Chronic low back pain with no diagnosis.?
I am a 43 yo female with chronic low back pain. I have been through MRIs, CTs, Mylorams, sensory and nerve conduction studies, plain x-rays, ultrasounds and physical therapy. I've had cortizone shots, as well. My pain began back in 1986 during my first pregnancy. At 26 I had a partial hysterectomy. Recently I have had two colonoscopies and surgery to remove my ovaries in which they found an extensive amount of scar tissue and endometriosis -- which was not the reason I had the partial hysterctomy. Until April 1, 2008, I would experience constant aching in the low back, but only suffered severe bouts about five or six times a year. On March 31, 2008, I fell flat on my back and have had severe low back pain ever since.
My symptoms are as follows: The triangular area at the small of my back will swell enough that I can cup my hand around it. The SI joint on the left side is very tender. I have a stinging pain that goes from the SI joint, around my buttocks and left hip, crossing over to my left groin area, down the inner thigh all the way to my toes. I have severe aching in both my feet. My left knee will swell twice its normal size. I often cannot walk or stand because the weight causes the pain to become more severe. I cannot sleep at night because I can't get comfortable.
This has always been located on the same side (left) with the same symptoms, although now the symptoms are constant. The doctors don't seem to be finding anything on any of the tests. My neurologist said that I have mild L5 nerve root damage, but nothing is compressing the L5 nerve root. I do have a small disk bulge at that level, but again, not compressing the root on films. She's the one that found mass that led to surgery and other findings (that didn't show up on films, either!)
I had colonoscopy from severe constipation with extreme gas and bloating, but that came out clear, too, but symptoms still exist. And I have had some unexplained weight gain, as well. Any ideas or suggestions on who I should see next?
Public Comments
1. I have a small disc buldge and have pain EVERYDAY in my lower back. My chiropractor did find I have a short leg, might be worth a check, it also makes my right knee hurt if I don't wear a lift. I do stretch and my physical therapist and DO have worked on my low back and tried to stabilize my pelvis so I have had times of relief. I think disc bulges and structural problems can cause pain, I am almost your same age. Some theorize that peri-menapause increases pain levels and I have been told Fybromyalgia, etc. I do get massages....really helps as well as moist heat and ice packs on my low back. Stretching everyday is a must for me. Good luck!2. I had a lower back problem for 14 years. I had an MRI, PT, and Chiropractor too. About a month ago I came across Dr. Bookspan’s website and did her neutral spin positioning and I’m getting better every week. (more and more activities that don’t hurt)
My problem was over arching the lower back. Disk problems are from over rounding. She has found that both can be fixed (most of the time) with proper posture and correct movements.
I have included an abs article that will help with lower back and a disc article that will help if you have a bad disc. I have also included her bio. For what it’s worth I like her book How To Fix Your Own Pain.
Both articles are similar with different stretches and explanations. This should not hurt and it will either help with the pain or help you figure out the cause of the pain. She also has an article for knee pain. Email me if you would like more help with this.
3. When back pain is due to loose ligaments, a very characteristic behavior of pain is observed. A patient with loose ligaments of the lumbar spine or pelvis will experience recurring dysfunctions at the intervertebral joint (degenerative disc and possible nerve compression), at the facet joints (locking in flexion or extension), and at the sacroiliac joints. In other words, the low back pain can be due to an unstable disc problem, facet joint locking, or sacroiliac dysfunction.
However, the low back pain can originate in the ligaments themselves. The ligaments in the lower back contain an abundant supply of small nerve endings. Good and strong ligaments will stretch very little when a load is applied to them. When the ligaments are weak, an excessive stretching will occur with the same load. The greater the ligament laxity, the faster the ligament will elongate or stretch. This exaggerated elongation of the weak and overstretched ligaments allows excessive pull on the non-stretchable nerve endings. As a result, pain and/or numbness is felt locally over the ligaments or referred distally in the buttock or in the legs, following a specific pattern for each ligament.
Ligament injury is very painful. This is, in part, because of the nerves in the ligaments, but also because ligament injury typically occurs where the ligament attaches to the bone, an area called the fibro-osseous junction. The outside of the bone, where the ligament attaches (the periosteum), is also full of nerve endings. The most sensitive structures that produce pain according to Daniel Kayfetz, M.D., are the periosteum and the ligaments. It is important to note that in the scale of pain sensitivity (which part of the body hurts more when injured), Dr. Kayfetz explains that the periosteum ranks first, followed by ligaments, tendons, fascia, and finally muscle, respectively. (Kayfetz, D. Occipital-cervical (whiplash) injuries treated by Prolotherapy. Medical Trial Technique Quarterly. 1963; June: 9-29.) When a ligament is injured, pain will be elicited from both the periosteum and the ligament. This is why ligament injury can and does cause severe pain. This also explains why ligament pain can come and go. The ligament will not be overstretched in certain positions, therefore no pain is felt at that time.
A patient with loose ligaments of the lumbar spine and pelvis will often complain of not only nagging low back pain, but also of an inability to maintain the same position for a long period of time. If the same position is held for a long time period, this will stretch the already injured ligaments with sensitive nerve endings. The patient will find relief by changing posture or position because the nerve endings are no longer being stretched. This relief is only temporary. As the new posture is maintained, the weak ligaments gradually start to give and the small nerve endings are again stretched, and the pain recurs.
Here are some typical pain patterns experienced with ligament injury to the lower back:
Lying Down
When lying in bed, position must be changed repeatedly to get comfortable
Sleep is poor, and often disrupted because of the recurring back pain
Arising out of bed and walking around often gives some relief of the pain
Morning
The pain is more intense in the morning
After lying down for 5 or 6 hours, the athlete gets out of bed early (5 or 6 a.m.) because
of the pain
Stiffness and pain in the lower back upon rising in the morning
Standing and Sitting
Standing too long aggravates the pain (like standing and watching a sporting event, standing too long at a cocktail party, or in line at the grocery store or bank)
Sitting too long aggravates the pain (observing a sporting event, sitting at the theater, taking a long drive, or watching a movie)
Walking around after standing and sitting too long helps decrease the pain
Anyone who has pain characterized by the above, needs to consult a physician with special training in the diagnosis and treatment of ligament problems.
