Disc Herniation and Ankylosing Spondylitis Symptoms

Q: Disc Herniation and Ankylosing Spondylitis Symptoms

Ms. <br>Lin： Generally speaking, young women without a family history have a low chance of developing ankylosing spondylitis. <br>It is mostly likely a problem with the muscles or soft tissues. <br>If there are accompanying symptoms such as lower limb numbness or sciatica, those

Herniated disc? Ankylosing spondylitis?

Hello Dr.
Wang, I apologize for the lengthy message...
^^" Last year during the Lunar New Year, I was squatting down while holding a child, and at that moment, I felt fine.
However, later that night, I suddenly experienced severe lower back pain, making it painful to lie down or sit, and any slight movement caused significant discomfort.
I then noticed a slight protrusion in the bone area above my groin.
After the New Year (around March last year), I went to an orthopedic department at a hospital for an X-ray.
Initially, the doctor suggested it might be a herniated disc, noting that the gap between the fourth and fifth lumbar vertebrae appeared too wide.
He asked if I felt tightness in my lower back upon waking, to which I replied that sometimes I did.
He then mentioned that it could be ankylosing spondylitis and recommended seeing a rheumatologist.
When I inquired about the slight protrusion in the bone above my groin, he did not provide an answer but suggested physical therapy would help.
After several sessions of physical therapy without improvement, I sought a second opinion from a rheumatologist to check for ankylosing spondylitis.
The doctor also performed an X-ray and had me do some movements, such as bending over, and then asked me to lie down to check for symptoms of ankylosing spondylitis.
He concluded that the X-ray looked normal and healthy, with no signs of ankylosing spondylitis.
After consulting two specialists without finding any issues, I decided to give up.
For over a year, I have been experiencing persistent lower back and buttock pain.
A friend then recommended I try traditional Chinese medicine for bone adjustment.
After two or three sessions, I found it quite effective, involving acupuncture, electrical therapy, and massage.
The practitioner noted that I tend to lean to the left while sitting, which may have misaligned my spine and possibly compressed the sciatic nerve.
He suggested that a few more sessions would resolve the issue.
Initially, I felt quite comfortable after the treatments, with significant pain relief, leading me to believe I was improving.
However, the pain returned intermittently.
I am eager to identify the underlying cause of my condition for proper treatment, as I now experience alternating pain in my left lower back and buttock, sometimes simultaneously.
Prolonged squatting also triggers pain, primarily on the left side of my lower back, near the area where my belt sits, and my left buttock, particularly where I sit.
Occasionally, the pain radiates down to my knee, and sometimes it feels like sciatica extending to the soles of my feet.
Since the onset of these symptoms, I have noticed that sleeping on a wooden bed makes it difficult for my buttocks to lie flat, as it feels like my pelvic bone is protruding and causing discomfort.
The bone adjustment practitioner mentioned that this is normal, as everyone has a "pelvic bone" (he spoke in Taiwanese, which I cannot write ^^").
Before these issues arose, I had a fall while disembarking during a trip about five or six years ago, landing heavily on my left buttock.
I experienced significant pain and was unable to walk for over five minutes.
In the following years, I had a few instances of waking up in pain after sleeping on a wooden bed, with twisting pain in my left knee and a sensation that my leg was about to give out (at that time, I did not have the feeling of a protruding pelvic bone).
I have shared these experiences with doctors, but they did not seem to take them into account.
Therefore, I am unsure of the primary cause of my symptoms and which specialist I should consult.
I would greatly appreciate your response.
Thank you ^__^

Miss Lin, 30~39 year old female. Ask Date: 2008/05/31

Dr. Wang Shouji reply Orthopedics

Ms.
Lin: Generally speaking, young women without a family history have a low chance of developing ankylosing spondylitis.
It is mostly likely a problem with the muscles or soft tissues.
If there are accompanying symptoms such as lower limb numbness or sciatica, those cannot be ruled out.
If there is no relief after a period of treatment, further examinations such as MRI are recommended to determine if there is any damage to the intervertebral discs or other soft tissues, and whether surgical intervention is necessary.
It is advisable to visit an orthopedic or neurosurgery outpatient clinic for further evaluation as soon as possible.
Wishing you a speedy recovery.

Reply Date: 2008/05/31

More Info

Based on your detailed description, it seems you are experiencing a complex interplay of symptoms that could be related to several conditions, including disc herniation and possibly ankylosing spondylitis (AS). Let’s break down your symptoms and the potential underlying issues.

Understanding Your Symptoms
1. Pain Location and Nature: You mentioned experiencing pain in your lower back, buttocks, and occasionally radiating down to your knee and foot. This pattern is often associated with nerve compression, which can occur due to disc herniation. The fact that you feel pain when sitting or bending suggests that certain positions may exacerbate the pressure on your nerves.

2. Previous Injuries: You noted a significant fall several years ago, which could have contributed to your current issues. Trauma can lead to structural changes in the spine, including herniated discs or other degenerative changes that may not be immediately apparent on X-rays.

3. Medical Evaluations: You have undergone evaluations by orthopedic and immunology specialists, with X-rays showing no signs of ankylosing spondylitis. However, the absence of AS does not rule out other conditions like disc herniation or lumbar strain.

4. Response to Treatment: You mentioned some improvement with traditional Chinese medicine treatments, including acupuncture and manipulation. This suggests that your pain may have a muscular or mechanical component, which can often be alleviated through physical therapy or similar modalities.

Potential Conditions
1. Disc Herniation: This occurs when the inner gel-like core of the disc bulges out through a tear in the outer layer, potentially pressing on nearby nerves. Symptoms can include localized pain, radiating pain down the leg (sciatica), and weakness or numbness in the affected leg.

2. Ankylosing Spondylitis: While your X-rays did not indicate AS, it’s important to note that early stages may not always show clear signs. AS typically presents with chronic back pain and stiffness, especially in the morning or after periods of inactivity, and may improve with movement.

3. Muscle Strain or Ligament Sprain: Given your history of physical activity and the fall, it’s possible that you have a chronic muscle strain or ligamentous injury that is causing your symptoms.

4. Sacroiliac Joint Dysfunction: This condition can cause pain in the lower back and buttocks, especially if there is a history of trauma or uneven weight distribution while sitting.

Recommendations
1. Further Evaluation: Since your symptoms persist, consider seeking a second opinion from a spine specialist or a neurologist who can perform a thorough examination and possibly recommend an MRI if it hasn’t been done yet. An MRI can provide a clearer picture of the soft tissues, including discs and nerves.

2. Physical Therapy: Continuing with physical therapy may be beneficial. A physical therapist can provide targeted exercises to strengthen the muscles around your spine and improve flexibility, which may alleviate some of your pain.

3. Pain Management: If your pain is significant, discussing pain management options with your healthcare provider may be appropriate. This could include medications, injections, or alternative therapies.

4. Lifestyle Modifications: Pay attention to your posture, especially when sitting. Ergonomic adjustments to your workspace and avoiding prolonged sitting can help reduce strain on your back.

5. Monitor Symptoms: Keep a detailed log of your symptoms, including when they occur, their intensity, and any activities that exacerbate or relieve them. This information can be invaluable for your healthcare provider in diagnosing and treating your condition.

Conclusion
Your symptoms are complex and may involve multiple factors, including previous injuries, potential disc issues, and muscular imbalances. A comprehensive approach involving further evaluation, targeted physical therapy, and lifestyle modifications may provide relief. It’s crucial to work closely with your healthcare providers to determine the best course of action tailored to your specific situation.

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