Back injury filter

August 20, 2005 8:03 PM

Back injury filter

Ive got this back injury that after seeing a chiropractor, a physiotherapist and an orthopedic doctor, rediculously i still dont know exactly what the problem is or how to fix it, so its time to reach out to my fellow mefi colleagues...
A vertebra about midway up my back is either separated, sunk, or has had the 'notch' knocked off, depending who you ask. Dont ask me why x-rays cant get a clear picture of this. Im skinny so if you look at my back with the naked eye you can see the notches of my spine except theres a gap where one is supposed to be. I did that to myself as a foolish teenager. Anyway it feels like the whole structural integrity of my back is compromised. I worked carrying trays of dishes around and eventually strained it and when i went to lie down on the floor to give it a satisfying crack, i really did it to myself. Ill never crack another joint again! I got the whole pain shooting down one leg thing. My back is still weak a year later. Im often asked by doctors if i have Marfan's syndrome which is a connective tissue disorder, but ive had it checked out and it looks like i dont have it. Ive got swollen, sensitive tissue to the right of the injured area of the spine. This makes me wonder if ive got a tendon wrapped around something...
So my options are to get the bones back in place which i think only surgery could accomplish, untangle a tendon, or just try to compensate for the injury by building up muscle, which im doing in the meantime. Im working on ergonomics aswell.
Has anyone had a similar injury or know of good ways to deal with one like this? All i did was roll onto a notch of my spine whilst breakdancing. It didnt really hurt, the vertebra just gave. And that was years ago and it aint fixing itself...

posted by GleepGlop to Health & Fitness (14 answers total)

Pain down one leg and swollen, tender tissue sounds more like some sort of disc injury. Like a herniated or ruptured disc (which can certainly come about from some sort of extreme vertebral torsion...like cracking your spine)

In any case, one way or another, you will probably need to get some work done. I'm simply amazed that the raft of doctors you apparently have seen have not been able to diagnose anything.

I ruptured a lower disc about 17 years ago and let it go until the pain was so bad I literally couldn't walk. I had to crawl about the house to get anywhere, and even that was painful.
posted by Thorzdad at 8:12 PM on August 20, 2005

Pain being driven somewhere other (your leg) than where the initial injury (your back) is usually caused by a nerve problem somewhere along the line. In this case, my money's on your Sciatica Nerve, which is commonly affected by back problems such a herniated or slipped disk.
Randomly enough, if you're like most guys and put your wallet in your back pocket and sit on it, that can cause pinching of the nerve causing pain with the removal of the wallet fixing the problem (I know your problem is beyond the scope of your wallet in this case, but just FYI).
And I don't mean this as a "Go see a doctor" post, but I would recommend asking around for the el primo back specialist is town. Maybe try a doctor who's also known to work on major sports athletes- they will cost you more, but it really is for a reason.
Lastly, coming from a family whose mom worked in the neurosurgeon floor of a hospital, I would be very weary of letting any ole' chiropractor actually mess with your back beyond a deep message. She saw her fair share of people who became severely injured from chiro's, and it was usually with someone who already had back problems because they're more susceptible to further injuries.
(dangit, herniated isn't it the dictionary? Bah!)
posted by jmd82 at 8:23 PM on August 20, 2005

A dear friend and Mefite (jklr) is busy recovering from surgery from a very related problem.

It sounds like you're deal with a nerve impingement -- as to what's impinging, who knows? Simple X-rays are limited -- if they're not shot from the right angle, they don't see anything. This is why we developed CAT scans (stacks of X-rays, taken at different angles and assembled by computers), and then took that technology and changed the imager (MRI).

Chronic inflammation is indicative of a long lasting, non-healing injury. As to what, I don't know.

jmd82 is right -- you need the back guy. Best way to find them is to work with your GP, possibly in consultation with a sport related osteo surgeon. The big kicker you need to point out -- you have a back injury that's referring pain to the legs. (jklr found her's the other way -- ankle/leg weakness that didn't show any identifiable leg injury, so the search widened, and found very damaged discs in the lower back.)
posted by eriko at 8:45 PM on August 20, 2005

Response by poster: Heres a couple of questions: Should i sit without a back support to train my back muscles or will that just make my back stiff? (it certainly does in the short term...)
And: I know the best way to sleep is flat on my back with a firm matress, but i get stiff and need to roll onto my side eventually. If i put on more muscle would that prevent the firm mattress from causing me discomfort? Because otherwise im thinking one of those snug cocoon-like hammocks that dont let you move...
posted by GleepGlop at 8:47 PM on August 20, 2005

What tests did you go through to rule out Marfan's? Are there any other connective tissue disorders that resemble Marfan's but haven't been ruled out? I only ask this because my roommate has Marfan's, and I know it took for effing ever to actually diagnose it, and it seems to be a tricky diagnosis to make. It seems suspect that your doctors would suggest Marfan's just because of back problems. Is there something else there that indicates it? I wish I could help you out -- I also have a weird back (hypermobile vertabrae), due to an injury when I was 12, but it can usually be taken care of by physiotherapy and working on my abdominal muscles, but it sounds like your situation is rather different.
posted by Felicity Rilke at 10:08 PM on August 20, 2005

The only thing that worked for me is a sturdy bar to hang from, do chin-ups, shake legs, etc. Start out easy. Do it immediately (can't stress that enough) after a long rest or sleep, when your back muscles are relaxed. Not only does this provide traction, but it strengthens your back muscles, which is difficult to do otherwise, since most anything else involves pain. Don't be a hero--do not lift weights, furniture, etc., Ask someone else to move that mattress. Do this for a month, and I guarantee you'll be a new man.
posted by weapons-grade pandemonium at 10:29 PM on August 20, 2005 [1 favorite]

Response by poster: I mentioned marfan's because i guess it makes peoples joints more loose and possibly more prone to injury. All i know is that they say cracking joints is harmless, but its permanently screwed my joints up.
This is a chronic injury. This aint going away by itself. Its funny, my back feels like crap after spending an hour doing light cleaning, but i spend an hour a day at the gym lifting weights and i feel better than new.
posted by GleepGlop at 10:48 PM on August 20, 2005

Wait... you have an unidentified back injury and you are lifting weights? I STRONGLY recommend you find out what is wrong with your back before intentionally and repetitively lifting heavy objects!

Have they done an MRI of your back or just some X-Rays?
posted by Justinian at 12:21 AM on August 21, 2005

There are lots of generic back exercises suggested for anyone with any kind of back injury, identified or not. I didn't get an MRI or even Xrays until March of this year, and I've been lifting/working out with an unidentified back injury for over 20 years.

Lifting weights/working out is the *only* thing that kept me from having surgery years ago; and is the reason that I could walk around without a walker two days after I finally did have surgery. Surprised the heck out of the PT. {Surgery entailed clearing the junk out of two joints, and screwing together two pairs of vertebrae; so two PLIFs (Posterior Lumbar Instrumentation and Fusion).}

The original damage was done over 20 years ago, and I was familiar with the usual manifestations of a pinched nerve due to a herniated disk. The weakness was a new one (especially since it came without the usual precursors of pain and loss of sensation).
posted by jlkr at 9:36 AM on August 21, 2005

If it was me, I'd go see my GP and ask for them to arrange an MRI. Then depending on the report I would then ask for a referral to see another Ortho. I would be cautious about my physical activity if I had symptoms you describe - at least until a diagnosis was confirmed, but that's me and I'd want to do anything to avoid jlkr's surgery, were it at all possible.
posted by peacay at 9:46 AM on August 21, 2005

First off, from the age of 21 on (our bodies are not built to last), the disc material starts to lose elasticity and fluid. Many people are walking around with herniated discs and never know it....because they're not impinging on a nerve.

Previous threads here and here

As I mentioned in both of those threads:
The lower back can only sustain about 20lbs of weight structurally. Everything else is done muscularly.
It appears to be that you cannot strengthen the back without a large degree of isolation (traditional exercises don't cut it.)

I'd absolutely find the orthopaedic doctor in your area who specializes in backs. He'll do an MRI. And then likely tell you that you need to be cut (as that's what Orthopaedic doctor's do.)
posted by filmgeek at 10:29 AM on August 21, 2005

Actually, filmgeek, a *good* ortho will not recommend surgery right away. They'll try, in order (at least in my experience): physical therapy with a specialist to strengthen the muscles in the back and abdomen; steroid injections into the spinal column to relieve any inflammation (repeated, if it works the first time); a back brace in conjunction with the injections; and as a very, very, very last resort, surgery.

My ortho has patients who are doing just fine with a steroid injection every 9 months, and have been for 2-3 years. I fast-forwarded through all of that, as none of it worked. (I actually had the PT tell me that I didn't need him, and to just cancel the rest of my visits because there was nothing he could do.)

And despite what WGpandemonium says, traction (hanging) doesn't always work. It made my symptoms worse, fortunately only on a temporary basis.
posted by jlkr at 4:42 PM on August 21, 2005

IAAD. Yup. Orthopod, at that.

The only advice in this thread that is correct is the likes of jlky's. There is a lot of misinformation out there (and up above in here) that is not only incorrect, but potentially harmful.

Back problems are extremely common (that's why everyone has some experience with them!) and typically benign, going away on their own. However, in the few cases when they are serious, they are very serious, and might require some intervention to fix.

It is unfortunate that you've had so many differing answers given to you. What you need, no doubt about it, is an orthopaedic surgeon with whom you can have a trusting relationship. If it means getting another "second" opinion, then that's what you should do. I agree with the advice of having your primary care doctor's assistance in finding such an orthopaedist.

jlkr is right. A good orthopaedic surgeon will only perform surgery as a last resort. Especially in the spine.

With all do respect, I can't reiterate this enough: much of what has been suggested and theorized in this thread so far is outright incorrect. Only someone who can ask the right questions of you, examine you, and look at your films can give any worthwhile advice to you.
posted by Dr. Sam at 7:13 PM on August 21, 2005

IAAD - neurologist, too - and I second everything Dr. Sam has said. Much of what has been suggested in this thread is downright incorrect and I wouldn't offer an opinion in this thread for love or money.

Except that, yes, what you need is a physician with whom you can develop a trusting relationship. Wouldn't have to be an orthopedist - it might be a neurosurgeon, neurologist, physiatrist, or a good internist or family practitioner.

This stuff is hard. If you could easily diagnose and suggest correct treatments over the net, or over the phone, don't you think we docs would have caught on to that by now?
posted by ikkyu2 at 8:29 PM on August 21, 2005