Question
About six months ago after running some stairs I all of a sudden woke up one day with a major back spasm. A few days later I started experiencing an old injury I had (SIJ Dysfunction/sacral torsion). I was requiring daily to every other day chiropractic adjustments for about 3 months because my pelvis was constantly shifting, and physical therapy was only causing more inflammation in the pelvis area. Then I finally started to get burning sciatica down my hamstrings while dealing with the sacral torsion.  My medical doctor finally ordered me a lumbar MRI to determine what my problem was. I have and mild disc bulge (3-4mm) at the L5-S1 and disc protrusion (1-2mm) at the L4-L5, moderate facet arthropathy at the L5, a right L5 pars defect, and a right L5 spondylosis. I finally got to the point where my pelvis started to stabilize and decided to purchase a decompression unit. I made the mistake of heating my back up on a massage roller bed (Ceragem) before I used a decompression unit (Nubax Trio). When I used the decompression unit I overstretched for two minutes and found out the next day I strained my thoracic and shoulder region on the left and right side. It basically took about 1 ?months to heal this injury and it was labeled as a grade 2 strain. I then tried to use the massage roller bed again to roll out my upper and lower back. The roller bed pauses and pushes up along your entire spine. I let it roll on my sacrum and lumbar area for a long time. When I got off the bed some weird things happened. My left knee began to swell up, then while I lay in bed that night my big toes began to experience burning nerve pain. I thought it was a cramp or something at the time. The next day my big toe tendons began snapping a lot and both knees had burning nerve pain, but I kept walking like normal not knowing any better. By the end of the day my left big toe was strained due to the amount of tendon popping I had going on; both of my feet had burning toe pain, numbness and tingling traveling down my shins to my feet, and weakness in my ankles. My shins and calves began to swell up and get tight, as if circulation was cut off to the area. Then my buttock, hips and hamstring started to experience burning nerve pain. Both legs had the same symptoms; it was just that my left leg was worse. At times now my feet will lock up at the top of the foot. I cannot move around at this point. As I was going through all of this pain I tried to have chiropractor check me to see if I was locked up anywhere. Unfortunately, the adjustments were only inflaming my sciatica instead of helping me. We also tried traction and exercises in physical therapy and each move increased my sciatica after the session as well. About a week after my leg symptoms started, my neck began to lock up and create really bad nerve pain down my arms. I require cervical adjustments about once every two weeks now and my neck muscles are always tight (Note: My Cervical Chiropractor believes the instability in my neck is because I now have to walk on my heels to avoid having my big toes snap and sprain, therefore, my upper back and neck are tightening up because my posture is changing. I have had a cervical MRI and Thoracic MRI done in the past and I only had two small (1-2mm) protrusions at my C5-C6/C6-C7 discs, andf no major findings in my thoracic area). About 1 week after the symptoms started I decided to pay for another MRI assuming I had herniated a disc or had a major problem occur while I was on the roller bed. The only difference in my MRI was that I now had an L5-L4 facet cyst (3mm), and it was on the back of the facet away from the nerve. This told me some type of inflammation occurred while I was on the bed, but I don抰 know what. All the other findings were the exact same as my previous MRI, which I had much less pain and sciatica at that time. My doctors recently did a nerve conduction test and everything was normal. It is amazing to me that I have this much nerve pain with no real answer. I have been spinning my wheels for two months trying to figure out what will help, and the symptoms in my legs and neck have only gotten worse in the past few months.  It seems like if I put any pressure on my pelvis or lower back my sciatica increases massively. When I filled out a nerve chart it would seem like I have problems at the S1/L5/L4 level. I can feel the nerve pain tingle and burn from my lower back down to my feet at times. Anyhow, I am wondering if this type of story sounds familiar to another patient your team has worked with before? Do you have any suggestions for me? As you can imagine the pain makes me desperate for answers. Thanks in advance for your support.

Answer
Dear Daniel,

Quite the narrative.  I am so sorry that you experience so much pain.  Back pain, as you have proven, can be very elusive. I have seen patients at times that have normal MRI findings, yet have significant back and leg symptoms.  I have also seen patients with severe findings on x-ray and MRI, yet they experience minimal discomfort.  This is one of the reasons why so many lower back surgeries fail... the surgeon finds issues on MRI, then opens up the patient and cuts on the damaged discs.  The patient is stitched up, heals, and then continues with his/her pain because the true pain generator, the cause of the pain, was not the obvious disc bulge that was operated on.

Every case is different Daniel.  It is possible that YOUR symptoms are due to the disc issues that you describe in your MRI.  You have to remember that an MRI is a snap shot in time.  Perhaps you didn't have pressure from the damaged discs upon the cord or nerve roots while you were lying in the MRI machine, but when you are standing, walking, bending, lifting, etc etc, the discs bulge more, creating more nerve/cord pressure.

The spondylolysis of the pars interarticularis creates instability at the joint.  This instability can lead to inflammation and joint stress, which can lead to pain.

Facet joints, when inflamed, can cause pain that radiates into the leg.  This is not a true nerve referral pain like cord and/or nerve root compression pain, but none the less, it is a leg pain that spreads from the lower back. Facet joints can cause pain even when they are NOT compressing upon nerve tissue.  A pain specialist can do a medial branch block to deaden the nerve temporarily. If this eases your pain significantly, than it is a sign that the pain is coming from the facet joint.

Hip degeneration can cause lower back and leg pain.

Knee problems can cause hip and leg pain.

Piriformis muscle and other gluteal muscle problems can cause back and leg pain.

I have never been a fan of the diagnosis pelvis or sacral torsion.  Strong ligaments hold these joints pretty much solid and non-moving. There could be some mild rocking motions here, but these joints are almost as solid as solid bone. Separation/torsion would require significant traumatic injury, (severe car accident, significant fall, etc) to injure.  This topic is controversial.

If I were you, I would consider a visit to your medical doctor to have some blood tests run to rule out inflammation, inflammatory diseases, autoimmune disorders, arthritic disorders.  

Once these are ruled out as possibilities, I would start treating myself as if it were the discs that were causing the pain.  I would avoid any position or activity that causes me pain. I would then start with SIMPLE, non-aggravating stretches, and SIMPLE, core strengthening exercises (it almost sounds to me that you have a tendency to go overboard with anything that you attempt... so start out slow, with directions from a qualified PT/Chiro, and build as you SLOWLY gain strength and flexibility).  More isn't always better.  Sometimes slow and steady wins the race.

Once a bad back, always a bad back (ligaments and discs don't heal well).  So once I started to get some flexibility and strength back, I would CONTINUE those simple exercises forever... like brushing my teeth... every day... whether I was in pain or not.  I would not runs stairs again. I would find other cardiovascular exercises that do not put my back at risk (cycling, for example).

I know that there is a lot of data here, and some of it might be of value Daniel, while some of it is not.  I hope that it at least gave you some things to think about.

Keith Biggs, DC
http://www.eastmesachiropractor.com