guess its near my hip pain)

Another thing that may help with the hip pain diagnosis.

If im sitting, and i bring the left leg up,



Like that, probably not as much as that, but the same motion, the hip pain comes on worse, if i slouch, the hip pain REALLY comes on worse
If i slouch and lift my neck forward and back, it gets really agrivated.

Id think by lifting my leg like that, id be shortening my psoas? But the pains not really where the psoas muscle is....

And i know what you mean about fixing things that arnt the problem, i mean after all this is said and done it would be cool to fix anything outstanding, but for now its good to solve the hip,

Maybe its all linked I dunno, Ive spent the last year reading everything it could be and anything i thought it could be, to see if i could figure it out myself, I have a great interest in health and fitness, I guess it makes sense its an imbalance pattern.

[alophysio]

Hi,

Thanks for that interesting post - about that hip thing - is it possible to have a photo - you don't have to ID your face...it is just that a photo shows many more things than you can describe.

Can you clarify what you meant by "If i slouch and lift my neck forward and back, it gets really agrivated". Do you mean when you slouch and put your chin onto your chest or when you slouch and look up to the ceiling? Photo?

Now is it when you slouch and move your neck only that you get the pain or when you slouch, bend your hip up and then move your neck?

Slouching and lifting your head either forward or backward is not a sign of psoas being a problem. It is usually a sign of spinal cord tissue issues.

By this, i mean the by moving the spinal cord, it is giving you pain. This makes sense if you think of your spinal cord being like an electrical cable in a conduit - it is getting caught so whether you move it at one end (bending the hip up) or move it at the other end (moving the neck), then it will pull/catch/tug the cord and so give you pain.

Do you have any pins and needles or numbness anywhere? Any areas of increased sensation or decreased sensation? Are you more ticklish than before? I am sure there are many other symptoms that indicate possible cord problems. These also include muscle power (think underactive in your case!) or decreased reflexes - can't do those by yourself!!

Anyway, lets see how things go - pictures would be nice!

Thanks

[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.

[alophysio]

Sorry about the late reply but i am glad that things are going well for you...

[thomking]

Needs reply immediately for my question!
thanks in advance!
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