Doctors Lounge - Rheumatology Answers
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Forum Name: Rheumatology Topics
|maverick5687 - Mon Nov 10, 2008 1:56 am|
About 2 and a half months ago, I was at work and was lifting very heavy objects (100-120 lbs working in ankle deep mud) constantly over about a 2 hour period. My back hurt quite a bit, but i thought I was just sore from work like I usually am. However, over the next week to two weeks my pain developed into more than just soreness. I started experiencing muscle spasms, severe pain, debilitating cramps, and started to have trouble sleeping. I have been to two different doctors, had X-Rays and MRI's done, and all were negative. The doctors didnt really know what it was but said it was a strained muscle. Now I am not a wimp when it comes to pain. I played sports for a month with a torn labrum in my shoulder thinking it was just normal soreness. This pain in my lower back is unbearable, and brings me to tears at times. On a scale of 1-10, 10 being the worst, tonight it reached a 10. On top of spasms and cramps from my lower back into the back of my legs, my girlfriend noticed swelling in two different areas of my lumbar, which happened to be 2 of the areas where I was experiencing much of my pain. While massaging my back, she pushed with her fingertips in the areas of swelling (both areas were just on either side of my spine). When she did this, I could not help but cry, and I NEVER cry over physical pain. I KNOW that this is not a muscle strain, could it be a bulging or herniated disk? Please help me figure out what this is!!
|Tom Plamondon PA-C - Fri Nov 14, 2008 5:18 pm|
The MRI would show a bulging disk. There are however small joints in the spine called facet joints which can become inflamed and cause pain and ...there are small ligaments, tendons and even very small muscles in the spine area (that help support and stabilize the column) which can become tender, swollen, and inflamed...not to mention the large "strap" muscles that run the length of the vertebral column which often go into spasm.
Spasms cause pain. Swelling and inflamation cause pain. Sprained structures supporting the back cause pain. Immobility causes stiff structures which when moved cause pain.
So the level of pain is not surprising ...even without a herniated disk!
Treat the symptoms with heat or ice packs (or both); NSAIDS, rest, and walking as tolerated. Prescribed muscles relaxers may help. Refrain from lifting, bending, twisting, pushing or pulling or carrying until the back heals.
Any restrictions should be in writing from your family physician or occupational health doctor.
Watch for numbness, tingling or weakness in the legs; inability to urinate; or numbness in the pelvic area (the area which would touch the saddle while riding a horse). If present, seek medical attention ASAP. This may indicate the spinal cord is being pinched.
Since the pain has lasted beyond the typical one month mark (most acute low back pain resolves in one month) and the MRI is negative. It is time to see a Physical Therapist to start rehabilitating the back. It is important to break the pain-spasm-pain cycle and allow blood flow into tense and tight soft tissue.
This allows healing. Your back should improve with time and therapy.
|maverick5687 - Sat Nov 15, 2008 3:46 am|
Tom i thank you for your insight. Is it possible that if, during the MRI, I was spasming enough that a disc issue would not be visible due to the movement during the MRI?
|Tom Plamondon PA-C - Wed Nov 19, 2008 7:00 pm|
I wouldn't think a muscle spasm of the lumbar paraspinals would reduce a disc herniation (conceivable but not probable).
I would think that the entire MRI quality would be poor if lots of movement occurred during imaging.
Localized low back pain with spasm does not necessarily equate to herniated disk despite the pain level. Spasms are the body's natural response to injury - it says, "Don't move, I'm injured and hurt".
Healing takes time but also may require a manipulation or mobilization of the spine to realign malaligned structures. Moving misaligned inflamed structure can hurt and cause spasms chronically.
I would stick to my original recommendation to see a chiropractor or manual physical therapist for assessment and appropriate management.
A repeat MRI with contrast or a bone scan may be an option but I am not sure how much you would gain with these. An experienced orthopedist or physiatrist may offer their opion.
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