Back pain - speculate, possible treatments

In My Humble Opinion
1

Disclaimer: I’ve seen a doctor about this and will be doing follow-up shortly. Most likely cause is a herniated disc of some sort.

So I’ve got a painful part of my back, one or two vertebrae above the bottom of my ribcage (roughly). It only hurts when I’ve slept more than 7-8 hours (and then it can be quite unpleasant indeed, enough to badly disrupt sleep). It improves within 5 minutes of getting up.

Along with this is some numbness of the toes - worse on the left than on the right, which sometimes I can detect worsening within a few minutes of lying down. That largely (but not completely) improves once I’m up and walking around for the day.

A recent abdominal X-ray for something else didn’t show anything too egregious; presumably an MRI would be on order at some point. I’m assuming that would turn up some disc bulging or herniation.

Anyone else living with something like this? If my self-diagnosis (and the doc’s tentative diagnosis) is correct, what would conservative treatments be? Weight loss couldn’t hurt and presumably might help some, though I doubt the disc would go back in place.

I imagine surgery might be an option at some point but I’m quite sure I’m nowhere near bad enough to want or need that especially given the poor success rate. In fact, aside from disrupting sleep, it’s not causing any real issues right now. The numbness is becoming slightly more noticeable - it first developed about 4 years back.

I’d been thinking this might be the result of the botched epidural I had 21 years ago (21 years ago today, as it’s Dweezil’s birthday), but the doc says the epidural is usually lower than the place that hurts, so phooey - can’t blame that one on the incompetent anesthesiologist.

2

A large amount (I won’t say a majority because I don’t have reliable statistics) of lower back and neck pain is purely due to having underdeveloped back and leg muscles, and the resulting muscular imbalance overstressing the trapezius and erector spinae which are struggling to keep the spine in line without adequate support from the other ‘antagonist’ muscles such as the lattisimus dorsi (middle back). Before even considering surgery, get yourself to a doctor educated in sports medicine and get an opinion on whether a program to strengthen the core, pelvic, and leg muscles may help eleviate the pain you feel. That, coupled with weight loss, may both reduce or eliminate the back pain issues and otherwise improve your general fitness.

Back surgeries as a class of treatments are one of the most overprescribed and ineffectual procedures to treat chronic pain or disability. It is almost as much a scam as chiropractic for the effective long-term treatment of back and neck dysfunction. Get second, third, and fourth opinions from different types of specialists in chronic muscle injury and remediation before submitting to surgical procedures.

Stranger

3

Do you sleep on your side? I was having back pain when getting up, that would generally go away after getting up. Someone suggested sleeping with a pillow between my knees/legs and I stopped having back pain.

I also found that stretching my legs helped some, especially sitting with my legs forward and trying to grab my toes.

4

Usually the first approach is some form of physical therapy – stretching and core building activities. Now one could ask (as I did) why your basic daily living, walking, and standing isn’t enough to develop the muscles required to say, stand without pain, but you won’t get much of an answer. I think part of the problem is that as the discs degenerate with age, the body tends to compensate with muscles. But anyway, exercise, stretching, and losing weight might help.

If not, then it’s off to the MRI guys to find out exactly what’s going on. They might decide to attempt to treat the problem with steroids. They might just recommend lots of NSAIDS (e…g Advil) for a while (under doctor’s supervision so you don’t clobber your stomach or kidneys). After that, it sort of depends on the kind of pain you’re in and the level of disability you’re experiencing.

For me, it was a case of gradually just getting mostly better on my own, as long as I don’t lift heavy things any more, where the definition of “heavy” is a lot less than it was when I was younger.

5

Is there a decent book on the subject of muscle ratios as they relate to pain?

I get a burning pain in my thoracic spine. I could never figure it out or find an effective treatment until I started strength training my erector spinae muscles by doing back extensions. After doing that the problem went away.

6

Not sure what you mean by “muscle ratios as they relate to pain” but I like Becoming a Supple Leopard: The Ultimate Guide to Resolving Pain, Preventing Injury, and Optimizing Athletic Performance, despite the presence of some copyediting errors and the focus on CrossFit. (I see there is a second edition which may have corrected those errors.) However, it is quite technical and really more focused on athletic prefab/rehab by a proficient athlete or trainer. Really, to develop the necessary amount of shoulder, core and pelvic strength to mitigate a lot of common back pain and injuries requires a fairly simple set of bodyweight exercises (squats, getups, dynamic planks, and presses) combined with good technique in lifting and carrying loads. I think kettlebells, sandbags, steel club/mace work, or a moderate level of Olympic weightlifting can be beneficial as well, but the additional technical skill that come with handling weights is not necessary, although there is no better fat-burning and conditioning workout than swinging and pressing some kettlebells or steel clubs, and nothing better for the shoulders and neck than a good set of 360 rotations with a mace.

Everything that needs to be done to develop good strength to protect the back can be done with bodyweight training with virtually zero chance of injury and only modest exertion. A couple of sessions with a good trainer or athletic therapist should be adequate to learn good technique for doing basic bodyweight exercises to strengthen the core and back, and are a lot cheaper and safer than surgery. They can also be a lot of fun, even (or perhaps especially) for someone who is not normally athletically inclined; discovering that you can do a full squat or handstand despite not being a star athlete gives one great confidence. The o.p. may have a more significant problem than just muscle weakness that requires medical treatment, but before even considering surgery or steroids I’d look at strength training for the multitude of benefits.

Oh, and you need to do more than just strengthen the erector spine for long term good health; you want to strengthen the pelvic floor, obliques, and upper trapezius. A short series of bodyweight or weight-assisted exercises, performed for about 30 minutes three to four times a week is enough to abate nearly all incidental injuries of the back, neck, shoulder, and hip well into old age.

Stranger

7

I have to disagree mildly with what** Stranger **is saying - some of it is absolutely correct, but if you are having numbness, then chances are higher than you’d think that there is an impingement of a nerve somewhere in spinal column. And bulges and/or stenosis don’t cure themselves, relatively speaking.

I did hundreds, maybe thousands of MRI’s/CT/myelograms and such in my days of X-ray/CT/MRI Tech on folks with similar symptoms and it was very common to find disc bulges/stenosis that were minimal and with bothersome sx’s but patient wanted to wait to see if things got better. It was very common to see same folk back in six months (or whenever) for a repeat ‘comparison-imaging’ to see if impingement had worsened or whatever. Usually, and I mean more often than not, things* were* worse, no doubt at all. I went through such a situation myself, and when both legs became gradually and totally numb (and I worked with for great Orthos and Neuros who told me to “just get the friggin’ surgery, dumbass!” many times) after walking a few yards or so a year or so later, I finally relented and threw in the towel and had my lumbar fusion/laminectomy. No probs since and was walking pretty much pain/numbness free less than 8 hours after operation happened! Had nurses worried but I felt free at last to move easily and Doc said if I could tolerate it, to just let me do what I could. Have to look really, really close to even see the scar on my lower back. My stubborness cost me a lot of quality-of-life time with my young daughter and teen sons, unfortunately.

Of course, having strong ‘core muscles’ and reducing possible obesity, etc, is always the best protection against (most) spinal issues, as Stranger said. Mine was purely foraminal stenosis (with rather slight disc bulging accenting my problem) where nerve(s) exit the spinal canal and radiate on downwards) of 95%+ narrowing bilaterally of the foramina! There was practically no room for nerves to exit the canal, so to speak. A very high degree of impingement. Neuro was totally shocked that I could even walk a straight line, to be honest, as he reviewed films with me and Radiologist I worked with.

Don’t be shy about getting some imaging done -> pics (ie Medical Imaging of appropriate modality, MRI in this case most likely, imho) are worth thousands of words and many, many opinions, IME of two decades of dealing with folks with sx’s as OP describes or close enough anyways. Getting a second opinion, if surgical fix is recommended, is not a bad idea either. And not long ago (5-10 yrs at most), most all Sports Orthos I worked with quit dealing with ‘spinal nerve issues’ - would refer to Neuro if there was any chance of nerve involvement. Just saying from my experiences, if that helps down the OP’s road.

And one last thing - success rates of properly diagnosed surgical procedures (and proper patient compliance post-op!) are not in general poor, trust me, as I was involved with many, many follow-up visits that had great outcomes. Folks with other non-treated sx’s/issues will gripe about a failed surgery when the particular surgery itself had nothing to do with those folk’s other issues. Folks with great outcomes don’t tend to preach to others about their great outcome, if that makes sense. Those with other probs will preach to whoever will listen about how bad their surgery was, IME.

However, for full disclosure, I was involved with two separate lumbar lami/fusion patients in one week where the two different ‘teams-of-two’ Orthos fused the wrong vertebrae-levels despite my near-perfect cross-table pre-op lateral lumbar X-ray w/ marker on patient’s back to allow counting the appropriate level to fix. Both patients were RN’s at hospital I worked with a lot, and I showed them their x-ray w/ Rad at my side to assure them it was not anybody’s fault but the surgeons for miscounting from where lead marker was placed for pre-op locating of vertebrae. That was last of any Orthos doing (most) spinal surgery at that hospital, fwiw. Neuros became the standard of care there for spinal ops and it seemed to be so at most other places I was familiar with. Not sure of applicability nationwide, but its the general approach in Idaho and Oklahoma, IME. HTH ya, **Mama Zappa

**Something that may help is to try and sleep with pillow(s) under knees (if you sleep on back) as this helps keep curvature of spine more 'natural/unstressed. May be worth a try is all I am saying. Hope all turns out relatively well for you - been there/done that, so to speak and I ignored it waaaaaaay too long despite it being something I knew about at a professional level. I was too focussed on working 60-70+ hours week at various places for money to restore a muscle car at the time and was money hungry. Kept telling myself I could hang in there til it was done - hindsight proves otherwise.

8

The burning pain in my thoracic spine was supposedly due to the muscles being too strong and tight in the pec minors, anterior scalenes, upper traps while they were too weak and stretched in the erector spinae, rhomboids, lower/mid traps. The burning pain was supposedly due to a buildup of lactic acid as the muscles couldn’t hold up the strain of being overworked.

So that would be one example of where a muscle imbalance causes a symptoms in a certain body part (burning pain in thoracic spine). I realized a while ago that weight lifting that strengthened my pecs or traps made it worse, but I didn’t know why.

Has anyone written a book detailing all the various muscle imbalances and dysfunctions a person can develop, what the symptoms are and what the treatments are? I have never seen that info centralized.

I can find info about what muscle X being too tight can cause, or muscle Y being too weak, or what happens if muscle A is too much stronger than muscle B but I’ve never seen a centralized source like a book that describes it all.

I’m currently having some problems I think are due to a tight piriformis muscle. My symptoms (both in what aggravates symptoms and what helps alleviate them) match piriformis syndrome but I would like a book about muscle dysfunction I can look it all up in rather than have a piecemeal learning from googling my symptoms.

“The big book of muscle dysfunction as it relates to pain and disability” would be awesome, assuming someone has written it.

9

How old is your mattress? You might want to ask your physical therapist about the right mattress for a problem in that area.

10

Just to clarify, I’m not saying that surgery is never necessary or that strength training is a panacea to back pain; just that much of what orthopedic surgeons prescribe as “necessary corrective surgery” is borne out of ignorance. This is why I recommend consulting with a doctor or therapist trained in sports medicine, because they have a good understanding of the effects of muscular dysfunction versus a scripted “let’s try this procedure, and if that doesn’t work, that one.” The vast majority of people that I know who have had back surgeries have had multiple surgeries, often without positive effect, and for problems that likely could have been solved by non-surgical and non-pharmaceutical means. Even an impingement or pinching of a nerve may be due to weakness of muscle or misalignment of the spinal column (which is still in an evolutionary in-between state between brachiating apes and an upright, plantigrade walking modern human with the added complication that most of us spend the vast majority of our days sitting in a position totally unsupported by the glutes and pelvic floor, and hence placing undue stress on the lower back to support the entire upper torso).

The notion that there is some perfect mattress that will resolve all spinal and sleep problems is a complete myth created by the same advertising hacks who convinced prior generations to put their faith in the health-giving properties of tobacco cigarettes of a particular brand. A well-conditioned person can sleep on anything less rigid than concrete all the way to the compliance of a marshmallow without suffering permanent dysfunction. Less compliant mattresses are generally better in terms of back support, but despite the notion that you have some specific ‘sleep number’ that can only be satisfied by a certain hardness of mattress material, your mattress is not the cause of your problems.

Stranger

11

Fascinating.

You did note that the OP experiences the pain after sleeping 7 - 8 hours, quite possibly on a mattress, and may be overweight (although it looks good her, I am sure)?

An mattress that dips in the middle, either because it is too soft or too old, will cause back pain. A very firm mattress that does not allow the frame to adjust will cause hip, shoulder, and back pain.

Replacing my mattress has alleviated my back pain; it might help the OP. A physical therapist might be better informed about what type of mattress is most likely to relieve strain in the area the OP feels pain.

What this has to do with tobacco and sleep numbers is not clear to me.

12

Long overdue reply here - thanks for all the feedback (especially Ionizer’s take from both sides of the table!).

Re mattress: We have a sleep number mattress - which I’ve grown to loathe for reasons unrelated to its comfort (we’ve so far had to replace every part of it except the bladder and pump, at least once). My setting is fairly firm - my husband’s side is so soft that if he’s not in the bed, I tend to roll off the edge of my side and onto his side.

I see the doc tomorrow for followup on a bunch of stuff. I expect I’ll get referrals for MRI and/or PT for the back at that point. I’m reasonably sure there is indeed some impingement- it’s behaving exactly like that.

Part of what prompted the thread was last week’s colonoscopy. I came home, ate something, then went upstairs and passed out for 8 hours. The pain was what woke me up. I ate something else (this was 10 PM), went back to bed by midnight, and the rest of the night involved waking up every 90 minutes or so in pain :(. Ibuprofen was, obviously, not the best thing right after such a procedure.

A PT may not know “the perfect mattress” but might have some anecdotal experience from other patients, so the suggestion to ask is not a bad one.

Sleeping: I always fall asleep on my side, but tend to wake up on my back - so no one-size-fits all approach re pillow under / between the knees would work. I’ll check into one of those pillows designed specifically for knees to see if that helps anything. Just what I need: more hardware in the bed (bite guard, CPAP, sometimes foot splint for plantar fasciitis…)

13

Speaking from my own experience, I’ve had similar pain, but it was lower in my back, and it would often send shooting pains and numbness down my leg. It wasn’t a lack of muscle strength, as I have an intense workout regimen, but it did turn out to be a combination of a few things. One of those things was some muscle imbalance which I was able to fix with a few therapeutic exercises and stretches. Another part of it was that my bed was old and needed to be replaced, along with how I was sleeping, and I adjusted my sleeping position. Another part was also my posture, made worse by the fact that I have a desk job, and I needed to pay more attention to how I sat and making sure I got up regularly. In your case, if you have extra weight you can lose, that certainly can’t hurt.

That said, in general, numbness or tingling is a pretty strong sign that there’s some nerves involved somewhere. It’s not going to just magically heal itself, but depending on what the problem is, it very well may be a bulging disc or some kind of misalignment. I’d be disinclined to think it’s a herniated disc just because, well, that should hurt when you’re standing too. Still, depending on the injury, it may be something that you can fix with some physical therapy, and if I were you, I would certainly try that route first. Back surgery can be a mixed bag, and I’d certainly get a second opinion before doing that, but then again, getting a second opinion for any non-critical surgery is just a good idea anyway.

That said, even though exercise to lose weight and strengthen the muscles is probably the best path forward, especially because you have this injury, don’t start a workout regimen until you see your doctor and see what you can safely do. Something that might seem perfectly fine could take an injury that could be healed with some physical therapy into something that necessitates surgery.

14

Interesting thread. I got a tentative diagnosis last week with a herniated disc in the lower back. I’m now scheduled for an MRI in a few weeks.

A few years ago I had a few problems with muscle pain in the lower back and also in my right shoulder and neck - both typical for someone working a desk job at day and gaming at night… I’ve since managed to keep those problems at bay by exercising more. I’m using a light/moderate program set up by a physical therapist working at my gym.

This time, things were obviously different - I have a deep pain in the lower back and radiating pain and numbness from the buttocks and down to the knee.

I guess I won’t know anything for sure about this until the MRI, but in the meantime I’m on sick leave and been told to take it easy. No stretching or workouts, but I can take short walks and try to lay down flat and avoid sitting. I’m also on ibux and tramadol for the pain.

The doctor says the most likely treatment will be physical therapy, and that surgery is now done only in the more severe cases.

15

Another thought, about surgery - if the weight is concentrated in an area that is putting excess strain on your back, your doctor might agree that removing it surgically is medically advisable. I don’t see any advantage to doing more damage to your spine lugging it around, especially since you might be unable to work it off.

16

Back from the doctor.

Interestingly, the location where I’m feeling numbness does not correlate to where the back pain is - I’d say the back pain is lower thoracic somewhere, but the toes seem more like the lumbar area. Since it’s bilateral, it doesn’t behave quite like plain sciatica (which would be one-sided, I gather).

We’re wondering if I have a non-painful disk herniation there, and a painful one further up that is NOT causing impingement at the moment.

So I get a double-barreled MRI when I get around to booking one - thoracic AND lumbar. She didn’t want to send me straight to electromyelogram / nerve conductance studies because I’ve had them in the past (many years ago, for another issue) and she has direct personal experience with them and knows how thoroughly unpleasant they can be (I frequently list mine on Dope threads about the worst pain).

A couple of things occurred to me as I was leaving the office:

  1. I have two kids. Epidurals both times. Epidural failed both times. Doc and I are speculating that perhaps something structural might be at play that contributes to that.
  2. About 10 years ago, I had a nasty fall. Bumped my head (no loss of consciousness or concussion evidence), bruised my leg so badly that to this day there’s still a bit of a groove in the flab and muscle, and broke my left elbow (radial neck, and I was damn glad that was the only “neck” I broke). A day or so later we spotted a bruise on my spinal area - possibly near the painful area. Now I’m wondering if that set this in motion.

I do have family history: when my mother was 37, she had a “ruptured disc” (which I guess is basically the same as a herniated disc) and was in agony. It was actually a surprise that she was able to avoid surgery; she did spend well over a week in the hospital.

17

An aside re replacing our mattress: We’ve stayed at a particular hotel 4 times in the past 2 years - and I find their beds VERY comfortable. I think I might have had back pain 1 of the 8 nights.

So I actually called them and got the name of the mattress. Unfortunately, it’s a company that evidently doesn’t have any distributors in our area (Jamison). Oh well.

18

You might want to look into a high quality futon, with a high density foam pad on top; problem is they do like to be flipped and turned and rolled, and they are pretty heavy, so that might not work for you.

Good luck with the tests.

19

I had some severe back pain years ago-had a MRI scan-the doctor showed me some images which seemed to indicate a disc problem. I opted for physical therapy-worked great, and I haven’t had a problem since. It is a problem that is mostly muscles in spasm. the surgery option should be a lst resort-I have known too many people who have had very bad results from surgery.

20

My experiences with back pain:

  1. I had a back injury when I was 12, caused discomfort for 20 years, finally saw a chiropractor.or about it. X-rays revealed a misaligned spine, a few adjustments later and it was gone.

  2. I lifted a heavy object, tore a muscle in my back. 3 days on muscle relaxants, fine.

  3. Roommate has congenital spine deformity. Heat treatment worked.

  4. Ex-wife has this strange some strange condition, similar to #3. Not long lasting, but incredibly painful for a few days every few years. Vicodin during those days and it’s fine.