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14993501 tn?1437776467

Localized back pain, stenosis-like

Hi everyone!
I am a 43 year old female who started experiencing a very tight back after my workouts last summer, I would experience them after my workout as I tried to cool down and just walk and I would have to bend over and stretch my back. I didn't think much of it but it tended to come and go and I could still use elliptical machines and run but it only presented the problem when I would stand for long periods or walk more than half a mile or so. Then it would just go away for a month or two and I decided not to go to the doctor and then it would come back. This April, it started getting worse and I've had it every day since the beginning of April. I feel fine when I sit, whenever I lift my leg or stretch my back. Any position in which im flexed and I don't have any radiating symptoms. When I go for a walk, at first I feel no pain at all and then slowly it starts to feel like something is tightening or pressure until it hurts so bad that I have to stop and bend over for relief. After I do so, I can walk about the same distance before I have to stop and stretch again. I went and got x-rays which revealed nothing and then they sent me for PT for 6 weeks and it didn't really do any good in might have made it a little worse. I was also prescribed steroids which did no good at all and I took Aleve which did no good at all. I then went to see a physical medicine doctor who ordered an MRI and revealed a few discs that were degenerating mildly. I have a broad-based disc bulge at l5 s1 but it is mild. It is exactly that spot which I feel pain in when I walk and stand and when I stretch I feel the stretch up a few discs above it. It doesn't seem to fit any pattern as its okay when I sit and relieved when I flex but they found no spinal narrowing also. The doctor just told me to keep active and in a 1 or 2 years if I didn't feel better then come back and he would try Prolotherapy maybe. The problem is is I have a4 year old daughter and I've had to give up most activities that require walking like taking her to the grocery store or going to the fair or going to pick fruit. When I cook dinner I have to sit down every couple minutes until the pain subsides and then get up again. It's also having a big impact on my mental health. I'm getting a second opinion next month from an orthopedic surgeon and I'm just really perplexed as to what other things this could be since none of them think that the disc itself can cause pain. I feel like the disc is causing me pain. Anyone have any thoughts?
4 Responses
7721494 tn?1431631564
Before you consent to prolotherapy, read some personal reports from people who have had it. And understand the procedure. I believe that if more people knew what they were in for, prolotherapy would have gone the way of leeching in the practice of medicine.

Your story is shared by millions. Early degenerative disc disease, maybe a disc bulge or two, and idiopathic LBP.

Treatments so far involve failed NSAIDs, failed oral steroids, failed PT (it usually does at L5/S1), and now you're having a surgical consult.

While some surgeons are excellent about choosing proper candidates for surgery, others like to operate as often as they can. Surgery should always be reserved as a treatment of last resort, only after more conservative methods of treatment have failed.

The wrong surgeon will convince you that you've already failed all conservative forms of treatment.

L5/S1 is the disc that usually fails first, because it supports the entire spine, and it sits slightly skewed to accommodate pelvic tilt.

Discs are innervated and can therefore cause pain -- it's called discogenic pain. Often, these annular tears are microscopic and impossible to see on MRI even with contrast.  A discogram is an interventional procedure that involves injecting die into the intervertebral space, watching a fluoroscope in an attempt to reproduce your back pain. It is the only definitive way to find discogenic pain.

Imagine a house when a part of the foundation fails -- that house will tilt. Same when a disc bulges, the upper vertebra tilts, tearing connective tissue, decreasing the intervertebral space, and placing pressure on one or both of the facet joint capsules, which leads to facet hypertrophy and osteoarthritis of the joint -- another source of LBP.

Broad-based disc bulges often efface the thecal sac, and sometimes spill into the intervertebral foramen. Both situations can cause pain of spinal stenosis in the former case, and foraminal stenosis in the latter.

But it's not visible on the MRI, so it's not real....

Remember that MRIs are static images and catch you when you are supine and at rest. It's almost like saying "smile for the camera." In actuality your back bends and flexes all day long. What may look like a simple bulged disc effacement can be a protrusion into the thecal sac, depending on position and activity.

And where there are disc bulges, osteophytes will soon follow. These tiny bits of calcified scar tissue group into hard chips and spurs that, when pressed against the cord or nerve root, cause pain.

There are other sources of pain invisible to MRI too, that come with more advanced cases of DDD.

Why not see an experienced spine and pain specialist -- a doctor with the DABPM credential. This is a board certified doc, usually an anesthesiologist, with advanced training in the neurology of chronic pain, advanced use of pain medication, the spine, and interventional pain procedures.

Instead of looking at surgery, you might consider a new treatment options -- stem cell therapy to repair that disc bulge, or platelet rich plasma therapy to help heal that disc and related soft tissue.

You might try the diagnostic procedure called medial branch block, that can diagnose a major source of spine pain -- an arthritic facet joint. When followed with an non-surgical procedure called a medial branch neurotomy, you might have 50% less LBP for up to a year.

Explore these options before you consent to surgery. You can recover from neurotomy -- the ablated nerve regenerates. You cannot recover from discectomy and fusion.

Learn all you can about the spine, your spine disease and its variants, potential treatment options, what they entail, and what you can expect as potential risks and benefits from those treatment options.

Visit a site like spineuniverse.com or spine-health.com for information on spine disease and its treatment.

Best wishes.
14993501 tn?1437776467
Thank you. Who does these other things you mention- the branch block, the stream cell treatment? The physiarist I went to did injections of some kinds, but didn't mention them to me.
7721494 tn?1431631564
Physiatrists are pain specialists who in general, work with the techniques of rehabilitative medicine.

Interventional anaesthetists (or anesthesiologists) are another kind of pain doctor that perform the kind of procedures I mentioned above. In the US we call them interventional pain physicians and they carry the credentials DABPM (diplomate, American Board of Pain Management.) In the UK, you would find this kind of doctor in the field of Anaesthetists, perhaps with the credential of  FPMRCA, which stands for Faculty of Pain Medicine of the Royal College of Anaesthetists.

Best wishes.
14993501 tn?1437776467
Thank you. I went to my PC and he is sending me for a second opinion with a sports medicine doctor. I will then probably see a DO or Pain Doctor depending on what he says.
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