Really Bad Lower Back Pain - #2

Julie Pfeifle

Yikes!!  I'm a long-time runner and triathlete - 56yo female - and have NEVER had lower back pain til this year.  First time was about 4 months ago as I was building for IM Coz and did a few long rides on my road bike, after having ridden my tri bike exclusively for almost a year.  I had originally been training for IM MD, which got canceled / re-scheduled, so I switched to IM Coz and just wanted a change so hopped on the road bike for a couple weeks.  I'm thinking that may have caused the first episode, as I didn't gently transition, but immediately jumped on road bike and rode probably 4 hours x a couple rides.  This first low back pain episode, though painful and scary as I hadn't ever experienced this before, was NOTHING like what I'm going through right now.  I had to move very gingerly for a few days and was mostly horizontal first day, but it was gone in 3 days.

This time... was just getting dressed yesterday morning and felt the lower back (same place) start to tighten.  Not too worried, so kept going about my day, again very gingerly.  It worsened very quickly and at morning eye doc appointment, got to the point where I coudn't walk (any compression of back was pretty much excruciating ).  Hubby had to come get me, and it took us ~20 minutes to get me in car.  Decided to go home, get me horizontal (when all pain was relieved), ibuprofen-load, and wait it out a day or two.  Last evening, when hubby helped me to potty, however, I passed out, woke up in a chair in living room, and wondered how the hell I got from potty to that chair!  At that time, we called ER.  Several hours, clean basic tests, valium, and dilaudid later, I was able to walk slowly on my own out.  They found no red flags (numb, tingly appendages, abdominal pain) of serious issues to be too concerned.  Figured fainting was due to pain, so no real concerns there. Sent me home with valium and hydrocodone prescription, which I'm taking today, and said "go see your primary doc tomorrow".  Have a 3:30 appt today, so will hopefully learn more what the heck is going on and what caused it.  fyi, I've had no unusual aches/pains in the prior 3 weeks post-IM Coz.  I did go for my first run Sunday - a very easy 6 miler - and felt absolutely fine afterwards.

Today, I'm mostly horizontal, with a couple practice walks to potty.  It's certainly better than yesterday; last potty trip was unassisted and only took me about 10 minutes travel time .  Still very tender, and certain movements take my breath away.

Anyone have experience with this kind of thing?  Would appreciate any words of wisdom & shared experiences.

Thank you!!

 

Robert Sabo

If it's just low back pain with no radicular/sciatica/leg symptoms and no bladder incontinence, then you need to see a good PT. Let me know if you have any questions as this is my day job. Also look at Dinhofer's thread on his back trouble he got at IMLP this year.

rlh2000

While being horizontal, try getting your legs up on something so your hips and knees are both at 90 degrees. Try to keep up some walks, mobility is good! For patients that are really acute, sometimes it hurts too much to move at their lower back, so we go away from it. When lying down, just try to move your head side to side, or lift your arms up and down. Even that is some mobility that is good.

Good healing vibes to you!

Brenda Ross

Try to find a good chiropractor. I swear by mine. Something structural could be going on, and if there is, then the muscles are going to continue to spasm because they are working hard to keep the spin in a position it is not suppose to be in.

Julie Pfeifle

Hi Robert and others, thanks for your replies!  I've now been to the primary doc and have more pain-killers, which I'm trying to minimize but still need to get around (I'm really not a wuss!!) She said it was key to do 3 x 800mg ibu daily to get the inflammation down, but man... I'm really bummed at how painful this still is.  I'm a little more mobile every day, as in can walk on my own, but very carefully, because any weird small motion can produce a take your breath away sharp localized pain.  "Localized" is good from what I hear; it's only in that very central low back area with no shooting pain down extremities.

My biggest concern is figuring out what the heck caused this and how to prevent it from recurring.  I'm also very worried that IM training and many years of run pounding is the root of this... please NOOOO....  It's so weird as I've really had no back issues until this year, and I've been running a very long time - over 40 years!

I don't feel like I got great next steps guidance from my primary doc, eg. don't feel like I really even have a diagnosis yet and no diagnostic tests.  Per your advice, sounds like I should find a good PT and/or chiro.  Why one or the other?  I do have a hypothesis that this may be as simple as I need to do way more core work to support this level of training, and it just caught up to me.  Hopefully, that's all it is... but geez... what a painful lesson!!! 

Robert Sabo

Rachel is the PT but I feel a good sports oriented PT can help you through this flare up and instruct you on a progressive strengthening and stretching program to avoid this recurring in the future. Your diagnosis seems to be recurrent lumbar sprain strain. An MRI does not seem to be needed at this time. If you fail to improve with PT then an MRI is indicated. Foot drop or bladder I continence needs an emergency MRI.

rlh2000

Agree with Robert. The PT vs. chiro debate can get heated. You will always find some people that swear by their chiropractor, and others who swear by their PT. Different philosophies, a lot of similar abilities. In my totally biased opinion, I'd vote PT :-)

Brenda Ross

I think both a PT and Chiro can work together. Chiro for structure and PT for muscle, tendon, ligaments etc... I would do what your gut says. If it is muscular PT is the way to go.

tim cronk

Julie,

I am not a Doctor, Chiro , or PT... But what I do have is 20+ years of ON/OFF back issues... When you describe your pain as excruciating , can't walk , pass out from pain (I passed out twice with my last broken clavicle and that was a shattered bone kinda pain not just a muscle) , and need to go horizontal for any type of relief , that sounds more like nerves, disc's, spinal than muscle... Treating what you do have with Chiro or PT without really having a diagnosis is crazy IMO.... There is no downside to getting the MRI needed to complete your diagnosis before treating it.... I gotta believe that the Doc's , Chiro's, and PT's would agree... That way you know.

20+ years ago I was taking a break in a recliner at work , that morning I had competed in a rock climbing competition, I felt perfectly fine until I tried to get out of the recliner. Somehow I was able to get up , hobbled to my supervisor , went home sick, could barely get out of the car when I got home , laid flat on the floor... I would describe my pain as excruciating... When Heather came home I had her take me to the ER , getting out of the car at the hospital it was cold and raining, I was shivering and I collapsed holding onto her while crying in the parking lot... Pain was off the chart I could not take it... They ended up giving me some kind of shot like Morphine or a derivative and then went home to spend the entire week on the floor... Doctors visits started with xray's and questions about sciatica , trouble urinating, ED, none of which I had... They kept saying well if you dont have any of those symptoms you don't need a MRI... Chiro , PT , more doctors visits followed... The pain subsided to the point I could go back to work after a week but it was not getting better... Finally the MRI was done and I had 2 herniated disc's... One was minor and one was major... More PT , chiro , stretching, yoga , talk about core strength (remember I was a rock climber and there was absolutely no weakness in my core).... I found all of that to just make matters worse... What worked best for me was doing nothing but walking and let it heal up.... Since then I have had numerous episodes of which none of them were that extreme (think only 1-2 days on the floor instead of 5)... To this day I am constantly aware of my back I get up out of chairs slowly , pick up things carefully, avoid twisting motions, and hinging at the waist , and still tweak in now and then...

rlh2000

Disagree with Tim on this one (whoa!). Unless you have the red flags Robert talked about, no need for MRI, and more and more evidence out there that getting an MRI leads down the wrong treatment path when not absolutely indicated. A good medical provider (whether MD, PT, chiro) can give a "diagnosis" without imaging. I put it in quotes because it might not be the type of exact diagnosis you get with MRI, but it is the type you need for successful treatment. The number of false positives produced by imaging are astounding- I have 5 bulging discs and many areas of arthritic changes in my back- and I have always been pain free! That could be quite confusing if I was having pain. So physical exam trumps MRI!

A PT can diagnose, treat, and educate you on lifetime maintenance stuff Tim mentioned. If you don't respond to PT at all, then yes, image away, but right now, I vote no on MRI.

Julie Pfeifle

Again, thanks everyone... this feedback is incredibly helpful! I'm going to make an appt to see a PT and take it from there. Think I've hit an improvement plateau. Still doing 2400mg ibu, but no pain meds last 2 days. Pain has interestingly localized a little right of low back center. Walking ok, but slowly. The combo of slightly bent over and chin dipping definitely makes it fire off (like getting into car, brushing teeth, even sipping coffee). Running, biking, swimming seems pretty near impossible... bummer! I am really a very bad "take it easy" patient!! We'll see what PT has to say. Might get a massage too. Hate this shit!!

Carrie Chavez

I ran in to Julie at a Christmas dinner and watched her move slowly. I had a long chat with her and gave her my PT diagnosis just from watching and listening and asking questions. What you describe are positive dural signs meaning something pressing on the dural sleeve of a nerve root ( for example a possible bulging disc). Often times these injuries are cummulative and not caused by a big movement or trauma. So what might seem like a benign activity the day before the pain started was actually the straw that broke the camels back ( sorry for the pun). The symptoms and improvements follow that diagnosis too. I gave her body mechanics ideas to prevent flare up. The fact that pain is centrally located is a good sign and that it is working itself into a pin point area makes me think it is healing. I hope you get in to a PT soon. For now do all you can to not flare it up. An idea for brushing teeth: have 2 cups of water. Bring cup to mouth standing brush/spit/rinse into cups without bending over. Do all you can to not anger your back. Let it calm down. Once pain subsides then the PT will introduce movement. I know it is hard to be patient but I am so proud of you for waiting and riding this out. Great feedback from all EN folks. You are all amazing!

Carrie