low back pain

by wendy

I am a 46 year old 5'7" 140lb female in pretty good shape after 30 years of multiple back & neck injuries/traumas, most recently (12/5/12) a fall in which my sacrum fractured/buckled on the underside of S2-4.

Although most excruciating the first few weeks, from what I can discern the fractures are healing well, but I am left with increasing pain from a second part of the injury. The MRI report identified high level of inflammation at a 'pseudojoint' that has formed between my anomalous L-5 spatulate left transverse process & the ilium. The space around the L5 nerve exit is greatly reduced structurally & the disc is slightly protruding & touching L5 nerve.

Apparently the 'joint' had been stable, but it was crushed in the fall & the inflammation is further compressing the space. "Motion is lotion" has been one of my mantras over the years, and with the many injuries I've experienced and has kept me going.

I manage successfully upper right quadrant RSD, among other conditions, meditate, do yoga, teach pain/stress reduction programs & practice as a massage therapist. Staying fluid is essential.

I've just been told that movement in this 'joint' is what is causing the increasing nerve pain - that it shouldn't move, but now that it does, inflammation increases across the injury & floods down through the left SI joint & pelvis.

Deep achey pain begins in the pseudojoint area, left lumbar & hip muscles spasm, then icey burn moves into hip, groin, pelvis, down leg to foot; at worst into bladder like horrid infection pain (yes, urine has been cultured - clean). Sitting seems to compress joint as does carrying anything other than my body wt. My rectum has had burning broom handle pain consistently.

I had gone back to work, but the pain increased so much, I've now been mostly in bed on my back for the past 3 wks & can only manage being up for a couple hours at a time without increasing the symptoms.

The rest of my body is beginning to suffer and I am borrowing money to eat/pay bills. Can this heal with bedrest? It seems there is very little I can do without moving this middle part of my body. I will be most grateful for any information/suggestions. I have been seeing a network chiropractor.

Hello Wendy,
It's very difficult to make suggestions without more information.

In general, I'd go along with you. That fracture is now more than six months behind you and it's probably time to move more rather than less.

That pseudo joint does move, though the amount of movement is limited obviously so a pelvic tilt type exercise, done within the pain threshhold would normally be okay.

A concern. That pain in the groin, bladder and rectum. The upper lumbar area needs to be carefully evaluated. Any pain up there? Ask your chiropractor to do a Femoral nerve stretch test and let me know. Also concern of what is known as a cauda equina syndrome emanating from the thoraco-lumbar junction.

Does pulling your hip to your chest, and then to the opposite shoulder give you pain in the groin?

Is the Slump test positive?

Frankly, you've had a serious injury and I feel it presumptious of me to be making suggestions without being able to examine you. Best you stick with your local doctors and chiropractor, and your own inner wisdom.

I hope this contributes.

dr B

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Interesting challenges of the day

1. Mr S is a 76 year old man with neck pain of some 9 months duration. Luckily, most of the discomfort is upper cervical which is only rarely arthritic; his lower cervical spine is a degenerative mess that I have left alone. After seven treatments his pain and stiffness is 50 percent better, and he is happy in the circumstances. He can sleep through the night now and that makes a huge difference.

2. Mr P is 32 year old man with very severe lower back pain radiating to the big toe which is 30 percent numb. He had an episode three weeks ago, took anti-inflammatories and was soon better as is typical of the medial disc herniation. But before it healed, after a trivia it came roaring back, much worse. The characteristic crossed sign was evident; sitting in a chair, straightening the right leg provoked severe left back pain and tingling in the leg. He is doing well.

3. Severe lower back pain is scary; just ask Mrs P. Just watching her get out of the car I she was in trouble; she had a slipped disc at L4 making her lean towards the opposite side; luckily she had no pain in the leg. Despite family pressure that this was far too severe for a chiropractor, she persevered. Within five days she was standing upright, and after two weeks almost pain-free. 

Despite a hectic job, she wisely took my advice and stayed home for what I call exercising bed rest.

4. Mr S has had lower back, groin and back of thigh and calf pain for fourth months.

He has a pincer deformity in the hip causing the stabs in the groin, and a degenerative facet causing the sciatica. Both are responding well to chiropractic and he is well pleased; sixty-five percent better after three treatments.

5. Mr T is a wise man; he has taken a warning TIA seriously and has lost 15 pounds, and has at least as much again to lose. A change to a low starch diet and half hour daily stroll has made the difference; but the walking is making his foot and back miserable. The expensive orthotic is hopeless; luckily his hips and back are fine, but he needs a simple heel lift; he has a short leg.

6. I too have had serious lower back issues, luckily fixed by my own chiropractor; so I too have to do my exercises, take care when lifting supers full of honey, gardening and using the chainsaw. Regaining the function of your spine is just as important as the pain.

7. My own granddaughter, only 7 is hypermobile giving her pelvic, knee and ankle issues. X-rays show a mildly dysplastic hip. Years ago we would have called it growing pains. She too regularly needs chiropractic care and luckily responds well. Increased range of motion is more difficult than too stiff in my opinion. Our care is for kids too.

8. This 65-year old lady is a serious gardener; every day she is bending, lifting and digging for 2 to 3 hours a day. It regularly catches her in the sacroiliac joint, so she has a treatment once a month that sorts it out. She does her lower back exercises faithfully.

9. This 88-year old lady is an inspiration; every day she is busy in the community. With a nasty scoliosis she manages very well with a chiropractic adjustment every six weeks and exercises faithfully done. 

10. Mr X is a 71-year old retired man who wants to continue with maintenance care every six to eight weeks; he had suffered from two years of lower back pain when he first came a few months ago. He has no discomfort now after 8 chiropractic treatments, but is aware that danger lurks.

11. Mrs C has been having severe headaches, and taking a lot of analgesics. It is a non-complicated upper cervical facet syndrome, and she is doing well.

12. Mr D is a 38-year old year man with chronic shoulder pain after a rotator cuff tear playing cricket. It responded well to treatment, but he knows he must do his exercises every day; for two years he could not sleep on that shoulder.

13. Mr D, a 71-year old man, has a severe ache in the shoulder and midback since working above his head. Trapped nerve tests are negative but he has advanced degenerative joints of Luschka; after just two treatments he is 50 percent better. Can we reach 90?

And so the day goes; chiropractors should not be treating the elderly most medical sites state but that is so much bunkum.

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