Question
About two years ago I started to feel an extreme tightness/pain in my lower back, where standing or sitting for a long time left me squirming around to "pop" my back and offer a few seconds of relief.

I started seeing a family friend chiropractor and acupuncturist (who has since moved away), who noticed I had really tight QL muscles as well as a short leg, and a fallen arch on the short leg side. After months of treatment and no relief, I got a load bearing, standing x-ray. This x-ray shows my right iliac crest and femur head at least a 1/2 inch lower, as well as a tilted lower spine/sacrum.

He gave me some rigid orthotics and and a heel lift matching the leg length discrepancy, along with some stretches.

It has been over a year now with the heel lift and stretches and my back is the same; extremely uncomfortable and able to "crack" any time with the slightest of movement. I don't have health insurance that will cover anything, so I'm trying to figure out what to do next.

My history may help a bit:
I have been biking professionally for years, and that seems to make it worse when I bike. I have pretty much stopped.

Heat, laying down, and muscle relaxers offer temporary relief.

Thanks for your time. Any help will be greatly appreciated.

Answer
Dear Matthew,

It sounds like, to me, that you had a good chiropractor and that he was evaluating and treating you with what he found. His thinking and procedures, in my mind, are sound.

One thing to remember is that many of the issues that can cause lower back pain cannot be seen on x-ray at all. An example would be disc dessication, disc degeneration, and disc bulging or herniation. Anything related to disc problems, ligament issues, etc are not demonstrated well on x-rays.  Back pain, although usually a mechanical problem, can be caused by a lot of different things.

Perhaps an MRI is your next step to make sure that you are not having disc or ligament related pain. (this especially would be indicated if your lower back pain is accompanied by numbness or tingling or pain in one or both legs or feet. Other possible indicators would be muscle weakness int he legs or feet or loss of bladder control or increased urinary frequency.) If you choose to get an MRI, you can at times negotiate a cash fee with the imaging facilitiy before the test is performed.

Pain in the lower back can also be related to some pelvic organ issues, so you should have a good medical physical to rule out any prostate issues (since you are a cyclists), etc. This might include blood work, rectal exam, etc.  

Another thought... have you taken x-rays of the lower back while standing in the orthotics and with the lift in the shoe to see if it benefiting your structural distortion?

Finally, I hope you understand how it is impossible to actually evaluate and give an accurate diagnosis and plan of action through an e-mail relationship. Ask around where you live and find another chiropractor and/or medical doctor to help you with your plan of action to get to the bottom of your issues.

Good Luck,

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