Left lumbar back problem lasting 10 months: what's the diagnosis (then what's the therapy)

[Frankie3211]

WORST AGGRAVATING MOVEMENT
“Hip roll” (or T-roll) to right, hurting the left lumbar area!! About four days ago (Friday) I was doing basic Pilates at home. Bridge, clams, hundreds, single and double knee to chest all went fine. Then, on my back, with knees up and legs bent, I slowly rotated my knees to the right, which twists the spine, especially the left lumbar. At about 30 degrees downward I got an incredible sudden pain in my lower left lumbar area. When I attended Pilates classes for several months earlier this year, I have never been able to do that move, and stopped at onset of pain, though then the pain didn’t continue. This time it triggered a huge and lasting pain, a re-injury (I thought I was moving slowly and gently, but perhaps I moved too far, or because it was the first time in a long time to do this). It is a fundamental, defining aspect of my condition for 10 months that this move causes pain, more so than anything else. Yet I can rotate my knees 30 degrees left and my right lumbar back feels okay. To be clear about the stretch I am referring to, an image is below, or find it at http://www.nismat.org/orthocor/progr...back/back3.gif, only I can’t nearly go all the way twisted to where knees touch the floor like she does. Before you say, I was stupid to do that stretch, let me mention that stretch was taught in my Pilates class for people with back problems.
Hip roll.gif

EVERYDAY SYMPTOMS
1) When I way up in the morning, my back feels good. The main daily symptoms come when I get up from sitting in a chair. I feel okay while in the process of getting up. It seems like two seconds after getting up a de-compression or spasm begins in my left lumbar area. This goes away within a few minutes. Also, the lower left lumbar area can begin to get sore while I am sitting for more than a few minutes. Yet, these symptoms don’t always occur (they are intermittent).

2) I get mild clicking or snapping that appears to be coming from my lumbar spine. This can occur in twisting my back while seated (moving around in my chair). This can occur at the moment of beginning to get up from seated, or when getting up from seated at the point where my spine becomes completely erect (when I reach the point of standing straight up). This clicking seems independent of symptom 1, or at least I cannot identify a link.

HISTORY
I developed a frozen right shoulder that commenced one year ago. Two months after that, when getting up from seated in a chair, I felt an acute line of pain in my left lumbar area. Before I had felt general, broad, mild dull ache across the lumbar area say when getting up from seated, but had no prior back pain issues. I had always done aerobic exercise, but never did core strengthening exercises. This new pain was clearly defined, specific, in a finger length line, left of the lumbar spine just above the buttock. Getting up out of a chair pain free became tricky. For several months I would scoot my butt to the edge of the chair, and then lift with my legs.

In December my physiotherapist said paraspinal muscles up and down my back especially on left side were very tight. When she put pressure on them with her thumb, I felt a thin line of extreme tightness along the side of the spine. After a few months, that paraspinal tightness went away. By January pain from getting out of a chair had all but disappeared. In January I felt pain getting into and out of car seat, but then that went away in a month or so.

Strangely, spinal clicking sounds commenced in December, in a frequent and serious way. This occurred when I got up from seated or twisted my back even slightly. My physiotherapist said the cause of such clicking or snapping was unclear and unknown, so just ignore it if doesn’t give you pain. Most of the time there was no pain, except once there was a violent double click in I thought my sacral spine that was painful in that area for a few days afterwards. Today, I get very mild, occasionally clicking sounds from the lumbar spine, about 10% of what it was at worst. Since Friday’s incident, the lumbar back has been worse, I’d say at 40 to 50% of how bad it was in December. Immediately prior to Friday’s incident, I’d say my back problem was only 20% as bad as originally.

PROFESSIONAL’S DIAGNOSES
The first physiotherapist diagnosed it as “L5 motion segment strain.” He ruled out SI Joint problems. The second physiotherapist couldn’t find a clear diagnosis. My general practitioner doctor ordered an MRI and X-ray but these were more or less normal for my age so he didn’t have a diagnosis but said my problem must be due to body core weakness because otherwise getting up out of a chair shouldn’t hurt me (therefore I have focused my exercise on strengthening my core, but have been doing gentle to moderate core strengthening exercises for 10 months now, including basic Pilates, without that solving my problem completely). A back specialist doctor couldn’t specify a diagnosis, but said he could rule out the scarey stuff—he recommended I go into a two week Back Rehabilitation Program at a local hospital. Currently I have taken some “remedial massage”, and the massage therapist could find no serious tension in my back area when she puts pressure there with her thumbs.

ADVICE SOUGHT
Any help with diagnosis would be greatly welcomed! Can we say anything more than “chronic nonspecific lower back pain”?
What would you advise me to do next, in terms of diagnosis or therapy? Are there stretches or exercise programs, or specific stretches or exercises, that you would suggest I consider? Would you recommend I go into the hospital two week Back Rehabilitation Program, which involves assessment by a team of physiotherapists, various types of physiotherapy including water, and an education program on pain, stability etc? They say they take in people with all ranges of back conditions, but somehow I think of them as for more crippling conditions such as surgeries or people who can't move without pain. While I'm affected, I'm not crippled (or maybe I just keep a positive frame of mind).
Or, to put it more simply, what would you do if you were me?

Thanks!

I am happy to answer any questions.

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[neurospast]

1st thing I would think of would be the Latissimus Dorsi which origins at the top of pelvis and inserts onto the Humerus. It is responsible for internal rotation of the shoulder and if shortened you cannot abduct nor flex your arm fully above horizontal. It would also cause a spasm on the exercise you have been doing. Another option would be the Quadratus Lumborum which neither would like your move. Both muscles tend to shorten if other muscles tend not to do the job they are made for and as a result other muscles feel the need to take over (eg Lattisimus and Q-Lumborum). Having said this; core control which is essential for pilates has to be taught carefully before you really start with pilates otherwise every move you make can cause movements of joints which go beyond their range of movement resulting in symptoms as pain. The latter is just a suggestion. By the way if you have irritated a muscle well enough it will cause you problems again and again (just the same when you irritate a stressed person; get out of his/her way!)

[Frankie3211]

Neurospast, thanks for your comments. If those muscles are irritated, what should I do? I tried doing nothing, active rest, for the first six weeks and it did not heal. Then I moved to core strengthening exercise, ultimately Pilates. Different thinking would be to look for triggerpoints and those muscles, but massage does not find knots there, so far. I am not sure what to do.

[Yarok]

hi

i think it is facet joint problemor change in side the disc.

take care