Question
I am an active 35 year old female in good health.  I have been battling lower back pain for 15 years on and off.  I have mild scoliosis.  The last 2 years I have been in constant pain, limiting my activities.  I have been to many doctors, done all the conservative treatments (physical therapy, pain medication, chiropractor, cortizone injection, lumbar stablilization, massage) with minimal improvement.  After MRI and CT scan and dicography, doctors have told me I have a couple of degenerative discs at L4-5 area, but am not a good candidate for IDET.  Options include nucleoplasty, fusion, or continued pain medication (which does not help much).  I do not have nerve pain, which makes my case that much more frustrating.  Fusion scares me, I don't know much about nucleoplasty, and am concerned about the side effects of being on pain meds for a long period of time. Could you give me your thoughts on these options?
Thank you.  MB

Answer
Ok MB, here's the deal..
First off the mild scoliosis sounds like you aquired it starting at the time your back pain started, in which case it may be a compensation scoliosis, which means in the right hands (of which you have not been yet) this probem can be fixed. Second, even though you may have degenerative changes at L4-5 so does 68% of the normal population and they don't have any back problems. That comes from a recent study. Honestly it simply sounds like all the health care professionals that you have gone to are playing the "what's wrong with MB guessing game" and I find that shabby. I have a feeling that the rotary component of your scoliosis has caused a narrowoing of the facets in your spine, which causes discomfort many times like you describe without the nerve pain. I see your case as a great opportunity to get excellent results if you see the right person. Normal physical therapy knows nothing but hot packs and ultrasound with a few stretches and exercise that don't treat the problem. Chiropracters know good techniques for some conditions, but they cannot tell what segments are moving too much already and which are not moving enough, (because they rely on their x-rays which shows zero movement), and therfore they are also guessing at what makes you better or worse. Injections help to numb a nerve, but if you don't have nerve pain then why inject them? Now you are at the orthopedist and surgery has been offered without anyone really finding the source of the problem, simply because they do not know how. There are certain professionals who have gone beyond their education, done the latest research, and studied more about the mechanics of the spine than anyone else on the planet. They are called Certified Manual Therpists, and they are hard to find, since only about one in twenty that spend the five years it takes to earn the right to even take the test actually pass it. They can feel the movement at your spine, and test each segment. They can tell you if the scoliosis is a factor, if the disc is a factor, if the facets are the factor, or how much of each one is the factor. They can open up facets, restore your movement, and avoid a million stabilization exercises that are probalby only contributing to your increased tone and tightness of the joints. They are the ones that can give you specific answers and get sucess. You are young, no nerve pain, and looking at surgery. Nonsense. There is much more for you that needs to be done. These manual therapists have the intials MTC after their names. Find a Doctor of physical therapy with MTC after their name and you will have the latest and the best treatment possible. I treat many pateints like you who assume all physical therapy is the same, and that is not true at all. You will notice a difference after the first visit, i'm fairly confident, based on patients that I have seen. If I am wrong, then surgery can always be an option, but look at the literature carefully first. Once you change your natural structure there is no turning back. I can give you some great references if you get to that point, (which I bet you don't).
This could be some really great advice, MB, if you follow it. I hope you take it in the sincerity it was given.
Dr. Jeff Carr, DPT,MTC,ATC,CSCS