Recurring Lumbar Pain: Seeking Expert Advice on Diagnosis and Treatment

I would like to inquire about lumbar pain issues?

Hello Dr.
Lee:
For the past two years, I have been experiencing recurrent lumbar pain.
When the pain becomes severe, I visit a doctor, but the usual diagnosis is either a muscle strain or advice to pay attention to the spaces in my spine.
After taking medication, I usually experience improvement, and the pain is mild or absent most of the time.
Recently, due to worsening lumbar pain, I switched clinics about two weeks ago in mid-October.
After an X-ray, I was told that my pelvis is misaligned, and there is little space in my spine compressing the nerves.
I was immediately scheduled for heat therapy, lumbar traction, electrical therapy, and manual therapy, and I am currently undergoing rehabilitation.
A few days later, feeling uneasy, I went to a large hospital's rehabilitation department, where another X-ray was taken.
The diagnosis was lumbar degeneration, with no pelvic misalignment and adequate spinal foramina.
Currently, after resting, the pain has improved, but it recurs with heavy lifting.
Sometimes when I bend over and then straighten up, I feel a slight stabbing pain in my lumbar region, and if the pain recurs, it can be more intense.
While sitting, I occasionally experience numbness in my lumbar area, which gradually subsides, and there is also mild pain while sitting, although it has improved somewhat.
My lumbar region feels sore.

Additionally, my right calf sometimes feels weak and sore, and recently, my left calf has also been affected.
I am unsure if this is simply a muscle issue in my calves.
I am currently confused about the discrepancies in my lumbar diagnosis.
Therefore, I am seeking your opinion online, Dr.
Lee.
Do I need further examinations? I have attached the X-ray images taken at the large hospital: https://drive.google.com/drive/folders/12Ds1EnO-gqL_Rf4ypow4eBggiT7ywlO_?usp=sharing

Guo Xiansheng, 20~29 year old female. Ask Date: 2017/11/12

Dr. Li Yongheng reply Orthopedics

Hello, based on your X-ray, there is mild degeneration of the lumbar spine, with no signs of scoliosis or pelvic tilt.
Your chronic back pain may be due to long-term work and poor sitting and standing posture, leading to myofascial pain syndrome.
It is recommended that you continue rehabilitation and strengthen your back muscles and other core muscle groups.
Wishing you a speedy recovery.

Reply Date: 2017/11/12

More Info

Understanding recurring lumbar pain can be quite challenging, especially when multiple healthcare providers offer differing diagnoses and treatment plans. Your situation, characterized by fluctuating pain levels, varying diagnoses, and the impact of physical activities, suggests a complex interplay of factors that may not be easily identifiable through standard imaging techniques like X-rays.

Diagnosis and Imaging
From your description, it appears that you've undergone various diagnostic evaluations, including X-rays and physical examinations, which have yielded inconsistent results. X-rays are useful for assessing bone structure and alignment but may not provide a comprehensive view of soft tissue conditions, such as disc herniation or muscle strain. In cases of persistent lumbar pain, especially when accompanied by neurological symptoms like leg weakness or numbness, advanced imaging techniques such as MRI (Magnetic Resonance Imaging) are often recommended. MRI is particularly effective in visualizing soft tissues, including intervertebral discs, spinal nerves, and muscles, allowing for a more accurate diagnosis of conditions like herniated discs, spinal stenosis, or muscle injuries.

Potential Causes of Your Symptoms
1. Muscle Strain or Ligament Sprain: Given your history of physical activity and the nature of your pain, muscle strain or ligament sprain could be contributing factors. These conditions often result from overexertion or improper lifting techniques.

2. Degenerative Disc Disease: As you age, the intervertebral discs can degenerate, leading to reduced disc height and potential nerve compression. This condition can cause chronic pain and may explain the intermittent nature of your symptoms.

3. Lumbar Radiculopathy: If a herniated disc is pressing on a nerve root, it can lead to pain that radiates down the leg, along with weakness or numbness. This could explain the occasional weakness in your calves.

4. Myofascial Pain Syndrome: This condition involves pain in the muscles and surrounding connective tissue, often triggered by stress or overuse. It can lead to referred pain and may explain the variability in your symptoms.

5. Postural Issues: Poor posture, especially during prolonged sitting or lifting, can exacerbate lumbar pain. Your mention of pelvic alignment issues could suggest that postural adjustments may be beneficial.

Recommendations for Further Evaluation
Given the complexity of your symptoms and the conflicting diagnoses, further evaluation is warranted. Here are some steps you might consider:
1. MRI Scan: If you haven't already, request an MRI of your lumbar spine. This imaging will provide a detailed view of the discs, nerves, and surrounding tissues, helping to identify any underlying issues that X-rays may have missed.

2. Neurological Evaluation: Since you experience occasional weakness and numbness in your legs, a consultation with a neurologist may be beneficial. They can perform nerve conduction studies or electromyography (EMG) to assess nerve function.

3. Physical Therapy: Engaging in a structured physical therapy program can help strengthen the muscles supporting your spine, improve flexibility, and address any postural issues. A physical therapist can tailor a program specific to your needs.

4. Pain Management Consultation: If your pain persists despite conservative measures, a pain management specialist can offer additional treatment options, including injections or alternative therapies.

5. Lifestyle Modifications: Consider incorporating ergonomic adjustments in your daily activities, especially if you sit for long periods. Regular exercise, focusing on core strengthening and flexibility, can also be beneficial.

Conclusion
In summary, your recurring lumbar pain is likely multifactorial, involving both musculoskeletal and possibly neurological components. A comprehensive approach that includes advanced imaging, physical therapy, and possibly a multidisciplinary team of specialists will be essential in identifying the root cause of your pain and developing an effective treatment plan. Don't hesitate to advocate for your health and seek further evaluations until you find a satisfactory explanation and management strategy for your symptoms.

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