Expert: Dr. Timothy K. Durnin - 7/17/2007

Question
Hello Dr.
I am writing because I am struggling with my back as of late. To give you some background information I am 28 and 6 years ago I had a herniated disc at L5 S1. I recovered from that fairly easily and have felt excellent for the last 6 years. Within the last 2 months I have injured my lower back again, this time without any nerve radiating down my leg, just pain in the lower back L4, L5 area.  All of my pain is worse on extension and not flexion. The doctor seems to think its a facet injury, but I am awaiting the CT results this week. An X-ray was done and it just showed the DDD in the L5S1 area, which I expected from the previous injury. Regardless I think that all my problems with my back are a result of hip inflexibility. I walk with my back moving and not my hips which I am trying to correct. I can remember as a teenager, having a hip flexor problem/tightness. As a result now I am stretching like crazy but the other night when i was stretching my hip flexor kneeling with the front leg and the other leg down with my knee behind, I released from the stretch and felt a numbness on my right outer, anterior area of my thigh. I thought for a moment it might be further injury to my back but did some research and common sense dicated that what are the chances I felt a herniated disc at the exact moment I released the stretch.  Slim to none in my opinion, so considering I was stretching a tight, problem area where the nerve runs, I figured it was MP.  What do you think? Can you offer any ideas with regards to my hip inflexibility and back problems? Especially considering I should be stretching my hip flexors for my back and likely it will aggravate the MP.  I am a bit overweight in the midsection, but muscular elsewhere.  34 waist, 5'8", 190.
Thank you so much!
Jonathan


Answer
Hi Jonathan,

Your doctor is probably right; you show all the orthopedic signs of a facet syndrome. This is easily treated with ice and manipulation by a highly recommended Chiropractor.
The stretches you are doing are correct for the problem.
I suspect the psoas muscle being the culprit.
Does it hurt pushing off stairs going up? MP is likely, but an L4 disc can't be ruled out on this information alone.
Does it hurt in the low back and/or shoot into the anterior thigh when you cough or sneeze?
Can you do a straight leg raise without pain?
If the answer to the stairs is yes, it's psoas. If the answer to coughing and/or SLR then yes, it's probably L4 herniation. You are obviously familiar with MP, you know what to do; anterior compartment stretches, ice inguinal area, lose weight, and avoid tight pants, therapeutic ultrasound treatments, ect... So I would stick to what worked before.
You need to have a full kinesiological, (muscle), work-up to target any muscle imbalance and/or short leg. This can only be assessed with weight bearing lumbar films and a competent, highly regarded and referred Chiropractor.

It is all related Jonathan, you can't fix the facet syndrome and ignore the muscle imbalance or the DDD, and this will lead to the equivalent of, "a dog chasing his tail". Get all issues addressed simultaneously, this would be the most efficient and fastest way to approach it.


Here is a link that describes the necessary treatment and aid in finding a certified physician to address the DDD and other issues.

http://www.coxtechnic.com/homepage.asp

If you need assistance finding one, I will be happy to assist.


Good Luck!
Dr. Timothy Durnin
drs.chiroweb.com