Nuts...

[sogood]

15 pages and going... Yep, this is certainly consistent with management of LBP. They fluctuate and last close to forever (too often than not).

Good luck with your latest treatment plan TLLs!

[scotto]

The neck damage won't heal (discs worn away) but at least the headache I had for 2 years went away. And I can ride the bike a fair bit.

Yes now also have it in the cervical vertebra, My lower back is fine since discectomy, now I have to take care with lifting but I can feel nerve pain down my arm, especially when I am tense and holding the bars on the drops.

dr noel dan (AT) edgecliff does a great neck....

[BruceGray]

Hi BruceGray,

You sound like you came out of the same school as (now deceased)Dr Kelvin Hobbs. He was a sports medicine specialists that I saw for tendon,ligament and fibres around the ligament damage, and he had me doing the ice thing for 8hrs a day and then exercise until pain came back for a week and then 4hrs for the next week. Painful as hell, but it did the job really well.

Hi Foo. I haven't heard of Kelvin but know several guys born in the early 20th century who had a more intuitive and effective approach to healing musculoskeletal complaints. Today, GPs and specialists rely too much on diagnostic imaging and anti-inflammatories, and not enough on sensitive orthopaedic assessment and icing. Further, few medicos or physios actually "manage" m-s injuries. They outsource it or give patients instructions to self manage. Most physios I know are reticent to tell clients to ice anymore than 3 times a day with 6 ice cubes in a commercially produced ice bag, which might be ok for a sedentary 75 year old with poor peripheral circulation. However, a healthy sports enthusiast needs more aggressive treatment in my experience....and compression in between.

Physios worry about ice burns, where the subcutaneous capillaries and tissue are damaged by being overly cooled. However, when crushed ice is used appropriately in 1-3 layers of 100% cotton toweling, ice burn risk can be largely reduced. The other thing that is important to do when icing aggressively is to ensure adequate hydration. (drink until your pee is as light as chardonnay or sav blanc). This ensures you have enough blood volume and interstitial fluid to conduct heat out of the body along the temp gradient towards the ice source.

Further, the most noted scientific studies of ice therapy showed optimal cooling occurs after 18-20 minutes of application. However, these studies were limited in their methodology (did not involve persistent intense pain, did not weight as heavily subjective pain scores, did not deal with deeper musculoskeletal trauma, did not deal with pain originating from within joints).

Headaches
Re neck pain and headaches, this is the one area I think physios can be cost effective. Many headaches, even migraine type, originate from inflammation in the C01,12,23 facet joints of the cervical spine, with often a catalyzing role by joints at C67,78,8T1. These joints are universally prone to tightness and poor circulation in westerners who experience high stress sitting at desks for hours and hours every week. This can be exacerbated by the road bike riding position. The pathophysiology goes like this:
- work or study stress leads to chronically tight shoulder and neck muscles, and a tendency to poke the chin forwards and tense the jaw muscles.
- this compresses the neck joints depriving them of healthy fluid turnover which is required for lubrication and nutrient and oxygen delivery. the joint surfaces also grind more heavily on each other, accelerating joint degeneration.
- eventually an acidic environment builds with excessive metabolic waste. This irritates the local pain nerve endings, which then send pain signals the brain. However, the brain interprets the pain signals as originating from the head (like a tight band around the head, often worse on one side) and often a tight dullness behind one eye.

Effective immediate therapy is to aggressively ice upper neck (top 3 joints either side) for 30 mins on 30 off until pain subsides to less than 3/10 pain, drink as much water as required to rehyrdate (often headaches are contributed to by dehydration in addition to muscle tightness), and take anti-inflammtories if tolerated.

A physio can ease the irritability and re-occurance of headaches by 'mobilizing' the upper three cervical facet joints either side, in addition to lower levels where needed. This can be very painful initially but the more vigorous the mobilization, the quicker the resolution of chronic headache. Some adjustment in posture and regular movement of the joints is generally enough to keep headaches from reoccurring.

Headaches that do not respond to reasonably aggressive therapy as above within 2-6 weeks, should be explored further by GP and orthopedic or neurological specialist. BTW, none of what I say is meant to be complete and definitive advice. It is meant to be educational, and best used by discussing with your health care provider.

[toolonglegs]

I tried icing for two days...but I didn't have much luck.Actually I was in a lot of pain Saturday.

I can either put this down to two days after the Osteo's treatment...or icing.5 nurofen 400's and an anti-inflam and anti-depressant at night only just bought it under control.Also I tried sitting with the bike on the trainer...but I sat bolt upright and only turned over a light gear...only managed about 15 minutes.

All pain seems to be in the lower back and hips.Not too much in the groin or leg...but still a bit at times.Flexiability went out the door as well...could hardly touch my knees.I notice a hot bath and heat pad rapidly improves my toe touching ability and reduces symptoms.

Anyway I am not sleeping as well as I used to and pain levels are OK...but I am on 3 Nurofen 400 a day.Staying away from a constant dose of anti-inflam's cause I hate them!.

I am stretching and doing my McKenzie type exercises a lot which may account for some of the problems.

Anyway I don't enjoy hitting the nurofen the moment I wake up... .

[cpical]

Spent 10 days in Byron Bay over Christmas/NY. Our bed was a bit narrow and not accommodating for our (wife and I) weight difference. Weather was 150% humidity for the first 5 days, almost constant rain. And my left hip pain re-appeared after a few days (don't remember when exactly). Now, it is gone. I have mentioned before that I used to be a hardcore (without adequate knowledge) proponent of hard mattress, and a victim of nasty left hip pain, until we bought a "proper" bed, with the middle mattress adapted to the sleeper's weight. I will not bother you with that again, but was wondering whether you had tried different mattresses.

[toolonglegs]

Been travelling around a fair bit lately...lots of different beds...including the hardest bed I have ever slept in while London...might as well have been kipping on the floor.Doesn't seem to make much difference.My personal bed is the best.

[ireland57]

The neck damage won't heal (discs worn away) but at least the headache I had for 2 years went away. And I can ride the bike a fair bit.

Yes now also have it in the cervical vertebra, My lower back is fine since discectomy, now I have to take care with lifting but I can feel nerve pain down my arm, especially when I am tense and holding the bars on the drops.

dr noel dan (AT) edgecliff does a great neck....

Thankyou. I've had an MRI and the surgeon told me it's too close to stuff (brain) to touch. I told him there was only a few cells to dodge and if my memory was left at .01% intact it would be an improvement but .....Nope can't happen.

[BruceGray]

I tried icing for two days...but I didn't have much luck.Actually I was in a lot of pain Saturday.

All pain seems to be in the lower back and hips.Not too much in the groin or leg...but still a bit at times.Flexiability went out the door as well...could hardly touch my knees.I notice a hot bath and heat pad rapidly improves my toe touching ability and reduces symptoms.

TLL, I take it you are traveling in the UK currently. Probably been sitting up more on long flights? bus/train? strange beds? lifting back packs or suitcases? Walking around on paved city streets that much more?

Apart from all that, can you explain what you mean by your flexibility going out the door? what flexibility are you talking about?

When you say you can hardly touch your knees, how do you test that? standing up, lying in bed?

Can you also explain exactly how you did the icing? how much ice? what type of ice? shaved, cubes, how much and for how long, what position were you in, and what did you put between the ice and your back, and where on your back did you put it?

When your back pain is acutely inflammed, as in pain is over 6/10 intensity, it is better not to move your back around much at all, which means little to no McKenzie exercises. You have to think of your lower back as a knee joint. If you knee was really painful and inflammed, would you keep bending it and walking around on it? No, you'd ideally rest it, ice it, wear a compression bandage in between icing, and elevate it. The same principles apply to the lower back, though hard to elevate it.

[toolonglegs]

I tried icing for two days...but I didn't have much luck.Actually I was in a lot of pain Saturday.

All pain seems to be in the lower back and hips.Not too much in the groin or leg...but still a bit at times.Flexiability went out the door as well...could hardly touch my knees.I notice a hot bath and heat pad rapidly improves my toe touching ability and reduces symptoms.

TLL, I take it you are traveling in the UK currently. Probably been sitting up more on long flights? bus/train? strange beds? lifting back packs or suitcases? Walking around on paved city streets that much more?

Apart from all that, can you explain what you mean by your flexibility going out the door? what flexibility are you talking about?

When you say you can hardly touch your knees, how do you test that? standing up, lying in bed?

Can you also explain exactly how you did the icing? how much ice? what type of ice? shaved, cubes, how much and for how long, what position were you in, and what did you put between the ice and your back, and where on your back did you put it?

When your back pain is acutely inflammed, as in pain is over 6/10 intensity, it is better not to move your back around much at all, which means little to no McKenzie exercises. You have to think of your lower back as a knee joint. If you knee was really painful and inflammed, would you keep bending it and walking around on it? No, you'd ideally rest it, ice it, wear a compression bandage in between icing, and elevate it. The same principles apply to the lower back, though hard to elevate it.

Hi Bruce...OK.
Yes I have been traveling a lot lately.But I am home now (France).I did suffer a lot on the flight as it is about 40 hours traveling time.So I have been home for 10 days now.

Flexibility...my osteo has me doing the McKenzie exercises...he says the most important one is when standing I do a backwards arch of my back with my fists in the low of my back.Hold it for a few seconds then go forward to touch my toes.He says the going forward not to push hard and that it is not as important as the backward arch.To do this at least 5 reps once a day...but if I want to do more then do as many as poss.I notice some days I can hardly touch my knees when leaning forward...where as a good day I can touch the floor with my fingertips...after a hot bath it is pretty easy to do that.So I am not sure why this can vary so much from day to day.
My main ham string stretches are done staning with one leg between knee and waist height on a chair and leaning forward slightly...this is actually a bit painful and I seem to be very tight in my hammies even thou I feel no pain in them apart from the light stretches.
The reason I am going on about my hammies is there seems to be a correalation between the days they are very tight and the days of most discomfort.

For the icing I have been using frozen peas...1 kgs bags straight onto my skin.I can keep them there no problem until they are not so cold any more (about 15 minutes).I do this while lying down in another McKenzie position (not sure what it is called but lying flat on stomach resting on elbows under my chest,so a slight arch in my back).3 or 4 times a day for 2 days I tried.Ice mainly from butt croack to 6 inches above.

Pain level in my back varies from maybe 3/10 to 6-7/10...but it is constant and requires pain killers to get on with life.THe nerve pain in my mainly rh thigh (front - femoral?) is about 8-9 / 10 and is pretty hard when it comes in constant waves...it has settled down a bit from a few days ago when I tried a ride.Was very bad near the end of the flight.When the pain is in the higher levels I just take pain killers and lie on my back...when it is lower I do a lot of different stretches on the psosas,ham strings and glutes,piroformis etc.I also do a bit of light core strenght stuff.

So at the moment most pain is a dull pain 3/10 in my lower back...much better than the weekend when walking was a bit uncomfortable.Also in my hip joint area...not specific...a little bit of groin and my lower abdomen muscles.

Phew!...cheers for giving me a hand btw...much aprecciated.
BTW...I have a pre-colonoscopy appointment on the 28th just to check that out...back pain is definately worse when I need a crap .Also going back to my GP to see if he can think of anything else to look at.Spinal surgeon app is end of Feb.

PPS...selling my powertap .

[toolonglegs]

Also...is it possible that tight hammies / psoas etc can cause this much pain and for it to become chronic?.

[BruceGray]

OK TLL,

what's causing the pain
I have no hesitation in offering that the pain is discal in origin. That means one or more of your lumbar discs are bulging or herniated backwards onto nerves. Read this article for an understanding.
http://en.wikipedia.org/wiki/Spinal_disc_herniation

Now it is also possible you have other structural issues that make the bulge worse, like
- Spondyllolisthesis, where one vertebrae has moved too far forwards relative to the vertebrae it sits on.
- compromised gaps between the vertebrae for nerve roots to come out.
- moderate scoliosis (mild scoliosis often does not cause issues as severe as yours)

The pain will not be 'caused' by the piriformis or tight hamstrings. These muscles always tighten up when the lumar discs are inflammed and painful. They are trying to act like a brace to stop you from moving the discs around further. Once the pain settles, these muscles usually relax and you have no trouble regaining length.


what to do about it

No one can say whether you have a slight bulge or a more advanced herniation. High resolution imaging would be required. However, to settle the pain, the treatment is similar. So,

1. DO NOT sit, lounge, or slump with your back flattened or flexed forwards. by this I mean you must maintain the arch in the lower back, which can best be done by using a small pillow, rolled up bath towel, or chair with a good lumbar support.

pic of lumbar curve which must be maintained.


This is really really important. Every time you sit with a slump or with the lumbar arch flattened, you are causing further damage to the already damaged discs. This will perpetuate the inflammation.

Best way to sit to stop irritating the lumbar discs.



2. DO NOT sit for longer than 45 minutes. get up regularly and walk or lay down. The longer you sit, the more you drive water out of the discs and flatten them. This irritates them and makes the pain worse, as does doing lots of walking or bending forwards. So you can see how the travel has made your disc/s angry.

3. REDUCE the amount of walking or activity for a week. Walking will irritate the discs. Don't do hamstring stretches while the pain is >5/10. and when you do hammie stretches, do not reach towards your toes, either in standing or sitting on floor. This hurts the discs. Don't get on a bicycle.

4. Spend more time lying down on a flat firm bed or lounge. Do not prop your head and trunk up on pillows or the lounge so that your lumbar spine is flexing. Lying on your side, tummy, or back is ok. When on your back, you may find it more comfortable to have several pillows under your knees. When lying on your tummy, you may find it more comfortable to have a pillow or two under your belly.

5. A BRACE can be hot and uncomfortable, but they can also help immobilize your discs while sitting and standing, help prevent you from slumping, and thereby allow the irritation that perpetuates inflammation to settle down. the idea would be to wear it while sitting and walking around, and take it off when lying and sleeping. if you had an inflammed ankle or knee, you'd do well to put a supportive and immobilizing brace on it. Well it is the same for the lumbar spine. Your discs need to rest and stop being moved and squashed by sitting for long periods, bending forwards, slouching, or picking up weights.



6. STAY WELL HYDRATED. Your discs need water in them to maintain their height and help circulate nutrient and oxygen.

7. EAT less wheat based starch - bread, pasta. Instead, eat low gluten foods like rice, and increase your intake of salad and steamed vege. Food high in gluten can exacerbate inflammation. Salad and vege help reduce inflammation. Adequate water helps reduce inflammation. Alcohol worsens inflammation as does anything with sugar like soft drink.
http://www.spinalcentres.com.au/article ... iew&id=449

8. DO NOT do any movement that involves reaching towards your toes, whether when you are standing or sitting. These movements require that the lower back flex forwards and this will make lumbar discs bulge further back and risk increasing the herniation. I doubt your osteopath meant for you to bend towards your toes when your back pain is exacerbated. Further, bending forwards towards your toes is NOT a McKenzie's exercise.

This is an example of what I mean by McKenzie's exercise, but you don't want to do it if your pain is >6/10 because that means the discs are still inflammed and any movement will irritate.
http://www.youtube.com/watch?v=Aj88fw0PRLE

9. ICING with a pack of peas, even 1kg, is not adequate. You need at least 3 trays of ice cubes, that are then crushed. You want 1-3 layers of wet tea towel between skin and ice. A pack of peas puts a plastic barrier between the ice and skin, and reduces how deeply the cold can penetrate. The discs are very deep down and hard to cool if you do not do it the way I suggest. Ly on your tummy with pillow under tummy, and put a couple of bath towels under your belly on top of the pillow to soak up the ice as it melts. The ice may be painful for 3-5 minutes but then that should settle. You can ice as much as 30-45 minutes on, 30-45 minutes off until pain goes below 5/10, then reduce to same duration for 5-7 times a day. After icing, wear a brace and don't do a lot of walking, and if sitting, get up every 45 minutes for 5-10 minutes.

10. As the pain settles under 5/10, you may find a little back massage relieving, but it is only helping to ease muscle spasm. The back muscles spasm to brace the back to stop the discs from moving, same as the piriformis and hams.


Finally, when you have a full blown acute herniation, hospital treatment is enforced bed rest for 3-8 days, with a weight attached the pelvis to apply traction to the lumbar spine, benzodiazpines to relax muscles, anti-inflammatories, and pain killers like morphine, pethediene, tramal.

[fatherofmany]

Hi TLL,

I had a problem a couple of months ago, my back was out and no matter what, I couldn't get it right. Pain every day.

So I looked at what had changed over the previous few weeks and... I had bought a new backpack. I went back to my old one and voila, back pain disappeared. The 2 backpacks have different contours and the newer one just didn't fit properly.

It could be as simple as that... you say you've been travelling around alot lately!

FoM

[Quinns Rocks Roadie]

BruceGray - thank you, very good information, precise and concise.
Can such a disc condition in the Lower Thoracic/Upper Lumbar region cause internal abdominal cramping and pain ?.

Eric.

[BruceGray]

BruceGray - thank you, very good information, precise and concise.
Can such a disc condition in the Lower Thoracic/Upper Lumbar region cause internal abdominal cramping and pain ?.

Eric.

Hi Eric, yes. The symptoms can either be directly related to pressure on nerves related to that spinal region, or secondary as in the back pain is causing secondary spasm of intestinal peristalsis, which leads to nasty cramping.

It is a good idea to have a GP keep an eye on your symptoms. If you cannot move your bowels, you may need a laxative, and if your symptoms seem to be progressively worsening, you may need further investigations.

Usually, the thoracolumbar junction is not as easily hurt as the lower lumbar. Trauma such as being thrown violently forwards with a car seat belt on, or coming off a motor bike or bicycle and twisting/bending the spine, or being thrown in the air and coming down heavily into a seat (such as during a car turning over), or a boat banging heavily through rough seas. These are the things that can cause compression fractures or damage to T12-L1.

It might help differentiate things by having gentle massage of the abdomen. Start with a smaller bath towel soaked in very hot water, and rinsed. Put a plastic rubbish bag over the bare belly for insulation. put the towel on top. if too hot, put 1-2 layers of dry towel between hot towel and plastic bag. leave on for 10 minutes...then take off and do gentle slow clockwise massage rotations of the abdomen, and go in progressively deeper, but don't cause pain. This can sometimes be very therapeutic and cause flatulence or sudden need to move bowels. after 10-15 minutes of massage, reapply the hot pack for 10 minutes. Also, drink adequate water beforehand. The intestines need water to start moving again. If you are still having difficulty moving the bowels, an enema might be the next step. But if the pain is that bad, you need a doctor to be assessing more closely anyway, and clearing other causes - bowel obstruction, perforated ulcer, diverticulitis, cholecystitis, appendicitis, kidney stones, crohn's disease, colitis, tumour, etc, etc.

[Quinns Rocks Roadie]

Ok thanks again.
Holding a kitchen benchtop and rotating my my torso until my back goes click helps.
I will implement your posture advices rigorously as I find this helps also.

Eric.

[BruceGray]

Ok thanks again.
Holding a kitchen benchtop and rotating my my torso until my back goes click helps.
I will implement your posture advices rigorously as I find this helps also.

Eric.

if the pain is eased considerably by 'cracking' your back, then it is probably just a facet joint that occasionally gets tight and incongruent.

This is very common in the thoracic spine, not so the lumbar. Nevertheless, it depends on the severity of the symptoms. There still might be underlying disc issues that cause muscle spasm, and the spasm effects the facet joint.

Hard to tell without assessing. If the pain is not really really bad, then gentle thoracic flexion, extension, rotation, and lateral flexion stretches and resistance work, combined with a physio massaging and mobilizing the facet joints, may help it settle down with time.

If you can relieve it yourself with exercise and self cracking, then great. Don't let anyone convince you you need it manipulated once a month Leaning over the back of a low backed chair with a bath towel folded over the top, often is enough. And it is quite safe for a partner to apply a rotational force to the effected area once it has been cleared of nastier stuff. I teach partners all the time how to do this.

[toolonglegs]

Cheers Bruce,good info there.I just wish something showed in the mri!.Obviously not a herniated disc but maybe bulging...I can't get sitting on standing mri's done.

[BruceGray]

Cheers Bruce,good info there.I just wish something showed in the mri!.Obviously not a herniated disc but maybe bulging...I can't get sitting on standing mri's done.

MRIs are usually taken lying down, and often don't expose a compromised disc.
Often you need to be standing and/or seated to do so.

Your symptoms in my clinical experience scream disc pathology, and you will lose nothing in managing it in the way I've suggested.

There's a slim chance you have pressure within the spinal canal on the nerve roots and/or spinal cord. THis is known as spinal stenosis, but from the info you have volunteered so far, it is more likely discogenic. The therapy would be the same either way.

[toolonglegs]

Hi TLL,

I had a problem a couple of months ago, my back was out and no matter what, I couldn't get it right. Pain every day.

So I looked at what had changed over the previous few weeks and... I had bought a new backpack. I went back to my old one and voila, back pain disappeared. The 2 backpacks have different contours and the newer one just didn't fit properly.

It could be as simple as that... you say you've been travelling around alot lately!

FoM

Cheers FoM....yes been traveling a bit lately but this has been going on seriously since may...and more likely for a few years.

Of note...since the osteo visit my shoulder pain has gone!.It wasn't bad but it was bugging me so thats one thing off the list.
Tried icing 3 times yesterday for about 45min to an hour each time...no pain relief yet.Still on 2 400mg nurofens / 1 very strong anti-inflam and anti-dep at night...so not as much as some days but more than others.

[thomashouseman]

Hopefully if you do manage to get a standing up MRI, you won't look like any of these: http://insideinsides.blogspot.com/

Sorry for the thread de-rail. I should know better

[Apple]

Hopefully if you do manage to get a standing up MRI, you won't look like any of these: http://insideinsides.blogspot.com/

Sorry for the thread de-rail. I should know better

Are they desperate for mods

[scotto]

....have an upright or seated MRI straight after cycling till symptoms start - that would be handy and easily done in sydney. i reckon they could scan you on a bike saddle given enough time and thought into things !.

great advice

[Apple]

....have an upright or seated MRI straight after cycling till symptoms start - that would be handy and easily done in sydney. i reckon they could scan you on a bike saddle given enough time and thought into things !.

great advice

Are there two of you scotto

[scotto]

oops, must have been my evil twin !

[toolonglegs]

yeah but not possible for me...maybe an x-ray.