Reoccurring back pain

by Betty
(London)


Good morning.

In Oct 2014 I was 3 months pregnant when I was diagnosed with symphysis pubis dysfunction. I suspect now I actually had an undiagnosed disc problem too as the pain was different - in my left leg and lower back and I couldn't weight bear. I suffered SPD during a previous pregnancy so I know the pain was different. I was treated for SPD. I gave birth in April 2015 and with walking and physio the pain subsided so life went back to normal. Then in August 2015 I was lifting a light suitcase when back pain reoccurred - I was told my hips were out of alignment due to not recovering properly from SPD again physio and walking helped and life went on as normal.

Sept 2016. I woke up with my back a bit niggly and decided to walk out the 'not quite right feeling'. By the time I got home from a slow 20 minute walk I couldn't stand up. Pain in my lower back & up and down my left leg. I was literally unable to get off the floor.

Early Oct I had an MRI.

Lumbar spine. Relatively preserved L5/S1 motion segment. The disc and endplates are satisfactory. Canal and thecal sac appear satisfactory.

L4/5 Loss of disc signal. Loss of disc height. End plate tip satisfactory. A broad-based protrusion observed with mild caudal extrusion in left paracentral aspect. Indentation of the anterior aspect of the thecal sac which is moderately compressed. Marked indentation on the left L5 nerve root in the left lateral recess with moderate indentation of the right L5 nerve root in the right lateral recess. The neural foramen appear satisfactory. Bulky degenerative facet joints.

L3/4 Mild loss of disc signal with preserved disc height. Endplates are satisfactory. Shallow broad-based posterior disc protrusion. Mild indentation of the thecal sac. No further significant neurological compromise. Bulky facet joints.

L2/3 Mild retrolisthesis. Mild loss of disc signal and height. Endplates appear satisfactory. Shallow broad-based disc protrusion. Bulky facet joints. Mild thecal sac compression. Lateral recesses appear satisfactory.

The remainder of the visualised motion segments appear satisfactory. The sacrum and S1 joints appear satisfactory. Retroverted uterus.

After months of manipulation, exercises, watching my posture etc I was finally getting somewhere. I was even without pain for 2 weeks. Then I woke up this Saturday morning and I couldn't weight bear on my left leg again! Pins and needles in foot and a weird heavy pain when standing. Can't sit - even on the toilet. Lying down on right side and back slightly ok...ranges from deep ache in calf, front of thigh near knee to pins and needles. Pain changes from 2 to I am crying. I am back to where I was...

Looking at my MRI do you think I am stuffed? I don't want surgery but am beginning to fear I won't have a choice. I would appreciate your thoughts. Is there any good news from my MRI report? I am 41 years old and need a new plan for my back...

Thank you.

No, Betty, you're not stuffed but what's really not clear is whether this is a pelvic or lumbar issue, or both.

And because you're unable to give me the physical findings on examination, but only what you feel, it's really not that clear.

I suspect that the "mild retrolysthesis at L2/L3 with the deep ache in the front of the thigh may be one of main foci in your case; it would seem as you believe that the symphysis pubis stuff may now be less significant; but, if your lie on your back and pull the knee to the chest and then opposite shoulder what happens? And if you drop your knee into the lotus position?

What I really would like to know is whether the femoral nerve stretch test is positive; it's difficult to do at home and interpret.

Question: in the good times between these episodes did you go on with your exercises faithfully?

If not, that's the big change I would make; go once again for treatment, but now every morning for the rest of your days do the exercises given to you every single day before you get out of bed. Like you would brush your teeth, and floss, even though you have no pain.

I realise I'm being vague, but that's because I'm unable to examine you. Ask about the femoral nerve stretch, and the knee jerk reflex and watch out for a weak knee starting to collapse on the stairs.

I wish I could be more specific.

Dr B

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Jan 31, 2017
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starstarstarstarstar 		Pain in leg when raising it whilst lying down
by: Betty B

Hi there.

Thanks for your response. I appreciate it.
I thought I was doing my exercises faithfully but having a toddler makes the no lifting rule difficult - perhaps that was it?
If I lie on my back and pull the knee to the chest and then opposite shoulder i just feel a tug in my lower back and a hard stretch in the back of my left leg. Lotus position is quite comfortable for me.

I saw an Ortho Surgeon today and with me lying on my back and him lifting one leg at a time caused me pain in my left leg only. I forgot to ask him about the femoral nerve test but i will remember for next time I see him which is soon.

He has suggested in having another MRI as my symptoms have gotten worse since Oct 2016. So, i am booked in to have one tomorrow.

Kind regards
Betty

Hello Betty,
Sitting in a kitchen chair, ask hubby to raise your right leg parallel to the ground, lower it, and now the naughty leg. What's the difference? If it does nothing, repeat with head flexed on the chest, and foot dorsiflexed, toes towards your head.

If you bend slowly forwards, is it much tighter behind the left leg?

Is it mostly behind the leg, or side, or front.

That raising of your leg, Betty, that the ortho did is called Lasegue's test; you are almost certainly getting sciatica.

Time to start hunting for an experienced, thorough chiropractor. Keep doing those exercises faithfully every morning; evenings too.

Let me know result of above test (called Slump) and the MRI.

Dr B


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Dr B

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