21 year old male, chronic left-side lower back pain

Hi all, i would really appreciate some advice on my situation as it has been a very long and drawn out process with little success.

April-May 2008:
‘Twinged’ left lower back doing deadlifts. Tried to train through it by continuing with normal program. Didn’t get any better, just felt ‘niggly’ on all exercises.

June 2008:
Saw chiropractor who just thought I was out of alignment so made some adjustments. Felt a little better initially but then got much worse – every gym exercise aggravated it so had to stop entirely. Daily activities like sitting, bending over, lifting anything became painful.

July-September 2008:
Started seeing osteopath once per week. Diagnosed as sacrum compressed against bottom of spine and overly tight muscles in back and legs. Was given daily stretching exercises as well as weekly manipulation and occasional accupuncture. Also forbidden from any physical activity to stop muscles re-tightening. Progress fluctuated forwards and backwards each week. By end of summer I was told I could return to gym gradually. Pain seemed to have reduced and no longer interfered so much in daily life.

October-December 2008:
Shortly after returning to gym back tightened up again causing a return to daily pain. Started seeing uni osteopath once per week. He disagreed with previous diagnosis (actually thought I was pretty flexible), instead thinking it was a weak core causing problems. Was given a daily core-strengthening regimen. Uneven progress again. Also ended up in hospital one night when back completely cramped up from laughing. X-ray shows no obvious irregularities. Osteopath gives up, refers to spinal surgeon. Second X-ray showed no irregularities. Started to develop sciatica down left hamstring.

March-May 2009:
Spinal surgeon thinks it’s a problem with facet joints. MRI shows degenerative disc disease and slight bulge at L4-L5, referred for facet joint injections at L4-L5-S1. Complete lack of any physical activity results in pain decreasing somewhat, sciatica disappears.

June 2009:
Facet joint injections provide pain relief for ~3 weeks then pain returns but worse with sciatica. Returned to light gym work at this time.

July-August 2009:
Discharged from surgeon. Started daily rehab program (light weight, high volume partial deadlifts and good mornings) which alleviated pain. Also started inversion, stretching and mobility drills. Made good progress but still slightly stiff/painful in mornings. Had two day break due to eye surgery (lots of lying down), back cramped up again, very painful. Doing nothing seems to make it worse?


September 2009:
Pain seems to focus at left sacoriliac joint. Occaisonally get soreness down outer left quad. New physio notices that hips are out of alignment: left hip is noticably lower than right effectively causing left leg to be 'shorter' although both legs are actually of equal length. Physio prescribes extra cushioning in heel of left shoe to bring hips back into alignment. Hard to tell how much difference this has made, although have noticed that left glute is constantly tight.


This is the present situation. I feel as though the physio has finally diagnosed the correct problem area (misaligned hips) but do not feel as though the root cause is being addressed; rather the symptom is merely being treated. My feeling is that a muscle has tightened up somewhere as a result of the injury, thereby pulling my hips out of alignment, as I did not have any problems prior to injury. I would be exceptionally grateful to anyone who could possibly shed any light on what the root problem actually is, I just want to be able to return to the active healthy life I once had. I should add that my work entails me being on my feet 90% of the day. Many thanks in advance.

is one hip lower...or the other is higher, this is important!
Is there an inflare/outflare any rotation of the ilium?

Having some muscle energy work to bring the ilium and sacrum back into proper alignment may help, as well as some postural re-education and core work to provide you a stable base for your days in the gym to help prevent your problems from building.

Hi, Very sorry to know that you had been suffering with the back problem for such a long time. In fact, no back pain should remain for than 3-months, provided correct diagnosis is made.

In your case, the lumbar disc being the cause of pain was evident from the begining itself. You said that the x-rays did not show anything. I suspect that some finding in the L5 vetebra is missed.

Well, now the tightness in back and thigh is just a nature's protective mechanism to prevent any further injury to the bulged disc. It will not at all be advisable to release the tightness of these muscles without attending to the disc bulge. Also, no further manipulations should be attempted in a degenerated disc.

What you require is methods to relieve the disc bulge, release of fascial tightness in the buttocks, stretching of a few buttock muscles, strengthening of your arm muscles, core strengthening and stretching of thigh muscles---all in sequence.

You may contact me on [email protected] for more guidance.

TAKE CARE

Hi everybody!
Well, smiles, your problem started as a traumatic injury but seems that some compensations have been established that do not allow you to move without pain. I'm not sure if L4-5 bulging is the main problem, according to what you described and to the MRI. You don't mention anything about narrowing of the intervertebral foramens or the spinal canal and therefore I assume that the disc does not put pressure on the nerves or the spinal cord. To my opinion, this bulging shouldn't cause symptoms, if all of the above are correct.
Assuming that the disc is not involved, then other structures should be examined, including intraarticular (eg facets) and extraarticular (muscles, fasciae etc) and not only at the lumbar spine. This must be done clinically by your physio or osteopath and I can't make any assumptions (actually I can guess but this is not the case at the moment). One thing I'm worried about is what you said about the length of your hips. If your left leg 'seems' to be shorter but in fact it's not, then it's not an anatomical abnormality but a functional compensation and you shouldn't use an orthotic device at all. A pelvic side tilt is a more possible explanation and this can be corrected. Now, if this tilt is secondary to a mild scoliosis or to a tightened muscle group (the gluteus could be but again this itself could be for example due to a tightened piriformis pressing the sciatic nerve and causing you hamstring area pain) or fascia or something else, it should be assessed by the physio/osteopath.
In conclusion, I think that the cause of the problem might be at the lumbar spine but not a bulging disc. It looks like more of a bad motor control secondary to an injury. If this is true (only a clinical assessment together with your medical history could prove this or not), then proper physiotherapy scheme could alleviate your pain and restore function. I'd like to hear from you if something changes.

Regards,
ilias