Question
I was going to an interview in a nursing home. As I was walking down the hall a little lady began
to fall. I turned to begin the proper procedure to bring her safely to the floor. The fall scared
her and she was looking to me to stop it. And I hurt my lower back. The pain begins a little lower
than the middle of my back and radiates down my right leg into my foot. I can barely walk, sit, or
lay down. It has been 4 days. I went to my doctor and he gave me vicodin. Saying if it isn't better
he will order an MRI. The medicine helps but when the drugs wear off the burning, stabbing pain is
back. Before it was constant pain. With the medication I can walk better, but still with some pain. What have I done to myself? Could this be serious?


Answer
Dear Mary,

Sorry to hear of your injury, by the way, thanks for being that good Samaritan.  You obviously have a strain injury of the associated musculature, but that alone does not explain the radiating symptoms.  There are a few structures in the spine that can cause the types of symptoms you have described.  Let me explain:

DISK:  The first thing that comes to mind is a disk problem.  This can range from a minor bulge with inflammation to a tear and fragment into the cord.  There are specific orthopedic tests designed to detect disk problems and your doctor should have performed them in his examination.  That would have given him the information to suspect a disk problem or not and whether or not to order the MRI.  Check out the below website for more information on disk injuries and diagnosis.

http://suncoasthealthcare.net/chiropracticinformation/discherniation.html

NERVE ROOTS: The nerves exit the spinal cord on each side through a hole in the vertebra.  They are susceptible to compression, stretch, or irritation at that point which can send pain, burning and tingling sensations down in to the buttock, thigh, leg, and foot.  The symptoms should be in a specific distribution according to the nerve root involved...these distributions are called dermatomes. For instance the L3 nerve root can extend pain to the knee but not necessarily below it.  From your symptoms I would suspect involvement of the L5 and S1 nerve roots.  For more information on dermatomes please click the website links below:

http://www.apparelyzed.com/dermatome.html
http://www.regionalabc.org/images/med-illustartion/post-dermatome.jpg

SACROILIAC JOINTS:  This is a bilateral structure formed by the sides of the pelvis (iliums) and the bone in the middle of your butt (Sacrum).  There are very strong ligament complexes surrounding the sacroiliac joint which when stretched or injured can cause significant amounts of pain.  The pain patterns for this joint encompass the entire leg and part of the low back.  So this could easily be a structure responsible for your pain.

FACET JOINT:  This is the actual joint of the spine...2 on each vertebra, 1 on each side.  these joints also have a capsule that when strained can cause significant pain, and cartilage inside the joint space which can become damaged or compressed and cause pain.  Symptoms from the facet joint do not commonly refer pain down the leg though-rather the pain is usually dull achy and diffuse across the low back, but sharp when compressed or with movement.  Therefore, the facet joint can be contributory but unlikely for the lower leg and foot pain.

For more information of the anatomy of the spine and to visualize the structures I have described above, check out the websites listed below:

http://suncoasthealthcare.net/chiropracticinformation/spinalanatomy-overview.htm...
http://suncoasthealthcare.net/chiropracticinformation/spinalanatomy-detail.html

My opinion is that you probably have a combination of the above structures being injured.  Again the best way to figure out which structures are the offending tissues is with a functional examination of the low back and pelvis to include orthopedic tests for all the structures I have described.  this is how I would approach the problem in my office and how any other doctor should as well.  the vicodin that was prescribed will only cover up the pain and slightly reduce any inflammation you may have.  It will not address any anatomical injury, and it is likely that you will need some rehabilitative exercises to help heal the tissue depending on the exact nature of the problem.  All of this will be compounded by the fact that the associated muscle tissue will likely be in spasm due to the body wanting to limit your motion in response to pain.

At this point I would not think that the injury is serious as everything I have talked about can heal in a relatively short period of time if addressed appropriately.  Conversely, if you have injured the disk there is the chance that it could be a severe injury and the MRI would be the best diagnostic option to choose for the further evaluation.  I do agree with your doctor not ordering the test right away, but I suspect that he did not perform an appropriate examination due to the fact that you did not relay any diagnosis from him.  

I would suggest that you see a chiropractic physician to have this examined further.  We are experts in the diagnosis of these types of conditions/injuries, and are very effective in the treatment of radiating pain.  The chiropractor should perform the orthopedic tests I have described, and will likely take an x-ray to visualize the facet and sacroiliac joints, the nerve root area well as the disk space for any degeneration which would complicate the issue.  Ask friends and family about a chiropractor they have visited that helped them, or call some offices to schedule a free consultation to meet with the doctor.  if you need any help finding a good chiropractic physician in your area, I would be more than happy to help refer you to one with the help of some research into a few trusted referral networks I have in place.

Good Luck Mary.
Respectfully,
Dr. J. Shawn Leatherman
www.suncoasthealthcare.net