Subject: Re: back pain
Forum: The Neurology and Neurosurgery Forum
Topic Area:
Posted by CCF NEUROSURGERY MD on September 22, 1997 at 14:21:56:
In Reply to: back pain posted by a val griffith on September 20, 1997 at 14:00:38:

: I suffered an injury in April of 97 in which someone accidentally fell on top of me while I was not expecting it. I was rotated and extended to the left with the persons 200+ body weight on top of me. I managed to push the person up but felt a snap in my back as my muscles went from a shortened to a lengthed position. I initially had burning type pain down my right anterior thigh and some unusual burning to my head and eyes. I had immediate pain in my right low back are which eventually went up to the right thoracolumbar area. I also initially had pain in my left thoracolumbar area which seems to have resolved. There was some initial increase in redness in my back which eventually turned into a large bruise extending from the center of my middle thoracic area down to my sacral area. My pain persists in my right low back area. As I have attempted to increase my activity it has become worse more constant and intense. Initially a muscle tear and possible pinch of the autonomic nervous system was suspected. I was advised to implement a limited active rest phase. MY MRI which was done only to L3-L5 showed some degeneration at L5 which was relatively normal. Regular Xrays were normal of the lumbosacral area. A possible zygoapophyseal joint fracture is a concern because of the load and the difficulty diagnosing it with the regular tests. I also have some popping when I go from a flexed to extended position with transient numbness. I am 35 years old and was running 2 miles every other day and playing tennis weekly prior to this. I have been limited in my ablity to work and would appreciate any suggestions/research articles/comments that you may have on torsional injuries that may assist me with my quest to return to a better lifestyle. I have had a subchondral bone injury in the past and am hesitant to push myself excessively with the increase in pain.
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Dear A Val Griffith,

First of all, if it hurts too much, don't do it. The key in such injuries
is to rest your back and to slowly increase activity over time.

It sounds like you suffered quite a jolt. It is conceivable that you had a
small fracture, for example of the facet joint, that was missed on the
plain films. Or, there could be a ruptured disc at a level higher than was
scanned on MRI. More likely, you severely strained your back muscles from
the strain of falling in an awkward position. It may take up to several
months for the pain to subside.

Again, the initial therapy for this type of injury is rest. Eventually
you should begin to stretch and walk, but go easy. NSAIDS (ibuprofen, etc...)
are often useful. Physical therapy may also be helpful to get you back on
your feet. The pain should slowly subside over time. If the pain persists
you should return to your physician for a reevaluation and possibly more
x-rays or a CT.

These are frustrating injuries. Patience is important as the body will
forgive, but often doesn't forget such an injury.

Good luck.

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