S/O: What kind of professional should I see about this?

[AlmiraGulch]

I've had chronic low back pain for years and years. Probably 16 or 17. I've seen a chiropractor off and on with only very limited success. For what it's worth, I'm a big fan of chiropractic, so certaily not hesitant to go that route. It just hasn't really produced any lasting results, even after years of steady adjustments.

 

It got so bad about 18 months ago that I went to the GP. They took x-rays and found nothing.

 

The pain is in my lower left back and radiates down through my buttock, hip, thigh, and sometimes lower. It screams sciatica to me, but then I can actually feel a lump in there at it's worst. It isn't a bulging disk because it's well to the left of the spine.

 

Massage helps, but I can't afford to do that all the time. Heat provides some relief. I'd like to get to the root of the problem, but I don't even know where to go.

 

What kind of doctor even deals with this sort of thing? And is there anything they can do? It's incredibly painful and even affects my sleep.

[kewb]

I would see a neurologist.

[Giraffe]

You need an MRI or CAT scan. X-rays will only show bone problems. Since it's to the left of the spine it could be muscular. It sounds like something is impinging on a nerve.

 

I feel your pain, literally. I'm in so much pain right now that I can't lie down, which is weird. Left leg burns and tingles, not in a good way. Back is screaming at me. I just want to sleep (it's 11:30pm)!

[gingersmom]

Either a neurologist (my first choice) or an orthopedist

[Anne in CA]

Yes, I had a shoulder impingement and no X-ray would show that problem but a physical therapist gave me exercises that have made the problem mostly go away. And I lift things for a living.

[Michelle in AL]

It does sound like sciatica. Shooting pain that crosses over 2 joints is almost always nerve pain.

 

A neurologist can do nerve conduction studies, or may treat based on symptoms.

 

There are several methods of treating the pain: Tricyclic antidepressants, neurontin or lyrica, lidocaine patches, and/or epidurals. PT.

 

Hope you feel better soon,

[Momof3littles]

I would start with PT, and ask them if they think an MRI is needed. Sciatica just means the nerve is flared up; there can be many factors that contribute to sciatica (tight muscle like the piriformis, problems in your spine, problems with stability of your sacroiliac joint, etc.). The only way to determine the origin is to get a thorough evaluation, and that's assuming you are dealing with sciatica in the first place.

 

Does it fluctuate with your monthly cycle? Sometimes that happens with sacroiliac joint pain as the hormones in your cycle fluctuate and can cause the ligaments there to be more lax. Does it "clunk" in or out?

 

Did the chiro ever actually give you a diagnosis?

[tex-bex]

This woman's amazing blog will have some great ideas and resources for you: www.alignedandwell.com

[Isabella]

I don't know if there are any Bowen Therapists in your area, but it would be worth looking, as this kind of thing can often be helped with Bowen treatments.

[fraidycat]

After suffering with chronic back pain for years and years, and having purchased and disposed of no less than 5 mattresses (and NOT cheap ones) in the 12 years DH and I have been married, last fall, I started sleeping in a Mayan or Brazilian (we have both kinds) hammock and REFUSE to go back to a bed. Every now and again, I'll end up sleeping in a bed for one reason or another, and each and every time I do, I wake up in the morning regretting it - all day long, and sometimes into the 2nd or 3rd day, even after going back to the hammock after the one night.

 

For less than $200 bucks, I remedied my back pain.

[Melissa in Australia]

physiotherapist

[Katy]

Sounds like sciatica to me too. Sciatica is oftentimes caused by tight hips, and can oftentimes be worse on one side or the other. Stretching out the muscles helps a lot. There are tons of stretches online you can find if you take an hour to google and try each one, but these are the ones that help me the most:

1. Stand with your back to the kitchen sink, heels about shoulder width apart and touching the cabinets. Your bottom will probably mean you are leaning forward a tiny bit. Tuck your bottom under as far as possible, stand up straight, and lean back over the sink a little bit. You will feel a gentle stretch on the front muscles of your spine. Hold it for about 30 seconds, relax, and repeat 3-4 times. Those muscles get tight from sitting and very few things we do in modern life properly stretch them again. Having them overly tight can pull your hips out of alignment and make them overly tight too, causing the whole situation.
    
   
2. Stand with your back up to the right end of a sofa. Lift your right leg up and put your right foot and shin up on the couch while standing. Lean forward a little and put your right foot up on the back of the sofa (where your head would normally rest), with your knee were your bottom would normally go. Press some weight down into your knee, which creates a stretch in your hips similiar to doing the splits but without needing as much hamstring flexibility. Hold for 30 seconds or so, relax, repeat several times then do the other side.
    
   
3. This one is easier with a partner. On a bed, on your left side with your partner behind you, reach with your right foot back up and around your partner and try to touch the bed on the other side of them as high as you can. When you've reached as high as you can, have them gently assist by gently pulling your ankle up and accross them while pushing your hip away from them. Hold for as long as you can stand (I can almost never make it 30 seconds), then repeat several times. Switch places and do the opposite side.
    
   
4. After those stretches I sit on the floor with my legs spread and gently try to lean my chest as far in towards the floor as I can go to also stretch out my hamstrings. I find they need it after stretching hips.
   

The last time my back got really bad DH said he used to have tight hips when he was training for his black belt and he found that kicking helped him the most. Stretch (gently) first. He said to start by kicking straight up with one leg, then do a sort of circle kick by bringing the knee up pointed to the side and then rotating the knee into the center, dropping back down. And finally some reverse circle kicks by bringing the knee up the center, then rotating it out at the top. I'm probably not describing these movements well, but they are similar to ones I did in Cindy Crawford workout dvd's in the 90's and in cardio kickboxing classes or TaeBo in the early 2000's, if those are a reference for you.

 

Hope that helps. If you try them and they make no difference whatsover I'd try a neurologist or ask for a refferral to physical therapy.

[AlmiraGulch]

Yes, I had a shoulder impingement and no X-ray would show that problem but a physical therapist gave me exercises that have made the problem mostly go away. And I lift things for a living.

 

So did you go directly to the physical therapist? How did you go about finding one in the first place?

 

It does sound like sciatica. Shooting pain that crosses over 2 joints is almost always nerve pain.

 

A neurologist can do nerve conduction studies, or may treat based on symptoms.

 

There are several methods of treating the pain: Tricyclic antidepressants, neurontin or lyrica, lidocaine patches, and/or epidurals. PT.

 

Hope you feel better soon,

 

So another vote for a neurologist. Makes sense. Thanks.

 

I would start with PT, and ask them if they think an MRI is needed. Sciatica just means the nerve is flared up; there can be many factors that contribute to sciatica (tight muscle like the piriformis, problems in your spine, problems with stability of your sacroiliac joint, etc.). The only way to determine the origin is to get a thorough evaluation, and that's assuming you are dealing with sciatica in the first place.

 

Does it fluctuate with your monthly cycle? Sometimes that happens with sacroiliac joint pain as the hormones in your cycle fluctuate and can cause the ligaments there to be more lax. Does it "clunk" in or out?

 

There is no difference in pain level based on my cycle. I does sort of clunk a bit when it's at its worst, kind of like it's "stuck". It kind of, I don't know....pops, or something, in my lower left back.

 

Did the chiro ever actually give you a diagnosis?

 

My sacrum tends to move out of alignment and that probably infringes upon the nerve, but it's so tight that getting it back in alignment is nearly impossible. I've had a string of chiropractors and it just doesn't move. The one person who can do a decent adjustment on my and really get in movement that low in the back is my cousin, and she lives 650 miles away.

 

This woman's amazing blog will have some great ideas and resources for you: www.alignedandwell.com

 

Thank you so much!

 

I don't know if there are any Bowen Therapists in your area, but it would be worth looking, as this kind of thing can often be helped with Bowen treatments.

 

I've never even heard of that! Off to Google.....

 

I used to have bad lower back pain. It went away when I replaced my old, cheap mattress with a much better one about 8 years ago.

 

That's great! Fortunately I have a fantastic mattress. I don't mess around with my sleep.

 

physiotherapist

 

Physiotherapist? I've never even heard of that. Off to Google.

 

Thank you so much for everyone's responses! I am just so sick of being in pain all the time. I need to try something else, but I don't want to throw away time or money so I appreciate your recommendations. At least now I'm pointed in the right direction.

[AlmiraGulch]

Sounds like sciatica to me too. Sciatica is oftentimes caused by tight hips, and can oftentimes be worse on one side or the other. Stretching out the muscles helps a lot. There are tons of stretches online you can find if you take an hour to google and try each one, but these are the ones that help me the most:

Hope that helps. If you try them and they make no difference whatsover I'd try a neurologist or ask for a refferral to physical therapy.

 

Thank you! I do stretches and have some that help, but I think my body is used to those and they just aren't particularly effective anymore. I'm glad to have new ones to try.

[Melissa in Australia]

 

 

 

Physiotherapist? I've never even heard of that. Off to Google.

 

 

Every single hospital, even country ones have a physiotherapist, large hospitals have whole teams of them. Plus there are heaps in private practice as well.

 

from this link http://www.cdm.ahpa.com.au/HealthcareProfessionals/AlliedHealthProfessionals/Physiotherapists/tabid/158/Default.aspx

Physiotherapists

 

What does a Physiotherapist do?

 

Physiotherapists use a holistic, person-centred approach to support patients across the lifespan to maximise their mobility and functional capacities, and therefore their independence and general wellbeing.

 

Services

 

 

Physiotherapists assist patients with musculoskeletal, cardiothoracic and neurological problems. They provide lifestyle modification and self-management advice; manual and electrophysical therapies; prescribe aids and appliances; prescribe exercise and supervise exercise classes; provide physical activity counselling and movement training and provide health promotion and prevention activities and advice. Physiotherapists treat a range of chronic conditions, often as part of multidisciplinary teams, including:

• Cardiovascular disease
  
• Chronic obstructive pulmonary diesase
  
• Diabetes
  
• Osteoarthritis
  
• Osteoporosis
  
• Obesity
  
• Hypertension
  
• Stroke
  

 

Physiotherapists are uniquely placed to address risk factors for chronic conditions. They have knowledge of the complexities of co-morbidities and physical limitations in people with chronic conditions and are trained to design programs that respond to these complications.

[AlmiraGulch]

Every single hospital, even country ones have a physiotherapist, large hospitals have whole teams of them. Plus there are heaps in private practice as well.

 

from this link http://www.cdm.ahpa....58/Default.aspx

Physiotherapists

 

What does a Physiotherapist do?

 

Physiotherapists use a holistic, person-centred approach to support patients across the lifespan to maximise their mobility and functional capacities, and therefore their independence and general wellbeing.

 

Services

 

 

Physiotherapists assist patients with musculoskeletal, cardiothoracic and neurological problems. They provide lifestyle modification and self-management advice; manual and electrophysical therapies; prescribe aids and appliances; prescribe exercise and supervise exercise classes; provide physical activity counselling and movement training and provide health promotion and prevention activities and advice. Physiotherapists treat a range of chronic conditions, often as part of multidisciplinary teams, including:

• Cardiovascular disease
  
• Chronic obstructive pulmonary diesase
  
• Diabetes
  
• Osteoarthritis
  
• Osteoporosis
  
• Obesity
  
• Hypertension
  
• Stroke
  

Physiotherapists are uniquely placed to address risk factors for chronic conditions. They have knowledge of the complexities of co-morbidities and physical limitations in people with chronic conditions and are trained to design programs that respond to these complications.

 

I was just reading about this! Not quite sure why I'd never heard of it before. Anyway, this does seem like it may be a good route.

 

I checked my insurance provider list, though, and there are none listed. Not one. Weird. Are they ever known by some other name?

[Melissa in Australia]

maybe they are called something different in America?

[AlmiraGulch]

maybe they are called something different in America?

 

Maybe. I actually think I'd spelled it incorrectly because when I searched again I found a few. The description sounds like a run-of-the-mill physical therapist, though, and from the description you provided they don't sound like the same thing.

 

I think I'll call them.

[LMA]

maybe they are called something different in America?

 

Physiotherapists are called physical therapists in the U.S. Generally, they work from doctor's orders instead of diagnosing.

 

For that kind of pain, I would see an orthopedic doctor who specializes in the back and/or a neurologist who specializes in back pain. Back pain is very hard to diagnose and it is not uncommon to either not find something or find the wrong source.

[Melissa in Australia]

the physiotherapists here have a masters http://sydney.edu.au/health-sciences/disciplines/physiotherapy/courses-careers.shtml

[LMA]

the physiotherapists here have a masters http://sydney.edu.au...s-careers.shtml

 

Here you can get a Doctor of Physical Therapy after a 5 year program in college. It's like a Pharm.D, not an M.D. They generally don't diagnose conditions. Whenever I called a physical therapist for my mother to get some help with her movement, they told me I needed a doctor order and a diagnosis. When she was seeing one, they noticed she had trouble with a knee and told me I had to get her an appointment with her orthopedic surgeon for a diagnosis. They usually have limited visits under insurance and are generally seen as support to a patient's health care under an M.D.

[gardenmom5]

have you done exercises that strengthen the abdominal core? (e.g. yoga/barre) there's like six layers of muscles - and most exercise forms only get a few at most. have you done anything to strengthen the psoas muscles? they stabilize the spine and pelvis. that is something you can do at home to youtube videos or dvds if you are committed.

 

the "lump" you feel when it's bad could be a knot. I recall one time getting a massage and she was working on stuff that was solid. uh - isn't that bone? nope. it's a knotty muscle.

 

or it could be a swollen lymph node. (i'm just throwing that out. how is your general health?)

 

eta: there are many articles online about how weak abdominals can cause low-back pain.

[Katy]

You might also try an exercise called Callanetics, which is sort of a pre-pilates blend of pilates and ballet. I ordered the DVD's from amazon but there are a few places you can watch the videos online. They are from the 80's and old fashioned (lycra leotards, tights, leg warmers, weird synthesizer music in the background, and a very soothing instructor voice that makes me sleepy), but if you can try it and find a huge difference once you know the routine you can work from your notes while watching the news or whatever else you'd like to on TV... the exercises are very effective for back pain and for slimming.

[AlmiraGulch]

have you done exercises that strengthen the abdominal core? (e.g. yoga/barre) there's like six layers of muscles - and most exercise forms only get a few at most. have you done anything to strengthen the psoas muscles? they stabilize the spine and pelvis. that is something you can do at home to youtube videos or dvds if you are committed.

 

the "lump" you feel when it's bad could be a knot. I recall one time getting a massage and she was working on stuff that was solid. uh - isn't that bone? nope. it's a knotty muscle.

 

or it could be a swollen lymph node. (i'm just throwing that out. how is your general health?)

 

eta: there are many articles online about how weak abdominals can cause low-back pain.

 

I have the weakest abdominal muscles in the entire world. I'm certain this contributes, but even when I'm in the best of shape my abs are always weak weak weak. I despise yoga, even though I know it's probably good for me. I did find one pose (frog?) that helped open up my hips, and that made me feel better. I'm glad you mentioned this. I really need to do it, whether or not I like it. I'm just very uncoordinated and not limber and it's very hard for me. I'd rather run 100 miles than do yoga, or any other exercise that works my horrible abs. Ugh.

 

The lump is likely muscular, especially since massage helps and it comes and goes. My general health is very good.

 

I've never heard of a psoas muscle, so I'm reasonably sure I've never done anything to strengthen mine! I'm going to go look it up.

 

I love having a bunch of smart people at my disposal!

[AlmiraGulch]

Oops! Double post.

[Isabella]

Why not Pilates instead of Yoga if you dislike it so much?

[Momof3littles]

Many physical therapists in outpatient orthopedics can practice via direct access (no RX needed from a physician first). However, insurance sometimes requires a referral or physician visit first. Physiotherapist=physical therapist in the US. The minimum degree is a master's degree, and the entry level degree is now becoming a D.P.T.

 

When you are having these pops, etc. and were diagnosed with a sacral issue, was your chiro giving you a comprehensive program or just doing manipulation? Were you given exercises to work on stability, suggestions for better positions for sleep, did they work with you on strengthening your core? While there are chiros who treat more comprehensively, IME PTs are more apt to give you a comprehensive program-strenghtening, stretching, getting your core stronger, looking to see why you have an imbalance in the first place, teaching you techniques to get your joint to go back in if you are dealing with sacroiliac issues (muscle energy techniques), suggesting sleep positions that won't torque your sacroiliac joint.

 

If you haven't seen someone who has addressed this comprehensively, that's where I"d start. While there are many wonderful outpatient orthopedic physical therapists without this clinical designation, you could try finding someone with their orthopedic clinical specialist designation (OCS).

http://www.abpts.org/apta/directories/abpts.aspx?navID=10737423513 Not all great PTs want to jump through the hoops to get that designation, but if someone has put in the work to get that designation, they'd be a good starting point for limiting the pool and finding someone really good. http://www.abpts.org/home.aspx

 

If they have concerns they may send you for additional testing, orthopedic or other appropriate consult, etc.

[Dahliarw]

I have huge issues with sacrum stability. I used a combo of chiro and pt (you need to find a pt that specializes in the pelvis) to help with core strength to help hold my sacrum in place. My main issue is that my pelvis never solidified from childbirth. My chiro had me wear what was essentially an elastic band around my hips to help hol my pelvis together and the pt helped my core muscles strengthen so that my sacrum will stay in place. I still go for monthly adjustments, but if it's out of place is pops back in.

 

All of that to say that having your sacrum out of alignment and an unstable pelvis can put straing on muscles and nerves and cause problems. It can take a combo of approaches to get your body back to where it needs to be.

[tinag]

I have a lot of lower back pain too. I have gone to the chiropractor off and on, but not sure if ithelped or not. I started doing kettle bell exercises and it is so much better. be careful that when you start you don't overdo it and make things worse. Before starting the kettle bells, I couldn't vacuum, or mop, clean the bathtub or pick up anything heavy without pulling my back. I love the kettle bells because I can tell they are strengthening my core and I don't have to do crunches or anything like that which I despise doing.