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Back Problems Message Board


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Hi,
Any advice would be really appreciated. I am a 44 year old male and have had a lower back problem for years (as long as I can remember really). I suspect it might have started from weight training when I was about 21 which included reasonably heavy squats and never having a trainer so, no doubt, bad technique.
About five months ago I had a serious crisis which kind of came out of nowhere: I just finished swimming and a little yoga, was putting my pants on in the change rooms, straightened up and felt “something change” in my lower back; a kind of feeling of “not being aligned” and loss of strength there, it didn’t hurt particularly at that moment though. I managed to ride the motorcycle home, but within two hours, I couldn’t stand, couldn’t sit, couldn’t move. Luckily, I had one position in bed on my side (the position we learn to put people in in first aid courses) that wasn’t giving me excruciating pain, so long as I didn’t move, I was okay. That first 24 hours, was pretty tricky and I was very worried. Though our toilet is only about three steps away from the bed, it took me about ten minutes to negotiate the trip and only possible by heavily leaning on my girlfriend. The bathroom has a step down that is about two inches high and I couldn’t even perform this without a few minutes of psyching myself up for it.
The previous year I was doing a lot of silk screen printing which involves being bent over a table and the few months before the crisis, I was spending all day everyday bent over a table drawing (I have since learned to sit up very straight when I’m drawing for long periods). Anyways, five months later, I still have pain everyday and can’t put my pants on in the way that I used to (I now have to lower the pants a lot more whilst trying to keep my back as straight as possible so I don’t hook the left leg up too much). About 6 months prior to the crisis, I had been doing about three yoga classes a week and last year for some months, about three tennis classes a week (the tennis trainer commented that I look unbalanced when I jog around the court for the warm up; also, as much as I love it, the tennis was giving me constant back pain and I eventually tore a calf muscle and gave it up).
I am still doing yoga classes once or twice a week but have decided to stop these classes because last weekend I hurt my back during the class and had extra pain for two days after which included an ache running down my left leg.
As I said, I have a history of lower back pain so: mid 2010 I had a cervical spine x ray which, according to the chiro shows nothing major, just some degeneration and calcification probably normal for my age and mid 2012 I had an MRI lumbar spine scan, the report of which said the following ( I don’t understand most of it but I suspect L5-S1 is the culprit):
“The alignment of lumber spine is normal. The marrow signal of vertebral bodies is normal. No evidence of compression fracture, osseous or paraspinal mass. Conus terminates at above level of L1 vertebral body. Sacralization of the L5 were observed.
D11-12, D12-L1, L1-L2, L2-L3 is normal.
L3-4 and L4-5: There is disc desiccation with central posterior disc protrusion with an associated annular rent. The disc protrusion measures approx. 2X14mm in size. Normal central canal, lateral recesses and both side intervertebral neural foramina.
L5-S1: There is disc dessication with a mild loss of disc space height. There is central posterior disc tear measures of 10mm. There is a central posterior disc herniation measures approx. of 5.0mm with broad base. There are facet arthrosis. There is moderate stenosis at the lateral recesses and intervertebral foramina with radicular impingement of the bilateral nerve roots.
After this crisis, I was seeing a massage therapist a couple of times a week for about a month, a chiropractor a few times (hugely expensive and did nothing but pop a few joints…it would be a lot more help if we sat a smoked a few joints), an osteotherapist once (who did some realignment work with me, a little reiki and pronounced me cured), a physiotherapist about a year ago a couple of times a week for two months, two years ago an acupuncturist a few times a week for a couple of months. If someone tells me that eating a large dog will cure my back pain, as much as I like dogs, I will eat one (I live in Vietnam so this wouldn’t actually be a problem).
My exercise regime right now is about 6 days a week, 30 minutes freestyle swimming in the morning (I try to make my body long when I swim), followed by some light yoga and stretching for an hour (I suspect I have been doing some stretches that I shouldn’t have been, ie trying to touch my toes with my legs straight out in front as this is very very uncomfortable. It may be that these stretches have been aggravating the condition). Then in the afternoon, I’m back at the gym and walk on the machine for 30 minutes and do some light (ish) weight training (Im always careful that my back is supported.) and I do a stretch class two times a week for an hour which I find can help a lot. I have been following this schedule for about a month but my back is not improving. I don’t have a job right now so I am also worried about my financial situation a lot (I’ve no doubt that this psychological tension adds to the problem). Between exercise, I spend most of the day now working on the computer. I am an Australian living in Vietnam so I don’t have access to cheap good medical (its outrageously expensive here for international medical clinics). Acupuncture is a cheaper option here so I am thinking to give that another go though it never helped when I tried it in Korea two years ago.
So, my back pain has become such a part of my life, I’m thinking of changing my name to Mr Back Pain. It’s always been like this but lately it’s really affecting my quality of life which…you know…sucks. So far I have steered well clear of surgery or even steroid injections.
I know this is a lot of information and I thank anyone to took the time to read it and can give any advice.
Thanks,
Glenn
Glad to see you haven't lost your sense of humor. It appears from your post, to be very much intact.

After reading about the initial injury I was going to write that it sounded like you herniated a disc...but I kept reading and the MRI report confirms that thought.

Basically things look OK until your three lowest lumbar segments.

[B]L3-4 and L4-5: There is disc desiccation with central posterior disc protrusion with an associated annular rent. The disc protrusion measures approx. 2X14mm in size. Normal central canal, lateral recesses and both side intervertebral neural foramina. [B]

The discs are comprised of 90+% "moisture." As we age (and the spine begins its aging process in our twenties) the discs begin to lose moisture. There are no direct means for the disc to get moisture -- what nutrients it does get comes from absorption through the vertebral endplates -- so as the disc begins to lose moisture, it tends to flatten or "pancake." This brings the bones of the vertebrae closer together and can result in a bone on bone situation, which often causes the nerves to be pinched. Desiccation is the beginning step of a degerative chain of events that is often caused by daily "wear and tear" and not necessarily from a specific injury.

I'm not sure from he way the report is written where the disc protrusion is located, but I gather there is one and not two. In any case, a 14mm protrusion is a good size and it has an annular "rent" which I think is what we call an annular tear. This is a tear in the outer layer of the disc and it can be very painful as there are nerve fibers located in this layer. Now surprisingly, apparently this large disc protrusion is not causing stenosis or narrowing of the central canal, the foramen or the lateral processes, which are passageways that run from the disc to the foramen (an opening through which the nerve exists the spine out to the limb). It is this stenosis that causes the nerve at this level to be stressed or even compressed, depending on how much of the space is taken up. But if I'm reading this right, the writer states these areas are "normal." I would think the pain from this injury would be felt in your lower back rather than radiating down to your leg/foot.

[B]L5-S1: There is disc dessication with a mild loss of disc space height. There is central posterior disc tear measures of 10mm. There is a central posterior disc herniation measures approx. of 5.0mm with broad base. There are facet arthrosis. There is moderate stenosis at the lateral recesses and intervertebral foramina with radicular impingement of the bilateral nerve roots. [/B]

The disc located between L5 and S1 is losing moisture which is causing a small loss of height in this space between the vertebrae. There is a centrally located disc herniation with another tear of 10mm. The facet joint or joints (can't tell from report) are showing signs of arthritic change -- they usually begin to enlarge, develop some bone spurs, etc. These two problems often go hand in hand and in this cause it is causing moderate stenosis at the little passageways and in the foramen on both sides which is causing pressure on the nerve roots. The space that is needed for the spinal nerves at this level is compromised by the disc protrusion and facet arthropathy and it keeps them from being able to function normally. They are getting "scrunched" which is probably resulting in pain felt down the back of your leg, perhaps causing some numbness and pain.

Since the MRI is older than six months, things may be different by now...although with your active lifestyle I think it is probably unlikely that the discs have repaired on their own. Generally people with lower lumbar disc problems are told to avoid bending or twisting at the waist, reaching up overhead or to the side, and lifting anything heavier than about ten pounds. When a disc is protruding, any sudden activity could cause further injury. (People also rupture a disc by a sneeze or a cough -- so it isn't necessarily a big move that causes the injury.)

There is a book I can recommend to you to at least look at while you are waiting for other treatment. It is "Heal Your Own Back" by Robin McKenzie. The author is a physio from New Zealand who several decades ago developed a system to evaluate and then treat back injuries and problems. It is a series of exercises that have allowed many people to heal herniated discs without surgical intervention. The exercises are now accepted and implimented by physical therapists all over the globe.

I would be very careful with yoga, particularly if you feel things are getting worse. In general, it is very important to build a strong core in balance with equally strong back muscles when there is a back injury...so keep that balance in mind with any work-out you are doing. Swimming on your back would be better as the spine is not in extension as it is when swimming on the stomach.
Proper spinal alignment is important. You may have some luck with acupuncture -- it would bring fresh blood to the area which might help with healing...but it's been my experience that you have to go for a long time for it to have much affect. But being in Asia, maybe it would be more effective!





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