What does my x-ray mean? And why wouldn't these same results show up on an MRI?

[loft33]

I got an x-ray on my lumbar spine and hips because I've been having some back pain. Really, the pain isn't in my back, but my SI joint. Anyway, I got the results of the X-rays today and I'm really quite frightened by them. From what I can tell, I have some pretty bad changes in the spine. Also, I did get a third X-ray where they measure my leg length and it showed that my right leg is 1.4cm shorter than my left. The right side of my body (butt and leg) is where I'm having pain.

Can someone who is more familiar with x-ray terminology tell me what these results mean exactly? And would PT help? Also, I had an MRI of my lower back in July and the neurosurgeon said my spine was totally normal. Why wouldn't the results that the X-ray showed show up on an MRI?

MBAR SPINE 5 VIEWS, 12/22/2011

HISTORY: Low back pain.

FINDINGS: There appear to be 5 lumbar type vertebrae followed by a

sacral segment which is transitional and incompletely sacralized.

Vertebral body height is maintained. Small vestigial disc space is

noted at the L5-S1 level. There is some facet joint hypertrophy at

L5-S1 level. No lytic or blastic lesion is seen. Sacral arches and SI

joints appear normal. No fractures are evident.

IMPRESSION

IMPRESSION:

Mild spondylosis. Transitional S1 segment.

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[sarahkelly]

I don't know your history but it may help to have someone go through this with you.
X-rays also don't always match-up to the levels of pain people experience.
I'm not sure this height difference between your two legs is even significant.Beside, you're 34 that decrepency was there more than 4 weeks ago and you didn't have the pain before then so I wouldn't focus on that too much.
how did the pain first begin and what position/action aggravates it the most?

[bikelet]

Hi there,

I have had a similiar problem with my SI joint before- with it causing buttock and leg pain and sometimes easing with leg squeezing. There is a really helpful self treatment is this video:
SI Joint Treatment - YouTube

I wouldn't be too hung up on the x-ray results- any abnormalities are discussed as being mild and I doubt that they are the cause of your pain. SIJ pain can occur from minute changes in the position of this joint which would be very difficult to prove on x-ray or MRI. The reason why this occurs is usually muscles imbalances around the hips and pelvis (as discussed in another of the youtube videos in the series) which put uneven tension on the joints and result in pain on one side. A leg length discrepancy also doesn't help but is unlikely to be the sole contributing factor, as many people have discrepancies but no SIJ pain.

PT to assess your muscular imbalances and teach you exercises for a long term solution would be a very good thing.

I wish you the best,

Bikelet

[MrPhysio+]

Hi Loft33,
SarahKelly and Bikelet have given good advice. Were your X-Rays commissioned by a Doctor, Chiro or Physio? Some health professionals over emphasise leg length discrepancy via questionable scan measurements and sometimes even without scans.

SIJ ligament strains can give a broad range of symptoms and can lead to sciatic referral pains with muscle imbalances. The erector spinae muscles on the affected side and the piriformis muscle can tighten up to compensate for the irritated SI ligaments, giving a low grade and sometimes spreading toothache type pain. The ache can refer from the SI joint to the groin either around the hip or from the back to the front. Sometimes the ache refers to the anterior thigh. If the erector spinae and piriformis tighten up your pelvis will feel hitched and rotated, also creating an apparent leg length change.

Aggravating factors include standing on uneven ground, lunging movements, swinging legs in /. out of a car, proplonged standing with weight through one leg more than another. Also, if you have an anteriorly tilted pelvis (sway back) it will worsen symptoms.
Core stability exercises can help. Not push ups. Try the plank exercise position instead then progress to an ab wheel, but do so slowly to avoid injury.

Your x-rays report on things that are within known normal variations in humans. X-Rays rarely show SI problems unless there has been major accident trauma or degenerative arthritic type conditions - often due to a faulty gene.
If the problem does not resolve I would suggest obtaining a specific SI joint stability belt, which must be tensioned when laying down, not in standing.

Let me know if you have any questions.
Cheers,
MrPhysio+

[loft33]

Thanks for all the replies, everyone.

So I guess what I'm just still confused about is does this "Transitional S1 segment" have anything to do with my SIJ pain? Or is that just an incidental finding which likely has no affect on my SIJ misalignment?

[MrPhysio+]

Hi again,
Yes, these reports can be confusing as there can be a fairly wide variation of what is coinsidered as normal in humans.
A transitional S1 segment just means that this joint has not fully fused. This should not cause SIJ problems and is incidental as you state.

Overall, your X-Rays are nothing to be concerned about. However you should have the symptoms checked out to receive correct diagnosis and treatment. Sometimes, if you have a sacroiliac joint strain, a SIJ belt may assist as I have mentioned previously.
Hope this helps,
Cheers,
MrPhysio+

[loft33]

Hey MrPhsyio+,

Thanks again for your reply.

I've had two chiropractors tell me it's my SI joint. And about a year ago I went to a physio and she had me do a side-lying leg raise to test my glute med muscles. Even as she was doing it I could tell (and obviously she could) that my right glute med "was about 80% weaker than my left glute med." I remember how astonished I was at the difference in strength between sides. With my left one I could resist against her pushing down. With my right one I couldn't even resister her push for a second. It was like my right glutes were jelly. My right SI joint is the one I have a problem with.

{BTW - I had an MRI of my low spine done July 1st, 2011 for a separate issue (burning pain in toes - turned out to be very tight calf muscles). Everything was normal (except they didn't mention the transitional S1 segment - that's why I freaked out about the x-ray). But there were no disk or nerve issues. So, I am pretty convinced this issue now is muscle imbalances causing SIJ problems on my right side.}

I've made a work out program for myself, which I plan to start next week. I was hoping you might review it. My goal is solely to achieve muscle balance to start.

Monday/Wednesday/Friday
At home:

• Planks 3 reps x 30 seconds
• Clams 3 sets x 20 reps each side
• Bridges 3 set x 20 reps
• Back-lying Pelvic Tilt with extended knee (weight on ankle, stabilizing pelvis when I raise leg) 50 reps each leg
• Dead Bug 50 reps
• Side-lying Straight leg raise (abduction) 3 sets x 20 reps each side
• Side plank 3 reps x 10 seconds each side
• Monster walk with band around ankles 3 sets of 20 feet in each direction

Then, at gym:

• Stair machine or bike for warm up
• Abductor machine
• Adductor machine
• Quad machine
• Hamstring machine

(I add those gym machine exercises because when I used to go to the gym, doing those in that specific order seemed to "reset" my SIJ when it felt out of alignment)

Tuesday/Thursday/Saturday

• 1 hour walk
• Stretching (I say "stretching" but what I used to like to do was compression for about 30 minutes with various-sized balls and foam rollers on my muscles (glutes, QL, hams, quads, etc) followed by about 30 minutes of stretching). It doesn't sound like a lot, but it's actually quite the "workout". Takes about 1 hour total.

I'm about 40 pounds over weight right now, so I'm looking for slow weight loss (2-3 per week) and stabilization of my body.

So what do you think of the program I lined out to start with? I was thinking of doing it for 2-3 weeks and then slowly adding more/harder exercises.

Also just a couple questions:

If my right glute med/min is so much weaker than my left, should I be doing exercises for the left side? I mean, if I'm doing a total of 60 reps of side-lying abduction on my right (weaker) side, should I do the same amount for my left (stronger) side?

I know for most exercises you should give yourself at least a day's worth of rest between them, but for the exercises that are working the smaller stabilizing muscles (like clams and monster walks) should I be doing those every day? And what about planks? Should those be done every day or should there be a rest period?

Thanks again, I really appreciate it.

[physiobob]

It an incidental thing, kinda cool which means that one of the sacral segments (which are separated at birth but ossify to form one bone) did not fully transform. It probably has nothing to do with your discomfort and can be something to show at dinner parties. So unfortunately for all purposes you are normal

Back/SIJ discomfort is 100% normal as well, I got mine first at age 25. Just get to some good rehabilitation exercise type classes and you get sorted and learn how to self manage one of those life long (albeit it intermittent) nuisances.

[MrPhysio+]

hi Loft33,
Happy New Year to you.
Sorry for the delay, holiday time has been busy here in Oz.

I will comment within your text, below.

I've had two chiropractors tell me it's my SI joint. Agreed, to a point. And about a year ago I went to a physio and she had me do a side-lying leg raise to test my glute med muscles. Even as she was doing it I could tell (and obviously she could) that my right glute med "was about 80% weaker than my left glute med." I remember how astonished I was at the difference in strength between sides. With my left one I could resist against her pushing down. With my right one I couldn't even resister her push for a second. It was like my right glutes were jelly. My right SI joint is the one I have a problem with. If the SIJ is affected the body may inhibit the muscle strength on that side to protect against further injury. Continued inhibition of the muscle leads to disuse atrophy ie further strength loss increasing dysfunction in a downward spiral.

{BTW - I had an MRI of my low spine done July 1st, 2011 for a separate issue (burning pain in toes - turned out to be very tight calf muscles). Everything was normal (except they didn't mention the transitional S1 segment - that's why I freaked out about the x-ray). But there were no disk or nerve issues. So, I am pretty convinced this issue now is muscle imbalances causing SIJ problems on my right side.}

I've made a work out program for myself, which I plan to start next week. I was hoping you might review it. My goal is solely to achieve muscle balance to start.

Monday/Wednesday/Friday
At home:

* Planks 3 reps x 30 seconds
* Clams 3 sets x 20 reps each side
* Bridges 3 set x 20 reps
* Back-lying Pelvic Tilt with extended knee (weight on ankle, stabilizing pelvis when I raise leg) 50 reps each leg
* Dead Bug 50 reps
* Side-lying Straight leg raise (abduction) 3 sets x 20 reps each side
* Side plank 3 reps x 10 seconds each side
* Monster walk with band around ankles 3 sets of 20 feet in each direction
All the above are fine except the Monster walk. I have a problem with this exercise, especially in the initial stages of core stability as lunge type movements will stress the SIJ. Standing / running on uneven ground, swinging the leg in /out of a car, prolonged standing with one knee bent etc can irritate the SIJ. Once core stability is increased and the SI joint ligaments have stopped being inflamed (can take months), more difficult exercises can be introduced.
Then, at gym:

* Stair machine or bike for warm up I do not like stair machines due to the pelvic torsion. I have found a higher proportion of Si joint injury in those using stair machines. the bike is not as bad, however i advise against bike exercise in the earlier stages. Rowing machine is preferred.
* Abductor machine Ad / adduction machines okay if done with perfect form ie only if you have fairly good core stability.
* Adductor machine
* Quad machine
* Hamstring machine

(I add those gym machine exercises because when I used to go to the gym, doing those in that specific order seemed to "reset" my SIJ when it felt out of alignment)

Tuesday/Thursday/Saturday

* 1 hour walk Okay if on flat ground without cambered surface until good core stability.
* Stretching (I say "stretching" but what I used to like to do was compression for about 30 minutes with various-sized balls and foam rollers on my muscles (glutes, QL, hams, quads, etc) followed by about 30 minutes of stretching). It doesn't sound like a lot, but it's actually quite the "workout". Takes about 1 hour total. avoid lunges!

I'm about 40 pounds over weight right now, so I'm looking for slow weight loss (2-3 per week) and stabilization of my body.
Good idea.

So what do you think of the program I lined out to start with? I was thinking of doing it for 2-3 weeks and then slowly adding more/harder exercises. Should be okay given the above comments and cautions.

Also just a couple questions:

If my right glute med/min is so much weaker than my left, should I be doing exercises for the left side? I mean, if I'm doing a total of 60 reps of side-lying abduction on my right (weaker) side, should I do the same amount for my left (stronger) side?
It is generally considered that you should maintain the strength of the unaffected side whilst bringing up the strength of the affected side. To achieve the rebalance you will need to do more exercise on the affected side. Keep progressions (reps, weights, times etc) within 15% of the current level and stay at that level until it is fairly easy then progress another 10 - 15%. This will reduce post exercise induced soreness and avoid reinjury.

I know for most exercises you should give yourself at least a day's worth of rest between them, but for the exercises that are working the smaller stabilizing muscles (like clams and monster walks) should I be doing those every day? And what about planks? Should those be done every day or should there be a rest period? All muscles react the same way for strengthening. If you are trying to bulk them up, give a days rest for rebuild and recovery. You can walk every day if not loading heavily with hills. If so, give days rest for heavy walking, and have one heavy then one light day. Be guided by how your muscles feel. Planks can really load the abdominals, so be careful.

Hopefully the above will help in your recovery. Once again, sorry for the delay in response. Feel free to ask questions if any more arise.
Cheers,
MrPhysio+