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Old 02-20-2008, 09:45 AM   #10
Scott Parker
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Join Date: Dec 2002
Location: Denver  CO
Posts: 489
Re: piriformis symdrome, rotated pelvis, lumbar sublux, out of comission for a while.

so after waiting a month to get an appointment with this doctor that my PCP referrered me to, i think i finally know what is wrong with my back and the good news is that i am most likely going to make a full recovery. this is absolutely amazing news because i have been living with this for over 5 years since the initial inury, and as a result other issues and injuries has arisen from that initial trauma. in the few weeks leading up to the appointment the piriformis syndrome had gotten so bad i couldn't sit for longer than 5 minutes or stand still in one place without moving around without experiencing horrible pain.

the doctor i went to is an osterpath, and he is double boarded in pain mgmt and rehab medicine. seriously, this doctor was amazing. not only did he not rush me and took the time to actually listen to me and explain everything (the original injury, how i've dealt with it over the years, the activities that i participate in inclding crossfit), he performed the most detailed and thorough physical exam i have ever received. we also went through every slide of the lumbar and pelvic MRI i had done two weeks prior.

there is a lot going on with my back, some of it i didn't even realize, and some things i was told i had that i thought were casue for concern, that ended up not being that serious. in the original dictation (who knows who even performed this dictation of the MRI) all it said was that i had degeneration around L5. from what i know now this is pretty much entirely common in people my age (31, soon to be 32 in a few weeks). after viewing the MRI the doc also saw a small bulge of the disc at L4, but it was so slight that he is pretty confident that this isnt causeing the bulk of my symptoms, but there is a small amount or nerve root impingment. also, the MRI showed that i have a narrower spinal canal that most which means that the potential for pressure on the cord and nerve roots is greater for me since i have less margin for error and less to work with, but otherwise my MRI really wasn't that bad for a healthy, active 31 year old. so i asked the doc, so what the hell is wrong with me? i am in a ton of pain.

so, like i mentioned above there are a few things going on. He diagnosed me with facet syndrome and said that i have a tendency to hyperextend my lower back. i noticed this a while back when doing push jerks and dip drives while looking in a mirror at my profile. i would always make a conscious effort to correct it, but one slip would jack up my back if i didn't keep the strictest form. for this he prescribed postural relearning therapy, which is a form of PT.

Another problem, which has been causing me tremendous amounts of pain for years is my right SI joint. on physical exam when the doc palpated my right SI joint i nearly hit the roof, as it felt like someone flipped a switch and shot a large amount of electricity into my butt cheek. for that he prescribed PT as well.

He also confirmed the diagnosis of piriformis syndrom and, surprise, ordered PT for that as well. The piriformis syndrome had gotten so bad the pain was now radiaiting in my legs and hurt to just stand around.

He also told me that my quads and hams are strong, hipe flexors are stong as well as abdominals, but there is a serious imbalance in my pelvic muscles, which is one of the reasons that i tend to hyperextend my lower back. it's also the reason why my hamstrings are so tight. the postural relearning will target these pelvic muscles, realign my pelvis, open up my lower back and loosen up the hamstrings.

I was also placed on a 6 day taper of oral steroids which will hopefully knock down a lot of the inflammation and give me relief, (i am on day 2 of the steroids and am already experiencing relief) and Diclofenac, which is an NSAID taken by mouth, and a transdermal NSAID patch to apply to my lower back. i am supossed to start the NSAIDs once i finish the course of steroids. my primary doc had given me a muscle relaxer (skelaxin) the week before because the pain and spasms were so bad, but i stopped taking those after two days because i coudn't really function on them. they gorked my pretty bad.

i have to call this morning and schedule my PT, and will keep everyone posted on my progress. One thing i would like to mention, is in another post the debate was brought up whether or not an MRI would change outcomes or course of treatment. i think in my case it may have made a difference. another doc may have treated my symptoms as a disc injury and been prescribed a totally different form of rehab, but who knows. i honestly think the thing that made the biggest difference in my plan for treatment though is that fact that the doc actually took the time to listen to me and did a thorough physical exam and history and didn't rush me out the door.
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