Where to next? (Medical practitioner question)

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vosadrian
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Where to next? (Medical practitioner question)

Postby vosadrian » Wed Aug 09, 2017 2:59 pm

Hi All,

Before I start, let me say this is not the case of someone trying to save cash by fixing it myself online. I just want to get fixed and the normal medical establishment has let me down.

Some of you have seen some posts from me in the health area of this forum over the past few years as I have been struggling with unresolved injuries/ailments. I have spent quite a bit of money seeing anyone I thought could help, but have had minimal improvement with most treatments having no effect. Having recently been through a circle of specialists the last few months I am back at square one again and wondering what to try next.

I have a variety of symptoms that have increased over time from the first thing that was achilles like ankle pain in one leg to similar symptoms in other leg combined with sciatic like symptoms in both legs, and lower back/hip groin. I have foot numbness in one leg, pain in buttocks on other leg that radiates down leg in certain leg positions (hamstring stretched mostly). Lower back pain/hip/groin pain on the same side as the numb foot. I like to ride a bike but have had several bouts of 3-6 months off to see if it helps anything and it does seem to slow progress of issues but not do anything to fix them. I am off the bike at the moment just to get some relief from the pain which is worse with activity but settles to a base level after a few days..... the base level is more livable than the level when I am riding, but does not seem to improve further even after several months of rest.

My latest journey was GP for (more) lumbar scans, then to a neurosurgeon who said the back does not look too bad (despite scan report saying multiple moderate issues). Then to neurologist and nerve testing revealing that there are multiple lumbar levels of chronic nerve root dysfunction... then back to Neuro surgeon who acknowledges nerve dysfunction but can see no cause of it (there is a lot of mild-moderate issues, but nothing enough to cause symptoms or nerve study results) in the back so can do nothing and therefore i am back to square one.

I don't know enough about nerve conduction tests, but I am an engineer and I know they only put probes on my lower limbs and not on my back itself. I am not sure if a nerve dysfunction at a certain lumbar level means they have detected that the problem is in the spine itself or could it be somewhere along the sciatic nerve after it leaves the spine. There seems to be a bunch of issues I have googled that can cause sciatica symptoms without any lumbar involvement, but the general medical system does not give much weight to these issues and assume that all sciatica is by definition an issue in the spine. The issues I have found are:

* Piriformis Syndrome
* High Hamstring Tendinopathy
* SI joint issues

There are probably more. None of the doctors I have seen take these issues very seriously. Mostly they seem to think they are the ideas of crackpot therapists. I don't know either way, but I do know that the doctors have been unable to help me so I want to consider investigating these ideas more seriously. So I am looking for a practitioner who is willing to work outside of the box of normal medical practise. Maybe this is a neurologist who is more open minded. Maybe it is a good Physio/Chiro/Osteo etc that is experienced in difficult issues such as mine. Ideally I can find someone who specialises in tough cases like mine and has dealt successfully with such issues many times before.

Can anyone suggest anyone? I am in Sydney Hills District, but I can travel anywhere one off. If I am going to need to see someone regularly it would be great if they were closer to home. I did once travel to Melbourne to see a Physio who claimed he could fix my ankle by mobilising my lumbar facet joints in one treatment. He may have been onto something but unfortunately he could not meet his claim.

Any help appreciated!!

Cheers,

Adrian
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Re: Where to next? (Medical practitioner question)

Postby 10speedsemiracer » Wed Aug 09, 2017 3:33 pm

Have PM'd
Mmm, SunTour

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Re: Where to next? (Medical practitioner question)

Postby mikesbytes » Wed Aug 09, 2017 6:17 pm

I'm sorry I can't recommend anyone.

Am I right in saying that the prime issue is in identifying the cause of problems? I understand in some cases it can be really difficult.

In regards to the Sciatic nerve issue, I'm assuming you have been recommended to improve the flexibility of the Piriformis? Have they looked closely at the routing of the Sciatic nerve? Some have the nerve traveling thru the Piriformis instead of going around.
If the R-1 rule is broken, what happens to N+1?

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Re: Where to next? (Medical practitioner question)

Postby CKinnard » Wed Aug 09, 2017 6:52 pm

I am an Aussie physio with 20 years experience, but I am likely returning to the US within a few weeks, but I wouldn't offer to see you for one treatment if I was staying in Oz. You also directed your question to a 'medical practitioner' which I am not.
I think I have probably responded to some of your questions in the past, with varying response.

If I can pad out what you offer above. It sounds like your symptoms have PROGRESSED, are BILATERAL and NEUROLOGICAL.

Such a condition should be investigated comprehensively. It cannot be divined in one treatment by anyone. A thorough history of your cranium, neck, and thoracic spine is necessary, in addition to your lumbar spine. Your SIJs and pudendal nerves should be cleared (but I only know one guy in Australia who can do this competently). Your position on the bike, your other activities, your bed, occupation, diet, bodyweight, metabolic disorders...all these things need to be investigated.

Imaging is great, but they don't do MRI's when you are in time trial position on a bicycle.

When it comes to bilateral neurological symptoms, you want to start by excluding central causes (spinal cord, canal, central stenosis, synovial cysts, epidural abscesses, spondylolisthesis, discitis, arterial compromise, space occupying lesions anywhere in the central nervous system).

Bodyfat % and diabetes also need to be investigated.
As does your cycling history. There are several nerve entrapment syndromes and arterial endofibroses specific to cyclists that should be cleared.

Anyone who tells you they can get a quick result in one treatment is naive.
I suggest you stop spending money on seeking quick pain relief, and spend it on getting the diagnosis right. That is more likely with a neurosurgeon at this point.

edit:
I agree with those who said piriformis syndrome is quackery. every case I've seen has been due to an irritated nerve root. muscles don't get over excited in their own right. usually their nerve supply gets compromised. sometimes massaging the piriformis gives great relief in the absence of low back pain. This is usually months after a back irritation has settled down, but the piriformis has remained scarred and tight. eventually the low back flares again and the piriformis tightens...again.
proximal hamstring tears are very obvious with imaging.
SIJ issues don't cause all of your symptoms. at most they'll irritate the pudendal nerve and give you some perineal/crotch pain or paraesthesia.

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Re: Where to next? (Medical practitioner question)

Postby Derny Driver » Wed Aug 09, 2017 7:35 pm

CKinnard wrote:... Your SIJs and pudendal nerves should be cleared (but I only know one guy in Australia who can do this competently)...

Dr John Garvey?

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Re: Where to next? (Medical practitioner question)

Postby vosadrian » Thu Aug 10, 2017 9:02 am

Thanks for all your help everyone. I have gotten one solid lead via PM from someone who is on the recovery from close to identical symptoms to mine.

It is an area I have not investigated and ticks a lot of boxes for explaining my symptoms. One symptom I forgot to mention above was that over a a year ago I was on a long haul flight and struggling for comfort with my back so had pillows behind my lower back with most of my weight on my tailbone area. At the end of the flight my tailbone/sacrum had become sore/numb and it has not recovered since. I struggle to sit at my desk all day as a result. In my recent run with the specialists I had MRIs done of lumbar spine and coccyx area. I checked my films when I got them back, and my Coccyx looks wrong. It has a sharp bend forward rather than a gentle curve. The MRI report mentioned an "anterior angulation of the coccyx" but no evidence of fracture or oedema. The MRI referral was to check for a fracture, so not sure if the reporting Dr looked in any more detail than that. When I saw the neurosurgeon he had a look at the Coccyx MRI. Mentioned the sharp bend and said it was likely I had a fall when young that had repaired in that position. He also said there was something unusual as there was some "uptake" in the sacrum. He did not think it was likely to cause my neural issues so left it at that.

I believe there are sciatic nerves in the sacrum area and some people can have abnormalities in the area with the sacrum not fully fused and the possibility of dislocation and subsequent nerve irritation, so I want to check out that possibility.

Mike, thanks for your suggestion regarding the piriformis. I have had difficulty getting most therapists and Drs to take piriformis syndrome seriously. Having said that, I had an Osteo who did and was doing weekly deep tissue massage while I was doing twice daily stretching over a couple of months. This did nothing to help, and seemed if anything to aggravate the radiating pain down that leg. Any stretching of the glutes/hamstring seems to build up pain in the leg. It is strange as it is not a sharp pain or a pins and needles king of thing. It is a gradual buildup of an aching pain starting at the glutes and moving down the leg over a minute or two the longer I hold the position. Also, I seem to actually be quite flexible in the piriformis. I can do Yoga pigeon pose quite well, and i get a fair bit of range of motion in piriformis stretches. I lose range of motion when I straighten the knee into a hamstring stretch, as I have terrible flexibility in the hamstring area.

Ckinnard, Thankyou for your help in the past. It has always been helpful. I certainly appreciate that my issues are not quick fix. I have not been looking for that. When I commit to a therapy approach I commit to it fully for a minimum of 6 weeks (normally weekly visits). I am very compliant with any home stretches or exercises I have been asked to do. I am not looking for someone to give me a tablet or injection that will fix all my issues. I am expecting to be working through issues for months or years. I also know that it is near impossible to diagnose over the internet, and even in a face to face environment it will take time to work it out. Unfortunately in my case I have been through 10-15 various therapists (Physio/Chiro/Osteo/Massage) and eventually they have all given up as they were unable to help. Some of them were pretty out there and tried some unusual things. That is why I started this thread. I am trying to find a therapist or Dr/Specialist who has successfully dealt with issues like mine before. I need to get through this and I am prepared for it to take years (but hopefully less!!) to get through it. I am willing to cease riding and other activity until I can safely do it in order to rule any mechanical issues with that out of the equation. I just need to find the correct path to get me there. I think this starts with finding someone who can go through diagnosis path comprehensively. I tend to find those I have dealt with have there area of expertise and they check to see if you have anything they deal with daily, and if you don't they send you away to look elsewhere. At the moment I think I need someone who can check out the lower spine areas into sacrum and nerve paths around the pelvic area. If you can suggest someone who I can see I would really appreciate it. You mention someone you trust. Is that in Sydney?

Thanks again all!!

Cheers,

Adrian
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Re: Where to next? (Medical practitioner question)

Postby Derny Driver » Thu Aug 10, 2017 9:08 am

I have had groin surgery done by Dr John Garvey, Macquarie St Sydney. My problem was nerve entrapment / impingement in the pelvic area. Might be worth having a chat to him.

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Re: Where to next? (Medical practitioner question)

Postby vosadrian » Thu Aug 10, 2017 10:26 am

Derny Driver wrote:I have had groin surgery done by Dr John Garvey, Macquarie St Sydney. My problem was nerve entrapment / impingement in the pelvic area. Might be worth having a chat to him.


Thanks Derny, I will look into that. Were your symptoms similar to mine?
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Re: Where to next? (Medical practitioner question)

Postby Derny Driver » Thu Aug 10, 2017 11:05 am

vosadrian wrote:
Derny Driver wrote:I have had groin surgery done by Dr John Garvey, Macquarie St Sydney. My problem was nerve entrapment / impingement in the pelvic area. Might be worth having a chat to him.


Thanks Derny, I will look into that. Were your symptoms similar to mine?

No not really mate ... mine was an unusual case, Garvey had never come across it before. But I believe he is the expert on groin pain. He was able to partially fix my issue to the point where I am not in pain any more. Unfortunately I am limited to gentle-moderate exercise only but I am okay with that.
He has recently had success with injections directly into the nerves down there, he offered it to me but to be frank, Im a bit fearful of it.

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Re: Where to next? (Medical practitioner question)

Postby CKinnard » Thu Aug 10, 2017 2:25 pm

Derny Driver wrote:
CKinnard wrote:... Your SIJs and pudendal nerves should be cleared (but I only know one guy in Australia who can do this competently)...

Dr John Garvey?


I know him by reputation only. I don't know what kind of manual tests he does with patients to discriminate pudendal nerve pain.

The guy I know is Peter Dornan at Toowong in Brisbane. he is close to retiring though.
He did a cadaver study about 15 years ago of the pudendal nerve, and developed an assessment and therapy protocol based on that.
Most Brisbane urologists send him patients who have perineal pain and bladder issues that do not respond to drugs.
http://www.peterdornanphysio.com.au/pudendal.html

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Re: Where to next? (Medical practitioner question)

Postby vosadrian » Fri Aug 11, 2017 10:48 am

Thanks all!

The pudendal thing sounds interesting. Initially I thought it was mainly associated with symptoms of our never region of which I seem to be OK. I certainly have some numbness/pain in coccyx/sacrum and upper inner thighs and one side inguinal canal, but no symptoms in the private parts (thankfully!!). After reading the report, it seems it can also be back/buttocks/thighs which I do have.... interesting.

I do have a couple of new leads to follow, so I will try them and see how I go. Hopefully some success. If not, I guess I will be back.

Thanks for your help!
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Re: Where to next? (Medical practitioner question)

Postby CKinnard » Fri Aug 11, 2017 3:24 pm

vosadrian wrote:I do have a couple of new leads to follow, so I will try them and see how I go. Hopefully some success. If not, I guess I will be back.

Thanks for your help!


Just keep in mind that you might have two issues simultaneously.
Many clinicians argue whether a condition is this or that....when time and again I've seen people who have two things going on at once!
i.e. in your case, you might have a central spinal issue, and a pudendal or other peripheral nerve issue....and you might even have old muscle tears pulling on a peripheral nerve.

I've been working in the US for the last few months, and one of the masseuses I work with is very experienced in the US and Euro pro cycling worlds. I taught her some stuff, and she taught me. She found a spot in my left hamstrings that hurt like hell. But I've been having cramps or spasms originate from it for a couple of years, off and on. I've had several massages for it in the past, but nothing changed it. She had the confidence to go in deeper, and I can feel it is not as excitable now when on the bike and elsewhere. She pushed it to the limit of what I could bear. I wouldn't have let anyone do that if they didn't have her reputation.

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Re: Where to next? (Medical practitioner question)

Postby vosadrian » Fri Aug 11, 2017 4:03 pm

Good point on multiple issues. I am pretty sure i do have multiple issues. It is possible they were reactive to an original issue but may now need treatment to fix as even with rectification of the original issue they may be unable to repair themselves. One thing with all of this was that in my search for the source of my inguinal pain, I had an MRI show a mass that was unknown and because of the unknown nature of it, they did surgery within days. It turned out to be a hernia that was then repaired during the surgery (this was not even presented as a possibility prior to the surgery). Unfortunately I still have at least 80% of the pain in that area along with some new things introduced by the surgery. I have no idea if the hernia was there before things started or came up recently. It could have been there for years and been an incidental finding..... but it probably had nothing to do with most of my other symptoms, and it was not going to fix itself without surgical intervention.

Either way, this is difficult enough to work through with a single issue as opposed to working with multiple issues at once. I think I have just have to concentrate on trying to locate the primary source issue and working on that. If I get some progress there but eventually find I have some residual symptoms I can then look at the seperate issues causing them. I would be happy to resolve a single issue at the moment!!
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Re: Where to next? (Medical practitioner question)

Postby CKinnard » Sat Aug 12, 2017 6:54 pm

Something I do for special cases I see where the bill is being covered by a sports team, and time is not as important, is to ensure I have anatomical charts and models available so I can constantly explain what each assessment intervention is effecting. And I usually ask high end clients to read up on anatomy before seeing me, so they can explain where the pain is in more precise terms. Naturally they are not going to get it right all the time, but I want to know they are prepared to invest time in sorting their problem out, rather than just rolling up unprepared to make an effort to help me sort it out. These people usually don't have the right attitude to rehab or life in general.

At least if I do this, even if I cannot find the source of pain, the patient should be able to explain his condition to the next health professional a lot more intelligently, and judge better if the next guy actually knows his stuff.

If you have had a hernia, the causes of that should have been elucidated - whether have asthma or other respiratory issues that make you cough a lot, straining at toilet, obese in the past, intestinal issues, whether you were born a preemie, etc.

Though I think you need to get your spine more closely examined. Some of your sensory symptoms above are consistent with Cauda Equina Syndrome, though it could not be severe if bowels and bladder work properly. https://patient.info/doctor/cauda-equina-syndrome-pro

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Re: Where to next? (Medical practitioner question)

Postby vosadrian » Mon Aug 14, 2017 9:20 am

CKinnard wrote:Though I think you need to get your spine more closely examined. Some of your sensory symptoms above are consistent with Cauda Equina Syndrome, though it could not be severe if bowels and bladder work properly. https://patient.info/doctor/cauda-equina-syndrome-pro


Interesting. I recently had an MRI of lumbar region including lumbar plexus. Would it have shown if I had this? It looks pretty scary. I have had some bowel issues, but nothing too bad, and generally things down there seem OK.

Also, I have invested a lot of effort in understanding my own anatomy and what can cause my issues. I feel I know more than most doctors I have seen about my particular issues. I am not sure if this is good or bad really. Getting too invested in fixing it myself can be consuming and effect other areas of life, and may effect the way you deal with doctors who may have different ideas to yourself. Having said that, I have become very open minded and will try anything... since the things I think it should be do not seem to respond.
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Re: Where to next? (Medical practitioner question)

Postby CKinnard » Mon Aug 14, 2017 12:44 pm

vosadrian wrote:Interesting. I recently had an MRI of lumbar region including lumbar plexus. Would it have shown if I had this? It looks pretty scary. I have had some bowel issues, but nothing too bad, and generally things down there seem OK.

Also, I have invested a lot of effort in understanding my own anatomy and what can cause my issues. I feel I know more than most doctors I have seen about my particular issues. I am not sure if this is good or bad really. Getting too invested in fixing it myself can be consuming and effect other areas of life, and may effect the way you deal with doctors who may have different ideas to yourself. Having said that, I have become very open minded and will try anything... since the things I think it should be do not seem to respond.


1. What health pros are not good at is communicating the shades of grey. They like to put conditions in discrete little boxes, that are lined up all nice and neat. The human body is not like that. Rarely does one go from having no pathology to pathology. Usually pathology progresses. i.e. cauda equina syndrome requires a central pressure within the spinal canal below L1-2 level. If there is just enough pressure to cause pain and neurological symptoms when one is in certain positions i.e. slumped in a chair or on a time trial bike, then a MRI is unlikely to be reported by a radiologist as showing cauda equina syndrome. Does that mean there's no central pressure whatsoever at all times? No.

2. I've told you already that I prefer to deal with clients who take some ownership of their health, by learning about it. Any doctor who says otherwsie obviously hasn't thought it though very carefully. i.e. say a doctor has a New Guinea tribesman as a patient who has kidney disease, and the guy knows nothing about what's under his skin. How many precious doctor minutes is it going to take to explain the condition to the patient? and how compliant is the patient going to be if he doesn't understand what the kidneys do? Where some health pros get frustrated is with people who delve into the science and imagine all sorts of things happening to them, then waste the pro's time asking unreasonable questions, and getting unnecessarily anxious. I'd rather patients at least make an effort to learn so I can communicate with them on a higher level. They are also less likely to go spend money on dodgy products that dubious people hawk.

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Re: Where to next? (Medical practitioner question)

Postby vander » Wed Aug 16, 2017 11:44 am

CKinnard wrote: so they can explain where the pain is in more precise terms.

Pain may not be coming from a certain tissue, something that is quite prevelant in people with chronic pain.

vosadrian wrote: Would it have shown if I had this? It looks pretty scary.

Please dont freak out over all the possible things that you may have. This won't help in the long run. Soft neuro findings do not mean we need to freak out straight away. Altered sensation is common in people with long standing pain without any major issues to nerves.

CKinnard wrote:2. I've told you already that I prefer to deal with clients who take some ownership of their health, by learning about it. Any doctor who says otherwsie obviously hasn't thought it though very carefully. i.e. say a doctor has a New Guinea tribesman as a patient who has kidney disease, and the guy knows nothing about what's under his skin. How many precious doctor minutes is it going to take to explain the condition to the patient? and how compliant is the patient going to be if he doesn't understand what the kidneys do? Where some health pros get frustrated is with people who delve into the science and imagine all sorts of things happening to them, then waste the pro's time asking unreasonable questions, and getting unnecessarily anxious. I'd rather patients at least make an effort to learn so I can communicate with them on a higher level. They are also less likely to go spend money on dodgy products that dubious people hawk.

People that only know and are committed to a structural view of pain can be quite difficult to treat. Structure is not your destiny pain is a lot more multifactorial.

I have sent this to Adrian already but for anyone else reading on this video is worth your 20minutes.
https://www.youtube.com/watch?v=oji2mfcjisk
Structure contributes to pain but it isnt everything.

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Re: Where to next? (Medical practitioner question)

Postby CKinnard » Wed Aug 16, 2017 2:49 pm

vander wrote:
Pain may not be coming from a certain tissue, something that is quite prevelant in people with chronic pain.

Structure contributes to pain but it isnt everything.


A view taken too far by most clinicians.
One diagram you won't see in the Butler, Moseley, Hodges line of publications.

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Re: Where to next? (Medical practitioner question)

Postby vander » Wed Aug 16, 2017 6:37 pm

CKinnard wrote:
vander wrote:
Pain may not be coming from a certain tissue, something that is quite prevelant in people with chronic pain.

Structure contributes to pain but it isnt everything.


A view taken too far by most clinicians.
One diagram you won't see in the Butler, Moseley, Hodges line of publications.

Image


It is a view taken not far enough by most people. I have spent time with Butler and Moseley they arent as extreme as some people think they are. Also, there is a weight of evidence in their favour and it is just getting more and more in their favour.

Yes that sort of image isnt often reported. Do you have a link to the paper it is from?
FYI their point is not that the bio doesnt matter it is just not the whole story as a lot of people think it is.

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Re: Where to next? (Medical practitioner question)

Postby CKinnard » Thu Aug 17, 2017 1:47 pm

vander wrote:It is a view taken not far enough by most people. I have spent time with Butler and Moseley they arent as extreme as some people think they are. Also, there is a weight of evidence in their favour and it is just getting more and more in their favour.

Yes that sort of image isnt often reported. Do you have a link to the paper it is from?
FYI their point is not that the bio doesnt matter it is just not the whole story as a lot of people think it is.


I've spent time with them as well. And they'd both benefit from more time as clinicians, and taking the blinkers off.
Both have scoffed at me directly when raising the role of diet and weight loss as a serious first line intervention for chronic pain. This is what happens when people lose sight or never develop it in the first place, as to humans being integrated systems, and that each system cannot be considered independent of others.

J. Anat.(2010) 217, pp1–15

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Re: Where to next? (Medical practitioner question)

Postby vander » Thu Aug 17, 2017 3:03 pm

CKinnard wrote:J. Anat.(2010) 217, pp1–15


Review article not a good first start. With a schematic drawing. Referenced checked a few articles they referenced for them believing it happens a few animal studies where they cut into a disc and then part of healing the disc had increased nerve innervation (as well as blood vessel innervation) actually decreasing on those animals killed 2 years after the first surgery. Another study I couldn't get access to was a MRI study looking at healthy people and found over 50% of them with disc degeneration yet they didnt have any issues, I couldn't see if there was more in the full text.

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Re: Where to next? (Medical practitioner question)

Postby CKinnard » Thu Aug 17, 2017 3:50 pm

I don't agree with your take on review articles, especially one as well researched as this, with 5+ pages of references.

Unfortunately, I won't earn an income debating this matter with you; so I'll get back to the US studies I am currently involved with, that are adopting the approach Butler and Moseley had no time for over a decade ago. :shock:

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Re: Where to next? (Medical practitioner question)

Postby Davobel » Fri Sep 22, 2017 11:11 pm

It's a month later. Where are you now?

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Re: Where to next? (Medical practitioner question)

Postby vosadrian » Mon Sep 25, 2017 11:17 am

Not much has changed. This has been a 3 year problem for me, so not expecting miracles in a month, but would be good to see some progress in the right direction.

I went to see Vander. He was great in going through some pain science stuff with me. I really think this applies to me, I feel myself wincing at the thought of certain movements when I see others doing activity. I really have to get my mind to accept activity without trying to protect itself.

I also chased some stuff up on my Pelvis/Sacrum/Coccyx. I feel I understand what is happening better, and I think it is related to a tendency to tighten up my muscles in response to just about anything... particularly around the pelvis. I tried a chiro who I though might be able to adjust my sacrum, but that was unsuccessful. I am currently seeing a pelvis specialist physio who has identified a couple of muscles around my pelvis that are knotted up like ropes and we are trying to deal with them. I spend about half an hour a day on roller/lacrosse ball and stretching etc. I have long thought my left piriformis was an issue. Also my right glute med. These muscles are stubborn.... really slow progress. I feel I can get into my piriformis with the lacrosse ball better than a month ago where it was extremely painful to put any weight on the lacrosse ball. Now I can get my full body weight onto it. But not a lot of improvement in the pain/sciatica symptoms yet. Either way, that muscle needs to improve. Hopefully with patience I can get it healthy, and maybe the symptoms will improve. Sometimes though I wonder if I am treating the source of the problem or something that flared up due to a problem elsewhere?

I have just got back on the bike. Pretty unfit, but enjoying it a lot. Just hopefully that does not work against the treatments.

Cheers and thanks for asking!
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Re: Where to next? (Medical practitioner question)

Postby RhapsodyX » Sat Nov 18, 2017 7:33 pm

So, I'd been PM'ing vosadrian recently to see where he was up to, but my issue became acute so the "unknown" has now been resolved.

Back at the beginning of September after a sprint training session, I noted I was uncomfortable in the car with the back of the thigh aching. I've always been pretty slack in regards to stretching and rolling, so occasional rolling and stretching joined the training program. I did the AG Fondo in mid September, and suffered cramping in the back of the same thigh, after which the ache became a bit more of an issue. And, of course, my mates had a go at me for insufficient stretching. Four weeks later was the ACT Veterans "Gunning Two day", towards the end of which I noticed that the left foot was uncomfortable, but it wasn't until I hit rest days a few days later that I noticed the tingling foot. Off to the chiro I went, and he couldn't tell where the source of the problem lay - if it was my back, it was "atypical". But a bit of pressure in the back of the thigh had me lifting off the bed, it was so sore.

So exactly one week after Gunning (and two days after the Chiro), I did the Bowral Classic at a very conservative pace, and the next day returned to the chiro for dry needling of the thigh, which gave me relief for about two days. I saw the chiro again on the Thursday, the thigh pain was back along with the tingling foot and he couldn't give me a path forwards in terms of "what is this?" - so I got a referral to a sports medicine doctor and the waiting game started.

One week later, once again after a rest day, I hopped into the car on the Friday afternoon and the leg pain became unbearable. That night, I was woken by the leg pain, so early the next morning I took myself off to the local hospital, where they did lots of testing and *also* decided it was something in the leg. I was prescribed pain killers & naproxen and booked me in for an ultrasound on the Monday. And the ultrasound showed... nothing. That night, more research and self-testing at home showed that I failed the "slump test" for a trapped sciatic nerve - no more hamstring stretching for a start.

On the Wednesday afternoon I started limping, which I put down to screwed up biomechanics from the leg pain, so it wasn't until the Thursday morning when I suddenly realised that the limp was because I couldn't lift my heel off the ground when walking forwards - the calf muscle was weak.

Two hours later I had the MRI, and hour later I was in hospital while they assessed the "severely herniated L5/S1 inter-vertebral disc". The leg pain is the irritated L5 nerve root, the tingling and loss of calf muscle is the compressed S1 nerve root. The spinal cord is also displaced, but luckily it's not affecting any other nerves at this time. I've since had a consult with a sports medicine specialist (national teams kind of guy), he's got me in for a CT guided cortisone injection on Monday. The neurosurgeon consult is booked for December 6'th, by which stage it should be clear if I'm going under the knife. I'm going to push for the "conservative" recovery approach (non-surgical), as I've already been told by the sports medicine doctor that a discectomy will likely result in further herniation in the future.

And I really regret listening to the standard rubbish of "no, it can't be the back", "scans are unnecessary", and my prior history of back pain that never progressed beyond the GP doing some basic tests and prescribing anti-inflammatories and pain killers. I never considered my cycling to be in the "extreme" end (doesn't everyone do 10+ hours a week?), but the truth is that the roadie cycling position combined with a lack of flexibility puts significant stress on the discs, and without flexibility, strength & conditioning *off* the bike... issues like mine just aren't that uncommon.

No cycling for the foreseeable future. Limited ability to travel in a car (about ten minutes at a time). Popping pills. Really... just don't do it.

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