low back pain

by wendy

I am a 46 year old 5'7" 140lb female in pretty good shape after 30 years of multiple back & neck injuries/traumas, most recently (12/5/12) a fall in which my sacrum fractured/buckled on the underside of S2-4.

Although most excruciating the first few weeks, from what I can discern the fractures are healing well, but I am left with increasing pain from a second part of the injury. The MRI report identified high level of inflammation at a 'pseudojoint' that has formed between my anomalous L-5 spatulate left transverse process & the ilium. The space around the L5 nerve exit is greatly reduced structurally & the disc is slightly protruding & touching L5 nerve.

Apparently the 'joint' had been stable, but it was crushed in the fall & the inflammation is further compressing the space. "Motion is lotion" has been one of my mantras over the years, and with the many injuries I've experienced and has kept me going.

I manage successfully upper right quadrant RSD, among other conditions, meditate, do yoga, teach pain/stress reduction programs & practice as a massage therapist. Staying fluid is essential.

I've just been told that movement in this 'joint' is what is causing the increasing nerve pain - that it shouldn't move, but now that it does, inflammation increases across the injury & floods down through the left SI joint & pelvis.

Deep achey pain begins in the pseudojoint area, left lumbar & hip muscles spasm, then icey burn moves into hip, groin, pelvis, down leg to foot; at worst into bladder like horrid infection pain (yes, urine has been cultured - clean). Sitting seems to compress joint as does carrying anything other than my body wt. My rectum has had burning broom handle pain consistently.

I had gone back to work, but the pain increased so much, I've now been mostly in bed on my back for the past 3 wks & can only manage being up for a couple hours at a time without increasing the symptoms.

The rest of my body is beginning to suffer and I am borrowing money to eat/pay bills. Can this heal with bedrest? It seems there is very little I can do without moving this middle part of my body. I will be most grateful for any information/suggestions. I have been seeing a network chiropractor.

Hello Wendy,
It's very difficult to make suggestions without more information.

In general, I'd go along with you. That fracture is now more than six months behind you and it's probably time to move more rather than less.

That pseudo joint does move, though the amount of movement is limited obviously so a pelvic tilt type exercise, done within the pain threshhold would normally be okay.

A concern. That pain in the groin, bladder and rectum. The upper lumbar area needs to be carefully evaluated. Any pain up there? Ask your chiropractor to do a Femoral nerve stretch test and let me know. Also concern of what is known as a cauda equina syndrome emanating from the thoraco-lumbar junction.

Does pulling your hip to your chest, and then to the opposite shoulder give you pain in the groin?

Is the Slump test positive?

Frankly, you've had a serious injury and I feel it presumptious of me to be making suggestions without being able to examine you. Best you stick with your local doctors and chiropractor, and your own inner wisdom.

I hope this contributes.

dr B