Chronic Low Back Pain

[Juba66]

Hi all,

I'm hoping someone out there can shed some light on this problem I've had for several years.
I get episodes of muscle spasms in the low back that can be triggered by just a sneeze to bending down to put on socks.
Doctors say there's nothing wrong with me but believe me the pain is real.
When the back goes,the whole body leans to one side & the spine curves in one direction.It often changes to the other side but the pain is mostly on one side.
When this happens it can take days to weeks to settle down & become fully mobile again.
I also get pain down the top inner thigh,sacrum & buttock regions.
If anyone can give me an idea what to do,I'd really appreciate it as I'm lost for answers.
Tried exercising also but this can also make it worse.

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[SPPAWA]

Both the forward flexion of the lumbar spine when you bend over to put on your socks and the sneeze (similar to a valsalva's maneuover) suggest a disc problem which could refer pain to the areas you described. The most common area is the lower 2 discs, however, if you are getting pain radiating around to the front of you I would be suspect that there could be something else going on higher up possibly L1/2 levels. Have you had any testicular pain or bowel/bladder disturbances?

[physiobob]

Hey I see you are in Wahroonga, Sydney - my home town

You are surrounded by excellent physio's. Just go see one!

[Juba66]

Thanks for that sppawa.
I don't have any pain down the leg & was told it was unlikely to be disc related.
Still unable to find cause of problem but seems like I have a lot of muscular dysfunction.
Some areas close to the spine cause twitching when pressed & it seems the paraspinal area on both sides are very taut.

[SPPAWA]

Juba,

Both forward flexion and sneezing increase intrathecal pressure and can be irritating to discs. A disc is the most common source of lower back pain in both sexes and in people under the age of 55. Epidemiology studies show that it comes in at a whopping 40% followed by facet mediated pain (where is usually aided by flexion not aggravated) and SI mediated pain (which very rarely travels above the L5 spinous level). The position you get stuck in following your episodes is called "antalgia" and is commonly seen with a discal injury as well. There is also the potential that you have a menescoid entrapment (little window wiper inside the facet joint gets stuck outside the joint and squished... very sensitive and very painful) this too can cause antalgia. Facet mediated pain, however, differs from that of a disc in that it is usually accompanied by sensitivity of the overlying spinal tissues (they share innervation through the medial branch of the dorsal ramus) is your spine sore to touch? Please also don’t think that a discal injury can’t have a concomitant facet component as well, as this is also quite common and complicates the diagnostic process. Given the chronicity of your issue and constant recurrences an MRI is warranted to rule out anything more sinister than the above. I would also recommend seeing a good manual therapist who has the ability and training to both manipulate and appropriate a exercise program that will reestablish stability and proper neuromuscular control of the area in question, as both of these conditions I mention are brought about by poor proprioceptive reporting in this area. Your exercises need to be customed to your case and sometimes they can flare a condition… Don’t throw the baby out with he bath water. Your therapist should modify these for you and find easier ones until you reach a level of competency and then move you onto a more difficult progression.

Cheers, SPPAWA