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Verity has multiple lower back issues

Jun 21st, 2016

I have lower back weakness, irritation & pain that is brought on when sitting, standing still or pushing, lifting or carrying anything slightly heavy. Most daily task are a struggle & I have to spend most of my day either lying or walking to manage the pain.

It started Oct14 when I put some shoes on the floor, it felt like something went in my lower back & I was left distorted with my tailbone tucked under.

Physio initially helped work out the spasm but prolonged sitting at work sent me backwards & I have been unable to work for 11 months as cannot sit for long.

Scans have shown mildly degenerative disc at L4/5 with mild posterior bulge & a tear, wear & tear in facet joints & right sided pars defect. Steroid injections for facets did nothing then injections for my pars defect made me much worse & caused additional inflammation in the tissue.

Meds have helped but not enough to get me back to normal living or return to work even part time. My latest specialist has suggested a transforminal epidural but I have concerns about having another injection after the pars injection made me 10 times worse than I was previously.

One of my physios said I have core weakness & instability but strengthening exercises have done little to help & since the pars injection most stretching makes me worse.

I am 40, slim & was very active, swimming running etc prior to this. My disability is pretty invisible as I can walk & move pretty freely but when I sit, lift a few things in the supermarket or even push a heavy door I start to irritate my lower back & feel the weakness & if I irritate it enough then the pain sets in later.

Do you have any suggestions?

Jun 21st, 2016

The Guru Responded:

Hi Verity

 

What a sorry state you’re in – I don’t think it’s the end of the road for you, at all. It maybe a too voluminous an issue to fully solve via email and I’d hate for you to feel as if it’s same, same because it shouldn’t be.

 

First up, MRI can be pretty guff – they show lots of stuff, of which what’s normal and what did you have pre October 2014? Nobody knows but I’ve seen 1000’s of MRI which show pathology yet my patient is pain free and patients with severe pain and MRI which shows no pathology. It’s not what you’ve got on the scan but it’s what you do with it that counts – don’t treat the scan, treat the patient.

 

Your pars defect could be total red herring or it could be showing that you’ve got poor load accepting capability through a part of your spine – I’d need to see how you move to comment further…

 

On thing for sure is that stretching your low back will never get you better – it may give you temporary relief, but won’t solve why you need to stretch and in certain cases can make you worse, tomorrow.

 

Your low level activity seems to be pretty good, but when you try to ramp up what you do, the symptoms return. To me this is probably because you don’t have enough work resilience – you need a gradual, but simply paced rehab program that allows you to take more and more load until it becomes normal. Having a weak core and instability are very much part and parcel of what you’ve got, but they don’t sit alone in isolation – you need to have the ability to move better elsewhere (in your thoracic spine especially – make sure you try this stretch

 

So, you need the “right” type of exercise, rather than “just” exercise and so you need the “right” type of person in guiding you what to do next – let me know what part of the country you’re in and I’ll point you in the right direction.

 

You sound fully motivated and ready for a different approach – I agree go easy on letting anyone stick anything else in your back, they need to understand why it made you worse last time and why this time it would be different as the location of the jabs are pretty similar. Fail at decent conservative intervention, then go for it with sharp pointy things!!

 

The Guru

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