Question
QUESTION: Hello,

I抦 21, male, 6 feet, 250 pounds and my body fat percentage is greater than 30%. Last Tuesday I was at my college gym and I got onto a rowing machine. The person that had been using it before me had left the handlebar up and as I was reaching forward making a statement that I couldn抰 reach the handlebar, the person rowing next to me on my left gave me a sudden push forward and I felt about two crackles to the left of my sacroiliac joint, it may have been further out than the joint itself. At that time I didn抰 feel any pain; I got off the machine after grabbing the handlebar myself and rowing briefly and stood down and up to check if I felt anything. When I got home and lied down on my bed, I may have felt stiffness in my lower back but that was it.

On Friday I wanted to check if I would feel any pain in my range of motion from what happened at the gym. So I stood down and up, jumped up and down, hyper-extended my back, and while keeping my legs straight I reached down to my toes and also ran my hands down my legs from side to side. I didn抰 really feel any pain from doing these stretches. The next day on Saturday when I got up, I noticed pain in my lower back. As I type this letter now; I feel a pain in the left of my spine above the sacrum. On Sunday I felt a radiating sensation going down my right leg and the numbness feeling, though not as strong, came back in that leg yesterday. I抳e felt pain to the left and right of the sacrum, including in the sacroiliac joints, to the left and right of the hip area, and a little bit in the higher part of the spine.

I抦 not sure of this is happening or if it could be because I抳e been nervous about what happened, but I抳e felt like my bladder has been getting fuller quicker, like this morning I woke up feeling like I needed to urinate, but when I went to urinate, not much came out, it was tinkling a bit, and before I would urinate a lot stronger. I also feel like my desire of sex may have gone down along with the hardness of my erections, but this could all be a fear of having damaged my nerves.

What do you think has happened here?
What tests or x-rays can I do to put my mind at ease?

ANSWER: Hey Josh-

The good news is you can have an MRI done if you want a pretty sure answer as to your injury. With that i'll add a bit of my opinion, though I'm not a doctor...

The pain you describe could be several things, none of which would be untreatable or even "serious" injuries. Your spinal cord is in all probability unharmed. My guess is that you may have a deep muscle bruise or even a pulled muscle or something similar in there. If you're feeling any tingling or numbness or unusual weakness radiating from the area down your legs, you might have a swollen disc. Even that (which would be seen by the MRI) can be treated with a cortisone shot.

Any of the above would be helped to heal by taking Advil for 2 or 3 days and alternating heat and cold on the location. If you don't feel any lessening of your symptoms or if your anxiety about it continues, go ahead and see a doctor- that's why they're out there, to tell you if something's wrong or not- right? Based on my experience (opinion) you probably have a small injury and a small amount of anxiety about it which can combine and over-focus you on any twitch or pain. If you can, try to notice how you're feeling without dwelling on it.

i know that's a mouthful sometimes, but I think you're going to be ok
good luck, and remember the doc's out there and you're welcome to write back here too, ok?

leslie

---------- FOLLOW-UP ----------

QUESTION: Thank you for your reply Leslie. Since then I've stopped feeling direct pain in my sacrum and lumbar spine, but I still feel pain to the left of the area where the lumbar meets the sacrum (in the left hip area where I felt the original crackle). After a bit of research I've found out it could be in the region of the pelvic splanchnic nerves which are responsible for bowel and erection function. I would like to include that area in the MRI as long as the doctor hasn't lost patience with me as I've already changed my mind on a whole host of things, but what is that area called? Just the 憄elvis? Do you think it would be worth adding the lumbar spine in the MRI at this point? Also, would mild pain be not a worry in terms of if I had done damage to the pelvic splanchnic nerves in that area? I抦 just not sure what that crackle could have been, ligaments or muscles tearing or clicking over each other, would that have caused instant pain like nerves snapping? Thank you again.

ANSWER: hi Josh-

I'm not sure what area of the spine you're set to do the MRI on, but I would've gone for the lumbar to begin with (unless you have other symptoms up higher).

The only name I've heard the area in question called other than 'sacral spine' or 'pelvic region' is the ischium. Look it up before using it though to make sure I am reading correctly the location you mean... (adjective of the area is 'ischial')

As for your question about mild pain being a worry related to splanchnic nerve damage: i've never known neurological pain to be mild. Tingly to searing, yes, but never would i have described it as 'mild pain'. And to be entirely honest, you sound a bit obsessive with your concern. I mean absolutely no disrespect by this- I know I'm getting a limited view of the situation, and my experience is certainly not all encompassing.

I do think you should have the MRI of your pelvic area though, because it's always worth believing the experience of the patient. Also one of the best and often overlooked rules of psychology is that you must rule out organic causes before deciding it's a mental issue. (this might be a good thing to mention to your doctor if he's 'losing patience' with you?)

good luck
leslie

---------- FOLLOW-UP ----------

QUESTION: Thanks Leslie, there as been a lot of angst involved, and the hope would be that some of the symptoms are from stress. I suppose the last question I have is the orthopedic surgeon has given me an MRI referral for the lumbar and sacrum, is that enough or should I go back and ask him to include the 憄elvic region? I only ask because it would be a couple of weeks wait for the MRI and near impossible to go back and get another scan of the pelvic region if the lumbar and sacrum are fine. This is a link to a photo I抳e uploaded a photo (http://img407.imageshack.us/img407/459/9766zp3.jpg) showing where about I felt the crackle on a small posterior diagram, I抦 guessing that would be on the lining of the hip but you would still call it the pelvic region? Thank you again.

Answer
hi josh-
yes, hopefully at least some of the Sx are related to stress- at least you'll know for sure before long. i know it's a spooky thing to have weird things happening in your own body and have to guess at what might be going on.

As for the MRI- did he give you the orders or call the MRI people? I ask because sometimes you can tell from the wording they use as to whether or not surrounding areas will be included or if they just want the image of the spine. If you do have the orders, call the MRI place and ask what area is included in the specific words the doctor has written. Otherwise, in my opinion, it's worth a call to the doctor or the nurse at least to make sure- it would be far easier to do it at once.

Rather than request a certain region off the bat, I'd probably ask something like 'how much of the surrounding tissue will be included in the MRI'. If they give you the answer you want, you're good. If they say it'll be the spine itself only, you can mrntion having felt it at the location in diagram, etc etc. Depending on the doctor, you sort of have to choose your strategy lest you be labelled as whiney or crazy or any other thing that might let them blow you off. Hopefully your doctor is not so bad about this as some are (my husband had a horrible experience with a urologist, this is what i'm rememebering to make me add this part...)

anyway, as always good luck. Let me know how it goes, eh?
leslie