Lumbar back pain

Hy there, I am a physiotherapist with a lumbar pain.

You can call me PF.

I have a lumbar pain, at the right paravertebral zone at L4-L5 or L5-S1 level (I still don´t know the exact vertebrae).

This pain is pin-pointed and not a diffused one.

This pain increases when I am sleeping on my left side having my waist turned to the left, so my right knee will be forward by left one.

When I am seated I avoid crossing my right leg over my left one. This position will surely recreate the pain.

Also when I help someone heavy to get up (I pick him up from his right shoulder with my left arm). I will feel the pain in the right side if I bend my lumber spine towards by right side, but this doesn´t happen all the time.

I have a lumbar hyperlordosis and and thoracic hyperkyphosis, they never gave my problems.

SLR Test is negative, I even remember doing it one night to relief my pain.

Do you think it´s a Piriformis Syndrome ?

Is it a hyper-pression point of the right articulation between the vertebrae ?

Thank you.

Hello PF,

It's a good sign that SLR is negative, but try the Slump Test for sciatica ... it's similar to SLR but throws up useful and often interesting differences.

A piriformis syndrome is certainly a possibility with those postures provoking the pain. What does internal hip rotation do? Point pressure over the piriformis? If so I would be looking for a sacral subluxation.

What do lumbar flexion and extension do? Lateral flexion? A facet syndrome often provokes a positive Kemp's sign.

Frankly, it's difficult for me to advise. I would be looking for fixations in the SIJ, and lower lumbar vertebrae where the point tenderness is located. Orthopaedic tests for the SIJ, short leg, and active trigger points.

It's hard for you, but it's time to consult a colleague. There are tests and treatments that you simply can't do for yourself. I myself have just had a severe sequestered disc, L3-L4, nasty to see it on MRI, and utterly dependent on a colleague for luckily successful treatment.

I take it you are doing regular, disciplined exercises. I don't need to lecture you on the importance of that!

I hope this has contributed.

Dr B

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