I am the father of a 20-year old (formerly) athletic college student who first felt his lower back tighten about a year ago while he was using very light weight sitting and doing an overhead press. A few days later he was swinging a baseball bat and the lumbar pain began in full. He has seen orthopedists, chiropractors, and physical therapists. He has had shots (steroids/epidural) and acupuncture. He does core strengthening exercises and other (e.g., hamstring stretches) regularly. Bottom line, he hasn’t been able to return to any kind of running, biking, or do any mildly strenuous activities for over a year without major pain. He is able to walk to class and manage everyday life most days. The pain is localized to the lower back. It doesn’t radiate downward.
Here is what stands out on his (comparable) MRIs (July and December 2018). Everything else is unremarkable:
T12-L1: Disc desiccation with mild left foraminal protrusion
L1-L2: Disc desiccation with left foraminal zone protrusion
L5-S1: Bulge without central canal stenosis. There is mild bilateral foraminal narrowing.
Most of the professionals believe that he has “facet syndrome” (facet joints causing pain in conjunction with degenerative disc disease (DDD)). They believed this would largely resolve itself after treatment. Happy that the orthopedic surgeons just recommended physical therapy, but one year later progress is minimal, so we’re thinking this problem might not be soft tissue/facet syndrome.
We’re aware that anything DDD-related can be tough, but while he continues to work on further generally strengthening his core/stretching his hamstrings, I’d be grateful for any other specific ideas. Other forums to explore for recommendations?
I would recommend he look into a rhizotomy of the facet joint. Also called radiofrequency ablation, where an electrical current produced by a radio wave is used to heat up nerve tissue around the facet joints thereby reducing the pain signals. Although 61 years old now, your son,s back pain and treatment is very similar to mine. I had nearly complete pain relieve for a year. I later had back surgery, which after four months, has done little to relief my pain. I wish I would of just had the RFA Treatment again. Good luck. Back pain sucks. The procedure was covered by my insurance. The doctor will first inject the area with lidocaine a week or so apart, to test if RFA is what you need.
Checked the locator, and there isn’t a McKenzie-trained physical therapist who is readily accessible to us, let alone in-network for our insurance. If the recommendation is that my son should basically transition from the strengthening/stretching he is doing to McKenzie-protocol exercises, are there specific recommended videos? I see a book on Amazon (7 steps to a Pain Free Life by Robin McKenzie) and I see a few videos that show techniques on YouTube.
Re: radiofrequency ablation, it’s tempting to try for the possibility of a pain-free year or so, but we were hoping to find something to build on that would be more permanent. What kind of surgery did you have? Sorry to read that you’re in pain again.
Direct Lateral Interbody Fusion C3/4. So called minimal invasion due to small incision on side and less cutting of tissue by inserting tubes. Nothing minimal about the recovery, 3 months of no BLT (bending,lifiting,twisting). I am 4 months post surgery, and still in pain. Don’t expect much from Mckenzie, from what my PT said this is for the acute stages of pain. Not so much help when is it chronic like your son’s case. I would also highly recommend getting the book Foundation, by Eric Goodman and Peter Park. A lot of back pain comes from weak posterior muscles due to sitting in a chair in front of a screen of some sort. This book addresses how to reverse those weaknesses.
Not sure McKenzie is for facet syndrome…but get book or consult with just about any PT. When back is hurt many nerves get impacted and sometimes with all the pain some signals to key muscles impacted which may alter their functioning/sequencing. To avoid a much longer life with these reoccurrence episodes I think time spent learning proper/better body mechanics from sitting, bending, twisting, & loaded activities, etc would be good investment of time. The internet full of good instruction. Mobility Wod, athlean x, Peter egoscue etc.
If he’s had a cortisone injection in between facets and it didn’t at least temporarily stop the pain, an ablation isn’t going to help. It’s indicating that’s not where the problem is.
The responses on here from people trashing the Mckenzie methodology are not medical practitioners and quite obviously don’t know how it works. The program is for back pain… regardless of etiology. NO ONE can accurately diagnose tissue pathology of the spine no matter how many CT scans, MRIs, X-rays etc are performed. Invasive techniques may be be helpful to determine tissue cause, but they are completely inappropriate in a 20 yom. McK is unbiased towards tissue and relies on movement patterns regardless of length of time of onset. Claiming posterior muscles are to blame is nonsense and there is no literature to support such conjecture. RF ablation is a crazy suggestion for someone so young, results are suspect at best as well.
Realistically, if you can’t find a therapist, treat your own back book is a great resource. Chronic and unrelenting lbp in a 20yom is cause for concern and the suggestion of a rheumatologist can be a good idea. Don’t follow the suggestions of most on here as they are unknowledgeable. Find a medical professional and follow that advice.
I am the father of a 20-year old (formerly) athletic college student who first felt his lower back tighten about a year ago while he was using very light weight sitting and doing an overhead press. A few days later he was swinging a baseball bat and the lumbar pain began in full. He has seen orthopedists, chiropractors, and physical therapists. He has had shots (steroids/epidural) and acupuncture. He does core strengthening exercises and other (e.g., hamstring stretches) regularly. Bottom line, he hasn’t been able to return to any kind of running, biking, or do any mildly strenuous activities for over a year without major pain. He is able to walk to class and manage everyday life most days. The pain is localized to the lower back. It doesn’t radiate downward.
Here is what stands out on his (comparable) MRIs (July and December 2018). Everything else is unremarkable:
T12-L1: Disc desiccation with mild left foraminal protrusion
L1-L2: Disc desiccation with left foraminal zone protrusion
L5-S1: Bulge without central canal stenosis. There is mild bilateral foraminal narrowing.
Most of the professionals believe that he has “facet syndrome” (facet joints causing pain in conjunction with degenerative disc disease (DDD)). They believed this would largely resolve itself after treatment. Happy that the orthopedic surgeons just recommended physical therapy, but one year later progress is minimal, so we’re thinking this problem might not be soft tissue/facet syndrome.
We’re aware that anything DDD-related can be tough, but while he continues to work on further generally strengthening his core/stretching his hamstrings, I’d be grateful for any other specific ideas. Other forums to explore for recommendations?
I´m not a medic, but I find swimming helps my lower back pain
It´s a zero gravity exercise, and it strengthens the core.
I am really appreciative for having received so many ideas to discuss with my son when he comes home from college in a couple of weeks. E.g., the thought of consulting a rheumatologist is something I’d never have thought of. What a great community of athletes contributing here.
I ordered the $10 McKenzie book. Fwiw, my son’s pain could be referred, but it seems to be near his L5-S1 bulge…Jeff Cavaliere MSPT, CSCS (former NY Mets PT and so forth) says at 2 minutes+ here https://www.youtube.com/watch?v=9SKuFe2SERs that the “tried and true” stretches my son has been told to do/doing consistently may actually be counterproductive(?)
I know nothing but I’ve always thought that we needed to determine what was specifically wrong before we could determine a best course of treatment. This is all quite a puzzle. One year after my son’s initial symptoms while he was doing a very light weight press we seem to have exhausted the best efforts of our local professionals. So there’s little to lose by branching out to the likes of the McKenzie method or something else. Man this is tricky stuff but we’ll keep listening and trying.
Without meaning to sound like a quack here, because I’m quite serious:
Consider psychology with a pain management specialist. Chronic/persistent pain is mostly (if not entirely) in the head.
I would recommend someone but I’m on the wrong side of the Pacific.
My first thought was rheumatology workup to rule out ankylosing spondylitis as mentioned above. My second thought was to check for spondylolysis (sometimes referred to as pars defect or pars fracture. Sometimes referred to as a stress fracture). I’ve seen initial onset of symptoms with spondylolysis with overhead lifting. Usually it gets picked up on MRI, but sometimes it gets missed if you’re not actively looking for it. CT is the best imaging study to see it.
Just some thoughts from a spine surgery PA. Back pain is a really tough thing to nail down sometimes. Good luck!
Re: the psych angle, we’re open to possibilities, and this is about feeling better. My son and I are close and I know he is depressed and feeling socially isolated because his way of life has changed dramatically…not being able to run, bike ride, work out, and play sports. Anything deeper/underlying seems unlikely, but who knows?
Will add checking into spondylolysis to the list.
Re: batting, it’s actually a good point. He was playing intramural softball…had been practicing for a few days with roommates, but hadn’t been swinging a bat regularly for years. Again, he said that he felt a distinct tightening doing the light overhead press and then a couple of days later was in major pain after batting in a softball game. Now it seems the onset of lower back pain was inevitable no matter what sport/activity he was doing.
After one year of this, I’m still uneasy about the ramifications of the aforementioned Athlean-X/Jeff Cavaliere video comment about how the simple, recommended stretches my son has been doing could be counterproductive if you don’t know the source of the problem. Unless there’s a definitive diagnosis out of the blue, seems as if the most reasonable thing to do is have my son read the McKenzie Treat Your Own Back book and then closely follow its recommendations? Unfortunately he may have time to devote himself to it because he is disappointed that his back pain has greatly limited his summer work options.
Your son has chronic pain without a clear cause at this point (lots of potential possibilities).
As someone who works in this area my advice would be as follows:
You need a single practitioner to take charge in elucidating a diagnosis and therefore looking at potential treatment options. Where I live and work, this is a dedicated pain specialist as they tend to sit across the many medical and surgical causes of pain such as this.
Psychosocial factors are important in the setting of chronic pain.
Treatment of the pain may involve many different modalities (eg physiotherapy, psychotherapy, pharmacological, interventional)
Re: the psych angle, we’re open to possibilities, and this is about feeling better. My son and I are close and I know he is depressed and feeling socially isolated because his way of life has changed dramatically…not being able to run, bike ride, work out, and play sports. Anything deeper/underlying seems unlikely, but who knows?
I’m not referring to psychology as a way to treat the subsequent mood issues (though I’m sure that is tough for him).
I mean psychology (hypnotherapy, etc) as a direct approach to treating the pain. Surgery has a shockingly low success rate. People have had amputations and still feel pain in their absent limb. Pain is a conscious sensation, separate from actual injury. The more you respond to it, the stronger those neurons in your brain get. Same for medication, you’re just muting the signals, in response to which the brain starts firing even stronger signals. Cue addition to pain meds.
The necessary intervention is to retrain the brain to disassociate the stimuli from the feeling. Not every psychologist will be proficient in this, and most surgeons etc won’t be interested in it because they don’t make any money from it.
I probably haven’t communicated that perfectly because I’m only married to it. But try to find someone in your area to talk to.