QuestionCould you please give me your opinion on what might be causing these symtoms and what rehabilitation might be beneficial? Also, would you recommend me avoiding lifting over 50 pounds?
I fell 3 months ago, from ground level. It was a rotational fall; my right leg went over left, I twisted and landed on buttocks and forearms.
Symptoms occur sometimes just after sitting a lot during the day, then taking during a 300-500 foot walk or after mild/moderate work or exercises. I loose my ability to sit flat on my buttocks because it feels like I'm sitting on a large bony painful lump. Sometimes I have burning pain, sacral area with sitting. Pain is nearly constant, unless I am sedentary. After routine activities and/or mild to moderate work, I get intermittent lower extremity weakness (limp) and a feeling that my pelvic girdle is unstable sometimes. I have pain in my low back to coccyx region, radiates laterally with continued activity, but I always stop and rest to avoid aggravating and spreading the pain. More consistently, pain radiates to my groin area, sometimes posterior thigh(s).
Here are the eventful MRI/Xray results:
L1-2 mild disc dessiccation without disc herniation or stenosis
L2-3 broad based annular bulge & mild bilateral facet arthropathy are present creating flattening of the thecal sac but without significant stenosis or nerve root compromise
L3-4 minimal anterolisthesis of L3 relative to L4; Bilateral posterolateral 2mm-3mm protrusions, most promiently on Left; bilateral facet arthropathy creating mild stenosis & early left sided lateral recess encroachment
L4-5: right paracentral 3mm disc protrusion with fissure formation within annulus; bilateral facet arthropathy creates mild to moderate stenosis & right L5 nerve root & lateral recess encroachment
L5-S1 transitional L5 vertebral body appears partialy sacralized;
Coccyx fracture
The MRI was taken with me supine and my hips bent approx 40 degrees, knees bent 30 degrees. Would this position effect the MRI??
Thanks for your consideration and suggestions in advance.
AnswerHello Anna,
I am sorry to hear of your spine injury.
I will start from the bottom (end) of your question, and work my way up.
"The MRI was taken with me supine and my hips bent approx 40 degrees, knees bent 30 degrees. Would this position effect the MRI?",; yes, Position can affect the MRI. Now-a-days, with open MRI, multiple pictures, multiple positions can be taken to better evaluate the spine i.e.: http://www.fonar.com/standup.htm . I would recommend MRI pictures taken in flexion/ extension/ standing/ lateral flexion/ whatever position bothers you most for best evaluation.
"Coccyx fracture"- This coccyx fracture may also include displacement (misalignment) of the coccyx. Fractures usually heal in 6- 8 weeks in healthy individuals. Fracturing your coccyx shows that your injury must have been severe, it must have done a measurable amount of damage to you. Your (all of us), our coccyx is 'hidden' up deep between our buttock cheeks. To fracture the coccyx, you must have landed exactly right (wrong) to damage it, and/or you must have landed pretty >hard< on your buttocks!
I do not do any specific coccyx work in my office. Some Doctors of Chiropractic (DC) do. I would recommend visiting a Doctor (DC) that does do coccyx work. Look for a graduate of Logan College of Chiropractic, a practitioner of Logan Basic Technique, call your local doctor and see if he/she does this technique/ approach-- if not, there are many chiropractic doctors around, more then one in your community should be able to help you here.
"L5-S1 transitional L5 vertebral body appears partialy sacralized"- transitional vertebrae are with us since birth. They usually do not contribute to our aches/ pains/ symptoms. These transitional segments CAN contribute to structural stress elsewhere- maybe contributing to a herniated disc (for instance).
"L4-5: right paracentral 3mm disc protrusion with fissure formation within annulus; bilateral facet arthropathy creates mild to moderate stenosis & right L5 nerve root & lateral recess encroachment" - This finding should correlate to pain in your right lower back, right buttock, down the right leg (posterior) even up to and out of the toes of your foot.- all right sided.
"L3-4 minimal anterolisthesis of L3 relative to L4; Bilateral posterolateral 2mm-3mm protrusions, most promiently on Left; bilateral facet arthropathy creating mild stenosis & early left sided lateral recess encroachment"- This finding would most likely translate to symptoms, primarily on the left. 'Anterolisthesis'- this could be due to the trauma you described above.
"L2-3 broad based annular bulge & mild bilateral facet arthropathy are present creating flattening of the thecal sac but without significant stenosis or nerve root compromise"- bulge- could have been caused by your fall, may have been there before, easily aggravated by your fall. 'Arthropathy'= pretty synonomous with arthritic degeneration of your facet joints. The findings of 'arthropathy' at this level or the others precede your fall- they indicate osteoarthritic degeneration of that portion, or that joint within the spinal joint complex. see: http://www.spineuniverse.com/displayarticle.php/article106.html
MRI/ Xray/ CT scan could be/ should be viewed by your Chiropractic Doctor. I recommend that you see your local DC for these spinal problems, They are the type of complaint we see all day, everyday. With the Coccyx problem, I recommend someone who does Coccygeal Adjustments- and you will have to ask the doctor whether or not they do that, ask for a Logan Chiropractic graduate, or a Logan Technique practitioner, and if/ after the coccyx is corrected- I would also look for a Doctor that does decompression (ie: http://www.youtube.com/watch?v=k2SdNrBOd5s) in their office. You may need additional Xrays or other tests.
A note on tests:
You have many complicated and problematical findings on your MRI/ Xray that you show me here. Tests are important. BUT, we are not the summation of these tests. Some people have terrible findings--- and function fine, no pain, no problems, no symptoms,,, even run marathons. Some people have no findings,,,, but are terribly symptomatic- with pain and dysfunction, and cannot walk across the street. Your test results look significant, but proper treatment should make you feel and function much better.
Some information I hand out in my Staten Island Chiropractic office may be helpful to you:
PAIN
Pain is a 憆ed light on the dashboard?
Pain is your body telling you that something is wrong.
That RED LIGHT on the dashboard of your car-
-- do you ignore it until the car breaks down,
or do you get it checked and correct the problem?
Pain,
pain in your body-
-- do you ignore it until your body breaks down,
or do you get it checked and correct the problem?
Pain,
do you cover up the pain by taking a painkiller?
Take a painkiller,
mask the pain,
and allow a problem to progress in your body?
NOTICE ON PAIN RELIEVERS:
Label changes ORDERED by FDA; the FDA announced proposed label changes for OTC over-the-counter pain relievers to include the potential for stomach bleeding and liver damage (FDA news 206- 207; 12-9-06) ;
The American Heart Association issued a scientific statement recommending medical doctors change the way they prescribe OTC pain relievers from a first choice to an alternate of recommending non-pharmacologic treatment (AHA statement 2-26-07).
NSAID Acceleration of ARTHRITIS; an important side effect of Aspirin and other NSAIDS is that it will inhibit cartilage repair and accelerate cartilage destruction ( Journal of Rheumatology, 1982; 9: 3- 5 ). Many times people take NSAIDS for the pain of Arthritis, not realizing these drugs may make the underlying condition worse. These medications cover up the pain, and cause the problem to worsen.
Pain can often be the result of the Vertebral Subluxation Complex.
Vertebral Subluxation ( 慥SC?, 憇ubluxation? )
Vertebral Subluxation is actually a quite common condition. Doctors of Chiropractic look for pathological conditions which may require referral to other specialties, and also look for 慡ubluxation? Other disciplines look for pathology, but overlook the importance of alignment and movement in the spine which affects our nervous system (the master control system- ALL health disciplines learn this). VSC- 慡ubluxation??can be the cause of many symptoms and conditions.
Only a Doctor of Chiropractic will evaluate and treat for VSC, as well as other pathology.
The course of VSC is highly variable. Some patients with VSC literally cannot walk, yet other patients with similar test findings may be able to run marathons or lift heavy weights. Some patients immediately develop symptoms related to the VSC, some patients take years to develop symptoms. Some people suffer for only a few days with pain and symptoms, some people suffer for months. Some people recover in days, some take months or years, depending upon severity of the condition.
A subluxation interferes with the proper functioning of the nervous system (the master system which controls and coordinates all function within the body) and may cause various other conditions, symptoms and problems.
The Vertebral Subluxation Complex describes what happens when spinal bones lose their normal movement patterns and position. When subluxated, joints are in a stressed, vulnerable, compromised condition. Subluxation may cause Arthritis, Disk Herniation, or aggravate such conditions.
Vertebral Subluxation cannot be corrected through chemicals (medicine), stretching, yoga, vitamins or physical therapy alone. Subluxation- a neuro/skeletal/muscular- mechanical- problem requires a mechanical correction- - - a manipulation, best performed with the chiropractic adjustment.
Dr. Victor E. Dolan, Doctor of Chiropractic; Diplomat, American Chiropractic Board of Sport Physicians; Diplomat, American Academy of Pain Management; Certified Clinical Nutritionist (IAACN); FIRST Chief of Chiropractic in a Hospital in New York State (DHSI); As Seen in PREVENTION Magazine
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Disk Herniation
Low Back Pain can be caused by many different things.
Big, BAD, catastrophic things like a tumor or a cancer can cause low back pain (only a proper exam by a licensed doctor, like your Doctor of Chiropractic, or your family Doctor of Medicine, can evaluate your signs and symptoms, and perhaps refer for testing).
Big, bad things like a Herniated Disc, sciatica, possible fracture or dislocation can cause LBP (again, best evaluated by your DC or MD, and perhaps referral).
Bad things, like - Sprains, Strains, contusion, or Vertebral Subluxation Complex (all very efficiently diagnosed and treated by your Doctor Of Chiropractic.
Sometimes LBP is caused by a Herniated disc: Herniated disk is actually a quite common condition. However, the course of the condition is highly variable. Some patients with a herniated disk literally cannot walk, yet other patients with similar MRI findings may be able to run marathons or lift heavy weights. Some people suffer for only a few days with pain and symptoms, some people suffer for months. Although the course is highly variable, there are certain steps that are always helpful to follow: Ice the area when painful- 10/ 15minutes on, 30/ 45 minutes off; avoid certain postures and movements; bend the knees when coughing or sneezing; bend the knees when lifting anything; do not extend legs straight out when sitting, laying down, lifting, or driving. Avoiding certain movements and postures will prevent aggravation of the condition. Practicing good postures and movement patterns will help the condition heal and be less painful. Disk Herniation is often caused by, or often concurrent with the Vertebral Subluxation Complex.
Vertebral Subluxation Complex (a.k.a. 憇ubluxation?
The vertebral subluxation complex is the underlying cause of many healthcare problems.
A subluxation interferes with the proper functioning of the nervous system (the master system which controls and coordinates all function within the body) and may cause various other conditions, symptoms and problems.
Subluxation is a serious condition identified by its five parts:
Spinal Kinesiopathology:
This is fancy way of saying the bones of the spine have lost their normal motion and position. It restricts your ability to turn and bend. It sets in motion the other four components.
Neuropathophysiology:
Improper spinal function can choke, stretch, or irritate delicate nerve tissue. The resulting nerve system dysfunction can cause symptoms elsewhere in the body.
Myopathology:
Muscles supporting the spine can weaken, atrophy, or become tight and go into spasm. The resulting scar tissue changes muscle tone, requiring repeated spinal adjustments.
Histopathology:
A rise in temperature from an increase in blood and lymph supplies result in swelling and inflammation. Discs can bulge, herniate, tear, or degenerate. Other soft tissues may suffer permanent damage.
Pathophysiology:
The VSC contributes to OsteoArthritic degeneration. Bone spurs and other abnormal bony growths attempt to fuse malfunctioning spinal joints. This spinal decay, scar tissue, and long-term nerve dysfunction can cause other systems of the body to malfunction.
The Vertebral Subluxation Complex describes what happens when spinal bones lose their normal movement patterns and position. When subluxated, joints are in a stressed, vulnerable, compromised condition. Subluxation may cause Arthritis, Disk Herniation, or aggravate such conditions.
Vertebral Subluxation cannot be corrected through chemicals (medicine), stretching, yoga, vitamins or physical therapy alone. Subluxation- a neuro/skeletal/muscular- mechanical- problem requires a mechanical correction- - - a manipulation, best performed with the chiropractic adjustment.
Dr. Victor E. Dolan, Doctor of Chiropractic; Diplomat, American Chiropractic Board of Sport Physicians; Diplomat, American Academy of Pain Management; Certified Clinical Nutritionist (IAACN); FIRST Chief of Chiropractic in a Hospital in New York State (DHSI); As Seen in PREVENTION Magazine
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I hope this helps.
If you need further, do not hesitate to RE-contact me here at allexperts.com: http://allexperts.com/ep/965-100794/Chiropractors/Victor-Dolan-DC-DACBSP.htm
Thank you for the question. Good Luck.
Dr. Victor Dolan, DC
Email newsletter: http://drvictordolan.chiroweb.com
