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Old 08-04-2011, 06:20 AM   #1
Brad Kay
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Tenderness in Lower Back

I posted this on the Dragon Door forums last evening, but thought that I might share it here, as well, to get as much good feedback as possible!

"tl;dr - given tenderness and sharp pain in my lower back upon application of light pressure, over a year out from acute injury, is it time to finally bite the bullet and go get an MRI?

Hey all,

Some of you may remember that a little over a year ago I posted regarding a lower back injury that I developed at first while swinging, and then later severely worsened while deadlifting. I "worsened" it to the point of being laid up in bed for 5 days, after which point I took to Super Joints and Relax Into Stretch gently but diligently for a period of time, before returning to the Starting Strength template that I have followed on and off over the course of the last year.

By this summer, things had gotten markedly better. Whereas I remained careful with my lower back while warming up and training, I started to go long periods of time without even thinking about it, much less feeling pain or tightness in it. I was finally encouraged that maybe things were getting better, that is until this week.

This past weekend my wife and I drove from St. Louis up to Stevens Point, WI, which accounts for roughly 10.5 hours in the car over 2 days. By the end of that time, my lower back was really feeling it. To make matters worse, we're staying in the dorms on the college campus while she is here for teaching training, and the beds are atrocious. I wake up in terrible pain from head to tail every morning. In an attempt to relieve some of that tension, I asked my wife to message my back, and that's when I was painfully reminded of my lower back problems again.

My wife put a little bit of pressure on my lower back, with both hands palms down together at the wrists, and it was enough to make me scream. This was enough to finally convince me that what I have been praying was just muscular and I could continue to improve is actually more likely spinal and is going to require professional attention. When I first went to the doctor immediately after my injury last summer he said he didn't think it was spinal, but rather my si-joint, and gave me a course of anti-inflammatories to take, which I of course did while resting.

I guess my question is this: given this tenderness and sharp pain upon application of pressure, is it time to finally bite the bullet and go get an MRI? Do all roads point toward likely disk problems that require medical attention? In any case, I think I'm going to go to a different doctor to at least get a fresh diagnosis. Perhaps I'll have better luck this time around.

Thanks much for thoughts and insights."
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Old 08-04-2011, 02:05 PM   #2
Brent Sallee
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Re: Tenderness in Lower Back

Well, the 10 hours of driving didn't do you any good, that's for sure. Do you have any numbness or tingling? Does it get worse when certain postures? How's back flexion? Extension?

It could be a disc issue, but it could still be a ligaments or muscular strain as well (as indicated by the sensitivity to touch). Disc pain and inflammation could do the same thing though. With pain this severe, you definitely should go to an orthopedic surgeon and get an MRI. The pain isn't worth it. Herniated discs don't have to mean surgery so don't think it has to be the worst thing. Just go to the doc, talk about it, ask if you should do conservative care first (PT, ice), and go from there.
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Old 08-04-2011, 03:37 PM   #3
Steven Low
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Re: Tenderness in Lower Back

If they thought it was SI they probably should've referred you to a PT/chiro right away because most of those types of issues can be popped back in place if something had slipped....

I would go the physical therapy route first if that's the case.
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Old 08-04-2011, 05:01 PM   #4
Kelly Moore
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Re: Tenderness in Lower Back

Hi Brad,

Try to get an MRI as soon as possible. PTs and Chiros and Sports Massage Therapists could not find or relieve my extreme pain and movement issues (it became considerably worse when I sat or stood or laid down for any length of time....car rides were utter hell). Not until the HMO would finally agree to the MRI did they discover two pencil eraser sized chunks of unattached disc material in my low back (unfortunately, when disc material is no longer attached surgery is the only option).

Hopefully your situation may not require surgery (keeping my fingers crossed for you), but the longer it goes on without appropriate treatment that an MRI might be best suited to diagnose, the longer you stay in pain and the greater the chance of needless "collateral" damage. If your situation does not require surgery, Louis Simmons has some very good prehab and rehab exercises for back issues. He has saved some lifters from surgery and they are lifting massive weights today.
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Old 08-04-2011, 06:53 PM   #5
Megan Zetter
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Re: Tenderness in Lower Back

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Originally Posted by Kelly Moore View Post
Hi Brad,

Try to get an MRI as soon as possible. PTs and Chiros and Sports Massage Therapists could not find or relieve my extreme pain and movement issues (it became considerably worse when I sat or stood or laid down for any length of time....car rides were utter hell). Not until the HMO would finally agree to the MRI did they discover two pencil eraser sized chunks of unattached disc material in my low back (unfortunately, when disc material is no longer attached surgery is the only option).

Hopefully your situation may not require surgery (keeping my fingers crossed for you), but the longer it goes on without appropriate treatment that an MRI might be best suited to diagnose, the longer you stay in pain and the greater the chance of needless "collateral" damage. If your situation does not require surgery, Louis Simmons has some very good prehab and rehab exercises for back issues. He has saved some lifters from surgery and they are lifting massive weights today.
This is not true as the body can reabsorb discal material.
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Old 08-04-2011, 09:07 PM   #6
Brent Sallee
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Re: Tenderness in Lower Back

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Originally Posted by Megan Zetter View Post
This is not true as the body can reabsorb discal material.
That actually depends. Pencil eraser-sized does make it likely to be a very, very long process. When the symptoms are so bad, a sequestrated disc like that needs to be operated on. Many times, surgery is the best and fastest option in that case, but only in those cases. Most other disc pathologies, as I'm sure you know, respond very well to conservative care.
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Old 08-05-2011, 11:32 AM   #7
Megan Zetter
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Re: Tenderness in Lower Back

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Originally Posted by Brent Sallee View Post
That actually depends. Pencil eraser-sized does make it likely to be a very, very long process. When the symptoms are so bad, a sequestrated disc like that needs to be operated on. Many times, surgery is the best and fastest option in that case, but only in those cases. Most other disc pathologies, as I'm sure you know, respond very well to conservative care.
Brent, I definitely agree with everything you said. But I think people need to know that surgery is not always needed with a sequestered fragment. At times I suppose I should elaborate more on my posts. Thanks for your addition.
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Old 08-05-2011, 03:43 PM   #8
Brad Kay
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Re: Tenderness in Lower Back

Thanks, everyone, for sharing your thoughts and experiences regarding this matter. I ran across this link (WFS) http://www.eatmoveimprove.com/2010/0...ur-lower-back/ in another thread, and given all the categorical qualifications and having performed the self-evaluative tests over the past couple of days, I think that my Dr. was probably right in initially diagnosing my pain as SI joint related, and that I probably just didn't follow a proper course of action over the span of the past year to fully correct the issue, much less further prevent it.

So, I'm considering what is the best route to take to correct what seems to be an SI joint issue, and I'm leaning towards going to a local D.C. who specializes in sports-related injuries, and thus focuses a lot more on mobility evaluation, diagnosis, and restoration, particularly in relation to sport-specific movements, than your average D.C. might. I'm just hesitant to pull the trigger and dump money into professional treatment, as it seems to be rather hit or miss with most people, but I suppose I have to start somewhere.

I'm tempted to pursue things like Z-health instead of a more "traditional" approach to a potential SI slip or rotation, but am I right in thinking that going to a D.C. initially might be a good first step, and then going to a Z-health practitioner once the structural problem is realigned might be a good next step towards future prevention and better all-around biomechanical awareness? What would be your course of action?
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Old 08-05-2011, 05:53 PM   #9
Steven Low
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Re: Tenderness in Lower Back

Sounds fine to me.

It would've probably been 1000% better to get it checked immediately and taken action then but the past is the past... you do what you can now
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Old 08-05-2011, 08:33 PM   #10
Brad Kay
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Re: Tenderness in Lower Back

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Originally Posted by Steven Low View Post
Sounds fine to me.

It would've probably been 1000% better to get it checked immediately and taken action then but the past is the past... you do what you can now
Yeah. This was my first significant injury, and I think I had a pretty hard time determining how severe the pain was in relation to what qualifies severe pain. Moreover, I think I've heard so many stories of kettlebells, or deadlifts, or whatever exercise in tandem with proper stretching and mobility drills fixing someone's back that I figured that I could be one of the lucky number who fixes themselves instead of having to pay and muddle through the myriad of professionals, some more helpful than others. In retrospect, I might've approached things differently.
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