Lower back problems: Any Chiro's, Physio's,

Guys I have a quite a serious lower back problem due to an injury about 16 years ago. I am seeking advice from anyone who's career is in this field or someone that can speak from experience.

few years ago I went to see a chiro, she told me my hips were out of place therefore my 1 leg being a bit shorter. after about 4 sessions there was no change at all and i stopped going.my physio rekons its my core that needs to be strengthened and the pain should go away. the bio-kinet says i have a muscle inbalance and therefore suffer from back pain/spasms.

i am unable to stand or sit for more than a few minutes before the discomfort starts. i cannot run as the pain runs down into my leg and get weeker and weeker. i cant do squats or dead lifts without getting quite a bit of pain during and afterwards. Had to spend few min on the gym floor last night of doing these exercises. if anyone can advise on which route to follow i will really appreciate it. many thanks and look forward to all replies.:S

i dont think your problem has been diagnosed properly. all those things they said are probably true, but your hips being out of place and muscle imbalance doesnt just happen by itself. you have to figure out the cause and treat it. go to a orthopedist, get some xrays and MR scans so you can know whats the main problem and then go from there. good luck man!

THANKS FRIKKIE. DO YOU KNOW IF ONE NEEDS TO BE REFERRED TO AN ORTHOPEDIST BY MY GP OR CAN ONE JUST SIMPLY MAKE AN APPOINTMENT. WOULD PROBABLY NEED X-RAYS TO TAKE WITH?

evening captain.
It sounds like your problem has only been touched on by all these practitioners. From what you've said it sounds like all of those diagnoses may be true and concurrent. The severity and type of injury that you originally had would determine whether it is the origin of your pain, or is unrelated. Unfortunately its impossible for me to give my professional opinion without examing you in person, and there are a large number of possibilities for what is going on in your back. Where are you located and maybe i can be of assistance. Otherwise give me a few more details and i'll see what i can come up with.

hi Spike. i am in pe and you durban? Pity, real pity. appreciate you attending to this matter, i am desperate.

the injury occurred when i was about 15 while playing rugby. what happened was i was on the ground and another player fell on top of me bending me backwards so far that i lost my breathe. my GP at the time took x-rays and said nothing is wrong, perhaps just some muscular strain and gave me a voltaren injection. needless to say it never ever came right. i was also playing cricket and was limited to bowling 4 overs at a time due to my back not being able to handle it. so that is how it happend.

not what you would like me to tell you more. i have told you what i am not able to do. and when that happens say while running on the tredmill or training back, i feel a pain running from my back down into my legs. my legs start feeling week and walking becomes difficult. when i run and the pain comes, my foot would lift lower and lower off the ground till it starts scraping the ground and then no more. my back muscles feel they are permanently tense and nearly everynight i quickly lie down on the hard floor, my back would crack in a few places and my back muscles feel as stiff as can be. i would then move around massaging the muscles against the floor until i feel some relief. sometimes i will hit a spot and it would go into a spasm. this happens mainly higher up my back. muscle relaxer tablets do nothing for me. also when cycling, when i go into the bigger gears and need to push harder the lower back pain would start.

what else you need to know. please advise me and point me in the right direction, thanks

Ok, i have a number of questions for you in order to gain a better insight here.

When was the last time you had xrays of your back done? Were the ones done for the injury the last? The reason i ask is GPs and even radiographers can overlook things that they may not be looking for, so one OK doesnt necessarily rule out compression fractures etc for me, i would always ask for new xrays or to at least see the old original xrays for myself.

The weakness in the legs tends to suggest nerve root involvement, ie a compression or pathology on the nerve root as it exits the spine. This occurs on the postero-lateral aspect of the spine and in such an injury as you described, could occur in conjunction with some form of fracture. It could also be the result of anything less than a fracture, eg a subluxation (or loss of motion of a spinal segment) or even severe muscle spasm. Are there any other symptoms in your legs? Such as pins and needles, numbness, pain? If so, where specifically?

What sort of posture do you have? What i mean by this is, do you have an increased curvature in your lower back, or a flattened lower back?

Any pain or stiffness in other muscle groups? Eg hamstrings

Glad to be of help, and hopefully we can get you on the right track here.

Spike again i just want to express my gratitude and say that i am very thanksful. this problem limiting me in many areas of life and steals away some of that joy. but to answer your questions:

yes, the x-rays done for the injury was the last.
no pins & needles or numbness, but when cycling i would say the pain would run down the outside of my leg all the way down to my foot.
posture, i would say flat.
any other stiffness? Yes. when i got my new bike i went for a compuerised set up, but first they do a flexibility test to determine the setup of the bike. this was done by bio-kinet and turns out my flexibility is rather poor. tight hamstrings and tight glutes. i often do some stretches especially for my glutes and everytime they feel tight, one side being twice as tight as the other side. my right foot is "duck footed" quite badly and was told this can all be as a result of the imbalance in my back muscles that everything has pulled out of alignment. strange how this is the same foot that hurts only when i cycle, a combination of pins & needles which goes to numbness. this however could be something completely different.

i really hope you can help me on the right track. many thanks.

No problem mate, I rather enjoy this as it keeps my mind fresh, provides a nice challenge. Im currently doing my Masters dissertation and it gets mind-numbingly boring, so a good case study is a nice change .

First things first, those xrays need to be either re-done, or at least get someone elses opinion on the original (if they accessable to you). However, let me say now, if there is a compression fracture or the like, it will not likely be treated this far down the line. What the xrays will serve to do is show us what is going on in the skeletal system in terms of alignment and posture. We can also determine, to a lesser degree, any decrease in the size of the foramina (holes) that the nerve roots exit via, and thus chance of nerve root compression. I would love to give you an opinion on the xrays, and this may be possible in the new digital format. What you will need is a full series of lumbar spine xrays (anterior-posterior, lateral, oblique, flexed and extended) and possibly a pelvic view.

In response to your other answers, the lumbar flattenig would likely be the result of prolonged muscle spasm, and will in itself decrease flexibility.

The tightness of the posterior musculature, namely hamstrings and glutes, is in kjeeping with this and can also link pelvic abnormalities to this. Misalignment or loss of motion of the sacroiliac joints can add to the problems we've seen. This would need specific chiropractic attention to correct.

The right foot being externally rotated speaks a lot to me, this is due to the muscle spasm and inbalance, specifically the right external rotatores (specifically the piriformis muscle).

All in all there is a large imbalance of the musculature which has developed and compounded over time. A very careful and complete examination is gonna be necessary to determine the exact issues at hand, and a step by step treatment plan will nedd to ensue to correct the spasm and imbalance, and strengthen appropriate muscles. The way I see a problem like this is almost layered, with certain muscle issues being the result of others and the cause of yet more. There is no single definitive treatment but rather a gradual unravelling of the problem. Bear in mind it took how many years to get to this final point, and it'll take time to correct.

I am thankful that you are treating this as a case study. you sure about the new digital format? then i could get a full series of lumbar spine x-rays done and mail it to you. will inquire about it all. do i need my gp to send me for x-rays or is it something i can just go have done myself? dam there seems to be a lot going on with my back. is it possible that it could be much less complicated or highly unlikely considering all the sysmtoms. can you recommend any chiro's here in PE that would be good? is all this the work for a chiro or is it also for physio and bio? Spike many thanks again. here goes all my medical aid savings:( i look forward hearing from you again.

Sorry to be a bit of a hi-jack here, but Spike, i am in Durbs in about 3 weeks time... can i come see you for a few minutes about my lower back issues??

mr SA, find your own Chiro. this one in mine. kidding. as you can see Spike has been extreme helpful.

MR SA, no problem bro. Im always happy to meet fellow forum members. Let me know when the time approaches and i'll give you my number so we can meet up.

Captain, it is a possibility that it is less complicated, but remember, the body is a very complicated and sophisticated piece of machinery. Even the simplest of issues with it can have untold effects. I do not think you need be so worried about the complexity of this, all injuries are complex in their own regard. What im really suggesting is what appears on the surface is often hiding the real cause, and it is the job of a good practitioner to discover the reality underneath the symptoms and resolve the root cause.
You may be able to get xrays done on your own if you pay cash, but for med aid purposes you will need a referral. I have a couple of friends from PE that studied with me, i dont believe any of them are practising down there but im sure i could sniff out a good recommendation for you. Remember the chiro can also refer for xrays, so maybe save the 200 odd bucks on a docs visit simply to get xray referral , and get the chiro i send you to to make the referral.

Thanks Spike. i await your referal then! and hopefully send you copy of x-rays too.

@ Spike: Sorry man, one more thing, i dont wanna start a whole new thread for..
Who does a person go to if they walk on the one side of their heel?
My shoes ALWAYS ware on the outside!
Thanks

A Podiatrist can help with feet and foot posture. Special in-soles for your shoes can be fitted to correct this. Spike is this correct?

No prob captain, i'll find someone for you asap

MrSA, a chiro can assess the alignment of the feet, legs and pelvis in case that is at fault here. A podiatrist can work more exclusively with the feet.

There are also a number of chiro's that take further podiatry courses and work with feet more.

@Spike. i am seeing a sports dr on Monday, he will probably refer me for rhe x-rays/scans and then take it from there. he is the team dr for the both the cricket and rugby franchise teams here in the eastern cape. keep you posted. and i will wait for your referral.

Hey captain, sorry for the delay. Thre is a guy i know now practising in PE, his name is Dr Hitesh Manga. Give him a ring and see what he can do for you.

Hey Spike. went to sports doc and then my first pysio session today. i am unfortunately a bit discouraged. expected more from physio but then again he knows more than me. basically x-rays looks fine except for spine slightly skew and then my spine to straight which results in the muscles tenseness and spasms. GP says 3-6 months and i should be good. then i went to physio today and he says it boild own to chronic mechanical back pain/problem. asked if i will be sorted out, answer=time will tell. got given a routine of strectching exercises and next week i get a routine for strength exercises. i dont feel great about it again was wondering what your opinion would be. unfortunately its 180mb on disc so i cant email it to you? dont know what to do. try the routines for a month and see what happens or what?

This is tooooo funny...Hitesh is a good friend of mine...call him Mango

you have a number for his pratice?

The exercises will be an important part of the rehab, but a Chiro can offer you a bit more. I should imagine there is alot of immobility in the lower back and pelvis and that can respond well to manipulation. Give Hitesh a call on 041-4812099.

@tintin, Hitesh was a few years ahead of me at tech. Just ask him if he remembers the guy from Wild Hogs...