If it looks, acts, and smells like a rat, is it necessarily so?

[rgsteele]

Hey folks,

First post in these forums, glad to make your acquaintance. I'm no stranger to neurological issues; I've spent the better part of 5 years dealing with thoracic outlet syndrome. I tend to be one of those people that buries their nose in the medical literature and spends endless hours researching, reading, and using that information to advocate for myself. In many instances, I've found that I knew more about my condition than the myriad of sub-specialists I've seen - 13 and counting - mostly because (I assume, anyways) I spend many hours focusing in depth on a single topic, whereas they must deal with many topics and so have a less comprehensive view of a wider gamut of conditions. Although, there are some I'm pretty sure just didn't give a damn, which is part of the reason I've felt compelled to absorb the material and fervently lead the charge for my own health. But I digress...

At the risk of sounding like a know-it-all (which certainly isn't my intention), my propensity for self-education and number of times around the block with this stuff usually allows me to converse intelligently with my healthcare professionals to cut through the BS and get a deeper understanding of the problem more quickly by ruling out processes and procedures that are of little relevance or value. It never surprises me, however, when the dialogue coming from the other end sounds more like a tape-recorded version of the medical literature: there are no original ideas, the arguments and reasoning are rehashed and rephrased as I continue probing for explanations, and I leave feeling like I know nothing more than when I came, except that my bank account is now one co-pay closer to empty.

Here's the scenario: After moving in to a new house (and carrying stuff I shouldn't have, given my TOS), I start experiencing, more intensely as the weeks have passed (about 5 or 6 weeks at this point), lower back pain originating from L4-L5, radiating down into the glute, thigh, and calf, and numbness in my lower leg, foot, and toes. I had an X-RAY and MRI done, expecting to see some sort of disc bulge or herniation. They did in fact find a disc bulge at L4-L5, and evidence of degenerative disc disease at that level as well. "Great," I thought, "it's pressing on the nerve root - case closed, let's figure out what kind of therapy or surgery needs to be done." But, I was told that it wasn't bulging far enough to press on the sciatic nerve roots, and couldn't explain my pain or loss of sensation. Furthermore, they could find no explanation for the symptoms, explaining that it was probably the pain meds I take causing my pain receptors to interpret the signals incorrectly.

I've been told I was crazy or that it's been all in my head before - it's an unfortunate but common occurrence when doctors who can't find the answers get pressed for information. The ego can be a shameful thing in a professional context, and damaging at the expense of the patient. Knowing this, however, I was disappointed but not completely distraught. But, I also know that I'm not imagining numbness and pain. The body doesn't imagine acute pain (it can manifest other types of pain, e.g. fibromyalgia, but acute pain is a different animal) - it's a warning issued by the body to let you know something's not right. But, I'm still new to the lower spine and implications it has on the lower peripheries; I know only as much as there are corollaries to it from the upper peripheries, and probably don't know some of the important nuances that could help me reach a correct diagnosis (or one in the right ballpark).

So, I'd like to ask some more experienced spine sufferers: does pain in the lower back (right on the spine at L4-L5), which is exacerbated by pressing on the spine, bending over, sitting, and other such activities, with pain going down into the glutes and outer thigh, along with numbness in the outer lower leg and in the three middle toes (worsened by bending over), and tingling in the outer thigh and big toe (including the underside of the foot leading up to the big toe), sound like a disc pressing on the sciatic nerve? Or, would you more suspect something muscular around the hip/pelvis area to be constricting the sciatic nerve at a point lower than the spine? Obviously, not looking for a diagnosis here - just some educated opinions from those who have been there.

Thanks, and best wishes!

[Harrison]

RG, a very eloquent introduction indeed, but sorry you are here. I can't post much right now, but in the meantime, you may find this helpful:

http://www.adrsupport.org/forums/f44...me-chart-8663/

I am sure you already found similar references...

[Anne Marie]

Hi RG, your post touched me on SO many levels! I just posted myself for the first time today re pain meds. I have had moderate back pain, mostly lower back since I was 5, I'm 49 now. Last Jan I got out of my car and stood up to pain that put me straight back in the car on my way to the Dr. MRI showed a torn L5 S1 disc w fluid leaking causing extreme inflammation & pain. My x-rays showed such damage that the Drs were in disbelief I only had pain at the site, not on the sciatic nerve. My point, x-rays/MRIs HARDLY tell the whole story.

My 25 yr old son has had an orphan illness called Cyclic Vomiting Sydrome for 10 yrs. It took 5 yrs to get a diagnosis at Mayo Clinic, too many Drs to count said it was "in his head" to the point where it certainly went to his head in the form of deep depression & anxiety. He was hospitalized psychiatrically 3 Xs during those 1st 5 yrs...don't EVEN get me started on Drs egos when they can't figure out your condition!!

I don't have any medical answers for you but want to support you in continuing your quest in finding a Dr who will see your problem through to at least the point of managing your pain. We saw 18 before final diagnosis. I'm sorry you have to go through this. Anne Marie

[annapurna]

It's a pretty difficult thing to deconvolute without some testing. It could even be a minor bulge brushing on a nerve that sends isolated muscles into spasms which press on your peripheral nerves and kicks off your pain. If you get a massage or trigger point work in the hip and pelvis area, do things get any better? Do they stay better for any length of time? Laura fought something like this. Trigger point injections helped for about 20 to 60 minutes but that was it. We convinced ourselves later that other problems were leading to muscle spasms that were addressed by the injections but the underlying cause wasn't affected.

[Rob Wilson]

Wow. This sounds like my situation. I have L4 pain but L4 shows a small disc bulge and mild foraminal narowing. I overdid some yardwork and went into muscle spasm at L3/4. Now I have pain and weakness in front thigh. This could just be a nerve irriation caused by muscle and ligament tightening or a myriad of other things. Not necessarily a surgical situation. Need a good pain management doctor for injections, chiroporactor, trigger point masseuse, etc. before jumping into anything drastic.

[Slackwater]

Originally Posted by rgsteele

Hey folks,

So, I'd like to ask some more experienced spine sufferers: does pain in the lower back (right on the spine at L4-L5), which is exacerbated by pressing on the spine, bending over, sitting, and other such activities, with pain going down into the glutes and outer thigh, along with numbness in the outer lower leg and in the three middle toes (worsened by bending over), and tingling in the outer thigh and big toe (including the underside of the foot leading up to the big toe), sound like a disc pressing on the sciatic nerve? Or, would you more suspect something muscular around the hip/pelvis area to be constricting the sciatic nerve at a point lower than the spine? Obviously, not looking for a diagnosis here - just some educated opinions from those who have been there.

Thanks, and best wishes!

My short answer is yes, it's possible. There are percentages of herniated disc patients with and without symptoms, with varying degrees of herniation. Obvious compression shown on the MRI can result in varying symptoms. A slight herniation can disproportionately create a physical response. I am not qualified to suggest a differential diagnostic.

The Radiologist's written report on the MRI is the first place to look. The verbal from an orthopaedic surgeon is absolutely correct in their context, subject to clarification from a 2nd opinon (radiologist).

Did the orthopaedics gentleman review your MRI's with you?

Did you get a CD-ROM copy of your MRI's? Please get a copy of your MRI and the Radiologist's written report, if you are missing those.

Tight muscle tissue is possible. One orthopaedic gentleman showed me an MRI from around my hip. One slice of the MRI showed "white" tissue, not close to a joint. The orthopaedics fellow showed me the "white area (tissue)" on the MRI with his computer screen, pointing and said "you don't really have arthritis of the hip because this is a muscle in spasm" referring to the white area. The painful area was noted to the general practicioner; he referred me to see if an MVA trauma caused arthritis of the hip.

Your body's response, or context, may vary. However, a slightly innevervated muscle (group) from L4-5 may cause a response out the main dermatome area causing a pressure induced response elsewhere.

[Slackwater]

Originally Posted by Slackwater

My short answer is yes, it's possible.

See also, LINK.adrsupport . The article refers to a "Likelihood Ratio" linking physical symptoms assessed by your physician or physical therapist to an impingement.


2010 Jun 10. [Epub ahead of print] PMID: 20543768
The Accuracy of the Physical Examination for the Diagnosis of Midlumbar and Low Lumbar Nerve Root Impingement

[molarface]

In answer to your question, of course - if you have a rodent specialist looking into it!

I hope to post more on this soon, but after years of trying to get a "back problem" fixed we discovered that the problem was elsewhere and, as you suspect, muscle spasms are responsible for the pain. Many spinal surgeons look only at the spine as the only source of the pain. In fact, all we see on MRI, x-rays etc may be symptoms of another problem. It looks like it was for us. Check out your SI joint - but be forewarned, few spine surgeons will agree that it is the cause. They can't fix it you see................

[annapurna]

Don't give up on repairs to the SI joint. There are options for that as well, non-surgical primarily but in severe cases SI joint fixation might be needed even though it'll likely screw up the rest of your spine.

[Tatonka_usn]

I've been hearing similiar things about the SI joint lately as well. After a bout of EXTREME tenderness (to the touch) in my lower right back (right between the sacrum and illiac crest, the chiro I'm now seeing indicated that my SI joint was completely out of whack. He explained that MANY SI symptoms mimic those of siactica (sp?) and or disc issues, as they are very close together in proximity. They can include: pain in the lower back/buttock/upper leg (though usually not past the knee), typically one side affected (though can impact both), numbness/shooting pain in the anterior thigh (siatica is typically on the outside, or back of the leg), etc. This often leads to confusion as to the root cause, expecially when one problem often contributes to 2nd and 3rd order effects (which can appear more prominent).

In my case, I'm honestly starting to believe that the SI issues are as much the root cause of my problems as the herniated disc, stenosis and facet arthritis. I can't say this with any certainty as NO MD has brought this up as a possible issue, but I'd almost be willing to wager an even money bet that my last 2+ years of deterioration have (in fact) been SI related.

Just some food for thought.....

Alan