Simple lumbar question gone unanswered, please help.

[Jobbo86]

Ok I'm currently suffering pain from the space between L5 and S1, sounds familiar I'm sure. I've seen a few physios and so far have received no diagnosis. I've had an mri which revealed nothing but a slight bulge to the right side of L4 and L5's disc but this doesn't seem to be the source of my pain. The next step I'm told is a specialist and injections etc...not keen.

The part I can't understand is this. I can feel something hard as bone (it has to be bone) the rounded head seems to be maybe 5mm in diameter and right up against the base of the L5 spinous but also offset to the right by again roughly 5mm to the line between L5 and S1. It is also a few mm inset compared to the spinous process of the vertebrae.

How can an MRI not pick this up? The pain goes into the rhs gluteus medius and rhs outer thigh/hammy. If I press into the side of my hip at the top centre it is excricuating.

I find bending forward feels relieving, whereas if I hang and go limp something feels wrong and under lots of pressure in that area. I can't take time off work and I keep paying for someone to say "we'll do these exercises slightly differently and see how that goes". How can something so solid be that hard to identify?

PLease if you've treated or had anything like this I'd be appreciative of some advice.

Cheers,

Jarrath.

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[tonywoodall]

Most lower back problems are caused by ligament damage. The pain in the area causes local muscle spasm, hence the hardness at the base of L5 and this eventually can cause refered symptoms into the leg(s). The usual forms of effective treatment includes spinal mobilisation and manipulation + or - TENS, Laser, Ultra Sound, Lumbar traction, even local heat via Hot Packs, Short Wave Diathermy or Micro Wave. Some of these are old fashioned and some Physios may not use them. When you are not at the right Physio getting it fixed, your best friend is a hot pack.

[physiofixme]

Can you tell me why you believe the disc bulge isn't your source of pain?? Bulging discs are very commonly the source of low back pain. The bulge in the disc causes inflammmation and pressure on the structures around it therefore causing pain. The usual pattern of pain is referred to the buttock, hip and down the back of the thigh. If the bulge is large then pain can often be referred down below the knee.

Some useful reading/resources for you would be to look on the internet for the McKenzie Institute approach to back pain.

Can I ask how old you are and what caused your symptoms in the first place?? This may shed some light on what is going on. Also what activities make your pain worse??

[Jobbo86]

Thanks for the replies, This is definitely not spasmed muscle I feel and the disc bulge was considered minor and not interacting with nerves. The source of the pain is quite acute in a small area for one and feels directly related to that bony point/ligament. The muscles affected are not my gluteus maximus or rear thigh specifically either. It is high and bandlike on the hip right around from that point to the front/side, and down the side of the leg only, sometimes going into the outside of my knee. In saying that from someone who was used to being quite flexible (tae kwon do - lots of high kicking etc) my whole thighs and hips have become incredibly tight, the right more so. Oh and I'm 24, previously quite active in my daily life. I am pretty sure I've just found what it is though, the hard point and the resulting problem that is. I still would greatly appreciate help.

Imo the "bony point" that I can feel is the crest of my sacrum pressing against the lower RHS of the L5 spinous process. "Hold on" you say but hear me out, it was quite painful and inflammatory to do so but through alot of articulation and digging with my thumbs I am almost certain based on how it moves. The ligament does cause my muscle spasms and fluctuating debilitated state but this is the ligament directly stretched over or impinged on by the crested bit of the sacrum below and slightly to the right of L5. I am working away right now and cannot check but it is possible that the MRI only went down as far as L5 and did not see this. As for the physio I've been seeing lately I had asked previously but had dismissed this as the case because I was told that I did not have a twisted pelvis!

By standing against a wall and looking at it when moving around it seems to be turned to the left. I am pretty fit and have decent core strength so maybe this has masked it. The pelvis feels like it has shifted sideways to the right and tilted right side higher than the left. I'm very excited but a little worried as I don't know how to treat this because its been twisted for over a year and a half. It also seems that it might be tilted vertically.

I know I'm writing too much so I'll stop here and try to clarify my plea.
What on earth do I do? I've attempted to straighten my posture. This has brought pain to my LEFT SI joint and basically started to mirror the pain I'm still getting but lessened in my right hip/buttock but yeah really quite sharply in the SI joint on occasion. It has triggered a memory too ( I have ADD and memories are often blanked out or vague) of a near bike accident...around a year and a half ago and I'd never considered it to be the problem because I have pain specifically in the lumbar spine.

What happened was the front of the bike slipped and I stamped my (left?) foot down at about 50km/hr. It was a wide stamp and there was alot of sideways force aswell as forwards and I remember feeling a pretty painful crunching jolt. I was sore for a while but I had a general ache (probably the bulging disc and I was taking codeine for it) at the time so this probably masked the transition.

I know its been idiotic of me to let it get to this point and ignore the problem but I'm realising now its here to stay and my whole back is being pulled on by the muscles running up either side of my spine, causing other problems (because my foundations are out of alignment?). I'm desperate to solve this naturally and get back to a state of fitness which at the moment has me borderline depressed but who do I see and is this kind of thing even fixable now. My muscles have been trained with my pelvis in this position. I've been manipulated with twisting that was going the wrong way due to misdiagnonis based on the RHS facet joint of L4 or L5 causing inflammation (proved wring by the MRI). I have probably stupidly applied alot of force both spontaneous and consistent to try and get it to come back to centre but it won't even budge.

Also probably unrelated but also badly sprained my ankle a year ago and started to use it differently to avoid a crunching sound which has -after healing- built up my left outer calf a bit more than the right..and ironically the right ankle is not as strong as the left now which doesn't crunch anymore incidentally.

I know its a bit of a ramble but honestly its a trait of ADD and I can't really express myself any other way lol so please just some advice on whether I can heal or even a bit of direction would be really really good.

Thanks again,

Jarrath.

[Jobbo86]

oops forgot - activities that make it worse are pretty much anything strenuous involving bending and especially sitting for long periods of time.

[persy1]

Your sprained ankle could certainly have an adverse affect on your back because if you alter your gait you will put altered and abnormal stresses on your spine. A bulging disc can cause all kinds of problems--the outer layer of the disc is pain sensitive and can, all by itself, refer pain into the leg. Also if the disc is bulging it will also have lost some height bringing the small joints of the spine into closer proximity and jamming them together, restricting normal movement. You have probably developed 1 or 2 stiff segments by now which would tend to seize up if you sit for a long time causing pain and also causing poor nutrition to the disc. Have you tried looking into McKenzie techniques as suggested by a previous correspondent? Check out this link which shows a simple McKenzie technique for reducing a disc bulge. YouTube - How To Exercise With A Disc Bulge If you follow this link to the McKenzie Institute and click on "products" you will find a further link to a book by Robin McKenzie called Treat Your Own Back The McKenzie Institute (UK) Trust Website . My other suggestion is to look into Sarah Key treatment methods. Follow this link to the Sarah Key website (she is an Australian physiotherapist) Sarah Key and read "Your Back Pain" then click on th left hand link "The Back Block Video" in which Sarah Key herself talks about the Lumbar spine and demonstrates the use of a back block.
As a physiotherapist I tend to use a combination of these 2 methods depending on the individual patient, along with manual mobilisations (hands on stuff) and have found them very successful.
Kind regards
Suzy

[physiofixme]

How is it going with your back problem?? Any updates? It's always difficult diagnosing a problem without actually physically being able to assess a person. You could have jarred your sacroiliac joint when you stamped your foot down on the ground while cycling. This can sometimes result in your ilium (part of your sacroiliac joint) being "stuck" for want of a better word in a forward or backward position. Some manual therapy techniques by your physiotherapist and some stretches by yourself can remedy this. However - the McKenzie exercises targetted at your lower back can also be beneficial for sacroiliac joint problems. Let us know how you are getting on.

[alophysio]

hi jobbo86,

Good post and interesting info.

It is quite possible that every you believe is there is actually there. I trust (usually) what my patients tell me because they can feel things in their body that I can't...

...you very well may have a "twisted pelvis" - a rotation of L5 on S1 (or S1 under L5).

The main thing is to find someone who can...
1. Test if it is your disc once and for all - the thing about discs are that it is the chemicals that make discs irritate nerves, not the compression itself. it is like a sunburn. Nerves are pulled and pinched all the time without any problems in your body. It is when they are chemically irritated that they become a problem. So in sunburn, even a whiff of wind can be painful because your nerve endings are raw...and if you live here, your friends will slap you lots on the back as well!

2. Test if it is your hip, SIJ, L/S or thorax that is the main problem driving the other problems. Failed load transfer occurs in the "primary" joint and then the cascade effects then affect other joints. you want to find the joint that fails first during those movements. This is not something taught to physios at uni...

3. Test if your nerves and motor control are a problem. Nerve problems can be from shortened, scarred, irritated, compressed, stretched, pinched, etc nerves. They can coordination problems, all sorts of things.

4. Test if any joints are stuck, sprained, controlled etc

5. TEst any muscles that are weak, short, long, etc

Good luck.

BTW, you speak with more vocab than the ordinary patient...what is your background or training?

[persy1]

Hello Jarrath, just looked in on this thread on which I posted a while back, and curious to know how you are getting on.