Please explain the problem i have

[rajashar]

I have been experiencing sharp pain in my back, mid back and lower back. The lower back pain extends to the whole of right leg but is very sharp in the right butt area. I have been diagnosed with a Myofascial pain syndrome and proplase disc the MRI scan report reads as follows Diffuse Annular bulge of L4-5 disc causing thecal sac indentation No neural or foraminal compromise/ nerve root compression is seen Diffuse Annular bulge of L5-S1 disc causing thecal sac indentation No neural or foraminal compromise/ nerve root compression is seen Diffuse Annular bulge of L4-5 disc causing thecal sac indentation No neural or foraminal compromise/ nerve root compression is seen Mild Facetal arthropathy at L4-5 level . I have been advised a myotherapy IFT and SWD by different doctors. Please advise what the real problem is and what should be done

The Pain in the lower back causes a heavy feeling in the right leg and the pain extends from below the waist line

[CCF-Neuro-M.D.-SH]

First of all, keep in mind that I am unable to diagnose you because I am unable to examine you, this forum is for educational purposes.
    The symptoms that you relate are non-specific and there are many causes of low back pain/ sciatica.  The most important thing is to find out why you are having the pain, and then symptomatic treatment can be addressed.  It is reassuring that your MRI (by the report that you related) does not show any serious pathology, that requires surgery, etc.  Given the radiation of pain down your leg, I would suggest an EMG to evaluate for any electrical evidence of a radiculopathy (pinched nerve).  I would also recommend physical therapy and medications for neuropathic pain (neurontin, lyrica, elavil, etc.).  I would not suggest devices with little if any scientific support (IFT-interferential therapy or SWD-short wave diathermy) in randomized palcebo control trials (the standard for FDA approval, etc).
I hope this has been helpful.

[mike1105]

sounds myofascial to me too. i've been through it. i personally do not feel that this problem has anything to do with the findings on your MRI report. do you work on a computer? do you have good posture? the good part is that this problem of myofascial pain is totally fixable in the right hands, and if you educate yourself. See a website by Jolie Bookspan. this website gave me my life back.

[JCmcc]

you may want to consider Atlas Orthogonal Chiropractic, and/or-you may want to be screened for the DRX9000.

Good Luck!
JCmcc.

[mike1105]

I've been following your posts which are intelligent and informative. Here's my take on this patient: he's got no foraminal/nerve root issues, and his pain is in his mid/lower back, butt, leg. He's already been diagnosed with myofascial pain syndrome. As a 44 yr old  ex-dentist who has been referred from spine specialist to neurosurgeon to chiropractor to PT many times over, I finally learned one thing----- bones find themselves in certain positions becasue muscles pull them there. This patient most likely has tight hip flexors and a weak mid back from postural compromise. He needs to stretch the tight muscles and strengthen the weak ones. I would almost bet you this patient has a desk job and has rounded posture, or that this patient is overweight. From my experience, and I understand not all patients are the same, this patient will be in pain until he commits to good posture and appropriate exercise/stretching. Continuing to rely on machines or other people (other than a well trained PT, who actually trains patients to help themselves) to fix this problem for him will almost surely get him nowhere, with all due respect. Of course, as a disclaimer, this is my opinion only.

[JCmcc]

Hello Mike,
  I read over the information again after reading your post and looked more intently. The rounded posture that you point out, seems probable. I too have learned that posture has a certain role in many problems. I concur on your statements, if in fact, all of the facts are in and correct.
   If, however, he commits to following such routines-it would not be out of league for him to seek out massage therapy and general orthoganal support from a chiro who specializes that technique. As a neuropsychologist-I tend to rec this for many people with stress disorders that cause numbness, parethesias, to name a few. If he is a desk worker-depending upon his profession-there may be stress factors (or his personal life, who knows) that contribute to this problem. I am a big believer in combinatory effects.
   On another note; ex-dentist? Are you retired? Share if you want, if not, understandable.

Thanks,
John.

[rajashar]

thank you for all your advise...yes i am a desk worker but i always make sure of my posture....lower back touching the seat and not tilting forward...and i am not overweight i am 67 kgs at a height of 5'8".....

[JCmcc]

Then I go with my prior recs for you.

[mike1105]

HOLD ON...... JM-- I am in favor of massage therapy/stress release techniques for this patient, perhaps thu a myofacial/postural therapist.. My concern there is that most chirporactors blame alignment/pain on bony relationships, and tend to think they can correct these problems by adjusting bones ie vertbrae. They also like to try/bill for what I think are useless procedures like electrostimulation etc and ultrasound. This patient needs to understand that he needs to fix this himself with GUIDANCE from professionals. He will not be"cured" by professionals. To fill you in, I had what turned out to be upper crossed syndrome from my posture as a dentist. It developed into a mild case of TOS. For 2 years I had no clue what was wrong with me-- neck pain/shoulder pain/arm pain/ and worst of all chest pain-- sometimes I couldn't even breathe. I have learned that for myofascial issues the MUSCLES ned to be retrained. I fixed myself in 4-6 months of 3 times per day 45 minte stretching/strengthening/ TP release sessions. I would NOT recommend machinery that attempts to move bones, nor would I recommend "adjustments". this patient says his back is against his chair and he "checked" his posture. That is not enough for me to say that posture is not his problem . He needs to be evaluated by a myofascial/postural therapist, not a chiropractor. Again, my opinion. PS I will not go back to dentistry, as I do not want to even get close to what I went through ever again. I'm pain free now.