Acute Back Pain (never experienced before)

[Weatherman]

Hi All,

I'm on here looking for some advice really .

Two months ago, I suddenly experienced lower back pain for the first time in my life, which I treated myself with pain killers and anti-inflamatory's, after a few days it disappeared.

Last weekend I spent 5 hours on the road (driving myself) and ever since I have experienced terrible pain (which started in my lower back and has now moved over to my right-side just below my shoulder.) My back feels as though it is twisted to put it very simply.

I have an appointment to see my GP next Tuesday and wondered what I should be asking her to do for me, so that we can try and establish what is causing this pain (I have never experienced pain like it ).

A little history about me, that might help.

I am a female, 43, up until two weeks ago I smoked around 20 cigarettes a day, I am now down to 3 and will give up completely .

I work full-time in an office role, where I sit at a computer all day, my DSE assessor has looked at my work-station and made some adjustments to the height of my desk etc to make me more comfortable and I have also ordered a new back for my chair (apparently the chair I have has no lower lumbar support for someone of my height, I am only 5ft 2").

I am overweight (by about 2 stone) and will go on a diet as soon as I can.

I do walk a lot and when my back is OK do an hour of Pilates each week. Unfortunately I can't swim and am terrified of water, so this isn't really an option for me.

I recently brought myself a memory foam mattress and pillow, which has helped a little.

Does anyone have any further suggestions, I would be so very grateful, having read through the above I sound a little like a 'hopeless' case.

P.S. I have been through extraordinary stress this year as well, work problems, relationship problems and a grown-up son with problems, could this be linked in anyway to the back pain.

If you have managed to read all of this, then I am trully grateful

Take care,

Liza xx

 

[Flames Fan]

Yes

get them to check your sacro iliac joint

regards

 

[Cypriot Princess]

reason

 

[Lou]

reason being the Si joint can cause muscles in the lower back and even shoulder and neck to go into spasm and become painful!

 

[Pennsylvania lol]

I do sympathise, Liza: there is nothing worse than a bad back and it can just go on and on. Now I'm no expert but I would guess that everything you've written about has probably contributed to the state of your back, including the stress with regard to family problems. I just wanted to say beware of your GP fobbing you off with a few painkillers and telling you it will probably get better on its own. IME many GPs are resistant to alternative therapies but I think backs often respond to treatments that may not be available on the National Health. Of course one man's chiropractor is another man's torturer, ditto ostheopath but it might be worth you exploring holistic treatments if your GP is unwilling to refer you for a second or third opinion.

Good luck and hope everything works out for you.

Love
Sunanda xxx

 

[Sam S]

Hello Kerll 1,

My son was in a car acident 3 years ago, he was a back seat passenger his friend was in the front ,and someone else driving, my son complaines periodically of a pain in his back, not enough to stop him doing anything, but when the fire men got to the car. because they had to be cut out, except the driver who done a runner and left my son and his friend for dead, they thought that both were dead, the paramedics came and reaised both, even though seriousely injured were alive, that my son complained of his back amongst other things,
they sent him for an emergency scan, which showed that. my son has got an extra half a vermassageplaneta at the base of his back,
they told us that it is not uncommon a lot of people have this, but it can take anything like sitting to long to start the pain off,
they told us that about 40 per cent of the population have got this,
im not saying that you have but get it checked out,

take care

 

[nakisaghobadi]

My view would be to visit a chiropractor. I suffered and now I go every three months. Makes you feel fantastic. Good thirty quids worth each time.
Good luck.

 

[Nina]

I've posted this elsewhere, but it's worth repeating here, there seems to be a bit of a campaign on these boards about SIJD at the moment, it is NOT the be all and end all of mechanical pain, and beware of any practitioner who thinks that it (or any other problem) is. It can be used as a differential diagnosis in many many cases, and may be part of teh cause, but using it a diagnosis#1 for every patient means you've got a lazy therapist. It comes under the quote in my signature

As a chiropractor, I would be amazed at any colleague who doesn't know about this, but probably calls it something entirely different. I for one, have never (that I can recall) used that set of initials, so wouldn't immediately know what they were if someone came to me with that as a previous diagnosis.

I assume that when you are talking about "doctors" you're meaning GPs, who tend to know little about biomechanical medicine, as it doesn't fit with their training, until relatively recently there was debate (in orthodox medicine) as to whether the SI joint was even a mobile joint (as opposed to a fused suture).

 

[Billy W]

I am in agreement with BIA about the number of patients that come to me (physiotherapy) for treatment having been previously diagnosed as having an SIJ problem
It is to be hoped that all professionals will assess each patient individually and treat according to the findings of that assessment.

 

[Singquienia]

That's quite a harsh generalisation there Paul; though I fully agree to be very wary of anyone who requires/suggests that you need a 2 year course of any treatment, let alone twice weekly, in the early days of treatment.

I'd also point out that the main manipulating professions (chiropractors, osteopaths and manipulative physios) are regulated by law, though I'm well aware that some of each of those fall into this group we disparage.

It's a perfectly valid, and not uncommon diagnosis, as long as it's reached through proper diagnostics, I've known too many who just use it for all patients as they can't be bothered. This is mis-diagnosis, and forms the basis of what I (and I think Kaz) are complaining about. I also wouldn't put it as all that much below facet dysfunction (as opposed to degeneration) in terms of frequency, per level/region.

I'm not having a go here, but I would suspect a little professional bias here too, the vast majority of genuine SIJDs being diagnosed by chiros/osteos/physios won't need radiography, and should respond well to treatment (most certainly NOT twice a week for 2 years), and would therefore not be seen by yourself.
This type of professional bias exists in all the professions, I believe that it underlies pretty much all the antagonism between these 3 professions especially, we only tend to see each other's failed patients, and get a very skewed impression about each other through that.

 

[aAnarkrese]

Yes it may be so but medical doctors are trained to be scientific. If something is the cause it should be possible to demonstrate in patients with symptoms and not present in patients without. Specific treatment for the condition (e g steroid injection for inflamation or surgery for a disc prolapse) should work if the condition exists. This is not true for the overwhelming number SIJD diagnoses. I see SI joint degeneration regularly and it is as common in people with symptoms as in people without. Subluxation or malalignment occurs after severe trauma but there will be something to see. I occasionally inject the SI joints with anaesthetic and steriod and it never helps but injecting the facet joints does.
If we abandon the principle of scientific reasoning we may as well blame the evil humours for our illnesses.

 

[SIR]

How would SI joint instability show up on snap shot in time scan?



just found this regarding SI injections:




"Dear Colleagues,

In 1995, in San Diego, just prior to the congress, Andry Vleeming asked me why so many people with SIJD were getting a negative response to injection into the joint. I told him that the painful points were extra articular and that the injection was being held within the intact joint. Only if there were tears in the joint could the anesthetic leak out into the adjacent tissue.

In researching the web last night I found a recent article (J of Ortho Science, May 2007) comparing periarticular and intraarticular injections for sacroiliac joint pain.
The authors injected 25 consecutive patients with SIJ and found that it was effective in ALL patients. In a comparable group, intraarticular injections were effective in 9 of 25 patients. An additional 16 patients who had no relief from the initial intraarticular injection were ALL relieved from a periarticular injection.

The improvement rate after periarticular injection was 96% compared to 62% for the intraarticular injection. They concluded that for patients with SIJ pain, periarticular injection is more effective and easier to perform than the intraarticular injection and should be tried initially.

It appears to me that the periarticular injection should be the method of choice when doing a diagnostic injection for SIJ dysfunction. The intraarticular injection is obviously yielding a highly unsatisfactory number of false negative results.

See:
Murakami E, Tanaka Y, Aizawa T, Ishizuka M, Kokubun S: Effect of periarticular and intraarticular lidocaine injections for sacroiliac joint pain: Prospective comparative study. J of Orthopaedic Science, 12(3):274-280, May 2007

I hope this is of some interest to you and would ask you to please forward this to any associates involved with injections into the sacroiliac joints

Cordially,

Richard DonTigny, PT
2025 10th Ave
Havre, MT 59501"

 

[pomparents?]

Hello Ian,

Is this a response to the messages I sent to you regarding prolotherapy ?

If so, what were these injections (ie what did they inject) and what exactly did they inject into..ligament, cartilage etc ?

 

[stickybuns]

it was just a response to steriod SI joint injections. this guy believes that the most painful areas in SI problems are not in the joint but in the ligaments around the joint.

these were no prolo injections they were just short term pain killing injectiosn to find the cuase of pain

 

[Gbubb]

Oh ok.

I had read that some prolotherapists use that technique to prove where the pain comes from too.

In my case it was very obvious because you could put your finger right on it and certain specific movements I made would provoke it - and it was always exactly the same.

Are you a musculo skeletal medic/surgeon ?

 

[Kelly Khaos]

The upper 2/3 of the SI joint has no joint space (the gap on x-ray is filled with fibrocartilage) so an intraarticular injection is not possible so I don't know what these people were injecting.
When you inject a joint the steroid and local anaesthetic spreads over a wide area so a purely intraarticular injection will almost never occur. It certainly would not occur if there is no joint space as in the major part of the SIJs.

The arguement that current medical technology is insufficiently developed to show the abnormality or demonstrate an effect is well used by quacks. While there are still things waiting to be discovered and improvements in technology waiting to be made it is not a reason to abandon the scientific methods that have advanced civilisation to a level where most of us (in the West at least) can expect to live long and healthy lives and not die of smallpox, diarrhoea or an infected splinter.
You can always find a scientific article or research to back up even the most outlandish claims and what our patients pay us for is our training and ability to separate the good evidence from the rubbish.
What we see in conventional medicine, unfortunately, is a failure to address the spiritual and emotional needs that accompany physical illness. This was previously done by the healing orders of monks and nuns from which modern western medicine evolved and is now done by alternative practitioners. This is fine and I accept they are fulfilling a valuable role and contributing to patient well being but it becomes dangerous when some of these people begin to believe their own hype and think they can offer alternative treatment for appendicitis or a fracture.
I don't want to fall out with the chiropractors, osteopaths and physios on this forum because these specialties are largely accepted by conventional medicine and, like conventional medical education, have a grounding in anatomy and physiology but I have no time for the snake oil salesmen who are out to profit from people at a particularly vunerable time in their lives.

 

[ShaZoloiuu]

Back to my question who can a snap in time scan show up SI joint hypermobility? Problems with the SI joint do not always mean pain in the SI joint. I've had calf and shoulder injuries that have been fixed by stabilise the SI joint - i had no pain in the SI joint what so ever but its hypermobility was causing me probelsm elsewhere. I didn't have the joint manipulated once just stabilised.

Also i've had problems with my facet joints (click all the time resulting in muscle tension). Again they are hypermobile my MRI's are clean and injections did not change this other than the initial numbing effect. the cuase is hypermobility the symptom is some sort of facet joint inflamation. one guy wanted to kill off the nerves around my but i told him straight this would not fix the cuase of the problem infact could of made the instability worse due ot the multifidus being inhibited!!

Why do some many people with back and pelivs pain have "clean" scans and do not repsond to injections but still have back problems?

 

[VMR]

From quackwatch-recommended reading for the alternative view
The Rules of Science

Under the rules of science, people who make the claims bear the burden of proof. It is their responsibility to conduct suitable studies and report them in sufficient detail to permit evaluation and confirmation by others. Instead of subjecting their work to scientific standards, promoters of questionable "alternatives" would like to change the rules by which they are judged and regulated. "Alternative" promoters may give lip service to these standards. However, they regard personal experience, subjective judgment, and emotional satisfaction as preferable to objectivity and hard evidence. Instead of conducting scientific studies, they use anecdotes and testimonials to promote their practices and political maneuvering to keep regulatory agencies at bay.

I don't have to prove that SI joint hypermobility isn't a cause of pain. You have to prove that it is using accepted scientific principles.

 

[Roberto R]

what accepted scientific principles are there for SI joint hypermobility? i would love to know and i would go and get them done

i had a chronic calf problem for years from distance running. MRI scans, ultra sound scans (before and after exercise) EGM test (shocks being sent down my legs) Blow flow tests, back scans, diagnostic injections, force plate tests, muscle biopsi pre and post exercise, the lot. Spent thousands on it travelled around the Uk visting the "top" sports DRs, physicians, orthopeadic dr's the lot.

all the science in the world could not find out why my calfs kept cramping up when training.

Stabalising the SI joint solved the calf problems. all the science and technology currently available could not prove that.

 

[Kimberley]

I can only quote another paragraph from quackwatch:

"Science doesn't have all the answers."

Quacks use this ploy to suggest looking beyond what scientific medicine has to offer; they also imply that since medical care has limitations, they are entitled to have them too. Medical science doesn't claim to have all the answers, but its effectiveness keeps increasing because the scientific method offers ways to find more answers. The idea that people should turn to quack remedies when frustrated by science's inability to control a disease is irrational. Quackery lacks genuine answers and has no method for finding them.