Back and Neck Injury/Chronic Low Back Pain
QUESTION: I have a question for you.....
I work with the utility company as a pole climber to repair and build the electrical distribution system. The work is really entense and very demanding.
I was injured in 2011 with a fractured rib, which ended up turning into chronic back pain. My personal doctor and an orthopedic doctor that I was referred to said I would no longer be able to work under my normal job duties, but the company doctor told me to take advil and tylenol and that I should be fine.
The problem that I have is when I start doing anything physical I get flare-ups and my back stiffens on me, which casuses me to take breaks for the pain to go away.
Is it possible to continue to do my job climbing utility poles with my diagnosis?
I'm about to lose my job because of my injury and the workman's compensation doctors are saying it is not a perminant injury, so I would not be assisted in finding a job with the company.
I need help!
ANSWER: Hi Mark,
Sorry to hear about your problem. I understand you are stuck in the middle of your Primary, Orthopedic doctors and the Company doctor. Both sides have different objectives. It is not understandable why the company would not be more accommodating, considering your personal doctors advice and the fact that your job carries risks; not only to you, but most likely to others. However, chronic back pain is more a descriptive term and not a diagnosis. I'm not quite sure what the diagnosis is or the results of any tests. I would assume there would be an MRI to assist in the diagnosis. To document a permanent injury, there should be subjective (your description) and objective (your doctors) findings. These should correlate in forming a diagnosis. So, it is difficult to say if it is a chronic muscular or if there are other findings related to orthopedic testing and diagnostic imaging. There should also be outcome assessments (questionnaires) to document your capabilities related to physical performance. Therefore , I cannot say if there would be an optional form of treatment that may prove beneficial and I am not sure exactly where the location of the pain is. You also did not mention your response to the Advil and Tylenol, which I would assume is not productive.
In any event, I hope your company would have a change of heart in this matter and feel free to contact me with any additional information.
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QUESTION: Thanks for getting back to me so fast.
I did take an MRI and the things that came out were normal from what I was told. The report stated L2-L3 1mm disc bulge, L3-4 1mm disc bulge, L4-L5 1mm disc bulge, L5-S1 2mm disc bulge all of which I was told was incidental and normal findings. It also mentioned minimal bone spurs growth on my L2, L3, L4 all of which I was told was normal.
Thier was no objective evidence that was found by my doctor, but after being examined I was told by both treating doctor and orthopedic specialist that I was in fact in a lot of pain based off of the examn and my description.
The location of the pain is from my mid back and goes down to my low back. The best description I could use is when I am doing dishes at home, my back begins to hurt so bad I literally have to stop doing what I am doing and it feels like my entire mid to low back gets really tight and stiff.
I did not respond to the tylenol or the advil. I was given Vicodin and nothing happened. I have been given muscle relaxers, 800 mg Ibprophren and nothing. I have been to acupuncture, physical therapy, the chiropractor, and pain management and I have not gotten any better.
Another interesting thing is that I have a bulge right in between my shoulder blade and spine. It looks to me to be swollen and very unusual. I have had this examined by three different doctors and one doctor said it was a cyst. Another doctor told me it was to broad based to be a cyst and felt like it was extra bone growth over my old fractured rib producing osteoarthiritis. Then the orthopedic doctor said it was nothing.
3 doctors with three different opinions makes it extremely difficult especially when my wife, daughter, and I can see the bulge/lump in the mirror clear as day.
ANSWER: Hi Mark,
The bump, most likely is a scar over the bone from healing. An x-ray should show this.
Regarding your back, the findings are not "normal" or they would not be noted in a report. Disc bulging and bone spurs can be a part of "normal" aging, however, they can be a cause of pain. This would be discogenic pain - pain from the disc. The problem is there is no mention of any modic changes from the MRI, which would indicate a problem and could explain the pain and resistance to therapeutic measures. You may want to have the radiologist or your Orthopedist review the MRI films to check for this. Or, if the films are old, you may want to have new MRI studies taken with parameters to look for modic changes. If there are any signs of modic changes, this would indicate a completely different mode of treatment. There could be mild changes or no visible changes yet, however, typically the pain would be worse in the morning, easing up to the afternoon, worse in the afternoon and worse at night. This is a pattern of inflammation to a specific type of degeneration as noted in the MRI and is indicative of pain related changes and not a "normal" degenerative finding.
It is also possible that it could be chronic muscle spasm due to scar tissue and you may consider finding someone in your area that does Active Release and you can find someone at find a provider
. This would be a detailed examination of the muscles and, if problems are found, a very intensive treatment of the muscles. This could rule out or rule in the muscles as being the primary problem and either it would be ruled out, which would provide more evidence relating to the degenerative findings and discogenic pain, or ruled in and the treatment would make a big difference.
So, if I were the company, I would find an alternative way to keep you at work with minimal physical activity, because, I think there still needs to be some time for further investigation to document your case. At this point, it is one saying yes and one saying no, so you need further investigation and documentation.
I hope this helps. You may contact me any time and I wish you and your family all the best!
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QUESTION: I have actually looked up the bulge on my back on youtube and it showed a technique where you can rub the bulge and if it turns red it would mean that it was actually carlidge breaking up in the area. I had my daughter get a butter knife and some lotion to scrap the area of the bulge and it has turned into a dark red color, which means if the information on youtube is correct it is scare tissue. The interesting thing is that if I am bending and sitting for to long my back also begins to hurt.
The only Modic changes that were found were on my thorasic spine, which shows mild disc digeneration at the T6 level.
Most likely it is scar tissue around the healed fracture. Again, an x-ray may give an indication of this. The technique is interesting. I'm not sure about the diagnostic part, however, there is a technique called Gua Sha and we used this in martial arts to treat injuries, mostly strained muscles. So, this sounds similar, however, check other areas and you may get the same results.
The back pain can be from the bulging discs and degenerative findings. The fact that you have modic changes in your thoracic spine may be an indication they are developing in your lower back and any future MRI studies on your lower back should focus on this and the type modic changes found (1 - 3). I would still check into the active release to rule out muscle problems. They can check for some related muscles that may be involved which are not so obvious.
All the best!