Chronic Back Pain After a Sports Injury: Key Insights

Four years ago, I sustained a muscle strain from tug-of-war?

Hello Dr.
Chen,
Four years ago, I participated in a tug-of-war without warming up and sustained a strain.
After returning home, the entire left side of my back became swollen.
At that time, I received massage therapy and cupping, which led to significant improvement, and I experienced little pain or discomfort afterward.

However, about six months ago, I began to feel discomfort in the left side of my lower back, likely due to prolonged sitting while preparing for exams.
The soreness felt deep and was difficult to pinpoint externally.
Gradually, certain positions began to cause intense pain, such as bending down to pick something up or straightening my back.
I also had trouble sleeping due to the soreness, as lying flat felt uncomfortable, and I could only sleep on my side.
The soreness has slightly extended to my left thigh, but it is not very pronounced.
Over two months ago, I visited the rehabilitation department at National Taiwan University Hospital three times.
During my first visit, Dr.
Lu prescribed me two medications: 1.
Acemet Retard 90 mg/cap and 2.
SOLAXIN 200 mg/tab.
After taking them, I experienced significant relief, and the soreness decreased considerably, to the point where I felt little discomfort.
However, once I finished the medication, the pain returned.
During my second visit, Dr.
Lai prescribed a topical ointment and advised me to perform rehabilitation exercises at home for two weeks, including applying heat twice daily for 30 minutes, followed by the ointment, and doing gentle lower back stretches (forward, backward, left, and right bends).
After two weeks, there was not much improvement.
I then saw Dr.
Chen for the third time, who mentioned that the injury might be too deep for topical ointments and heat to effectively treat.
He prescribed the same medications as during my first visit and suggested that if there was no improvement, I might need to undergo rehabilitation at the hospital.
I would like to ask you the following questions:
1.
Could my symptoms indicate sciatica or a herniated disc? (After all, I had significant improvement with the medication previously.)
2.
Since I did not undergo any specific examinations and the doctors only conducted interviews, could this lead them to believe that I simply have a regular strain (old injury) without identifying any more serious symptoms?
3.
Is it possible for a regular old strain to be as severe as mine and persist without improvement?
Thank you for taking the time to review my situation.

TL, 20~29 year old female. Ask Date: 2011/07/07

Dr. Chen Wayda reply Rehabilitation

1.
It doesn't seem like sciatica or a herniated disc, but rehabilitation should be done instead of just relying on medication.
2.
The original condition does not require any special examinations.
3.
If an old injury was not properly managed, it may be difficult to fully recover in the future.

Reply Date: 2011/07/07

More Info

Chronic back pain following a sports injury can be a complex issue, often requiring a multifaceted approach to diagnosis and treatment. Based on your description, it seems you have been experiencing persistent discomfort in your lower back, which has been exacerbated by prolonged sitting and certain movements. Here are some insights into your situation:
1. Potential Conditions: Your symptoms could indeed suggest conditions such as sciatica or a herniated disc. Sciatica is characterized by pain that radiates along the path of the sciatic nerve, which runs from your lower back down to your legs. If the pain extends into your thigh and is associated with certain movements, it may indicate nerve involvement. A herniated disc occurs when the soft material inside the disc pushes out, potentially pressing on nearby nerves, leading to pain and discomfort. Given that you experienced significant relief from medication, it is possible that inflammation or nerve irritation is contributing to your pain.

2. Need for Comprehensive Evaluation: It is crucial to undergo a thorough evaluation, including imaging studies such as an MRI, which can provide detailed information about the condition of your spine and any potential nerve compression. Relying solely on a physical examination and symptom description may lead to an incomplete diagnosis, especially if deeper issues are present. Your healthcare provider should consider all possibilities, including structural problems in the spine, which may not be apparent through a standard examination.

3. Chronic Pain from Old Injuries: It is not uncommon for old injuries to lead to chronic pain, especially if they were not fully rehabilitated. The body can develop compensatory patterns that lead to additional strain on muscles and joints, resulting in ongoing discomfort. In your case, the initial injury from the tug-of-war may have set off a chain reaction of muscular imbalances, particularly if you have been sedentary due to studying. Chronic pain can also be influenced by psychological factors, including stress and anxiety, which can amplify the perception of pain.

4. Treatment Options: Since you have already tried medication and topical treatments with limited success, consider exploring physical therapy. A physical therapist can provide targeted exercises to strengthen the muscles supporting your spine, improve flexibility, and address any postural issues. Additionally, modalities such as ultrasound therapy, electrical stimulation, or manual therapy may be beneficial. If conservative treatments fail, more advanced interventions, such as injections or even surgery, may be considered, but these should be approached cautiously and typically as a last resort.

5. Self-Care Strategies: In addition to professional treatment, self-care strategies can play a significant role in managing chronic back pain. Regular gentle stretching, maintaining good posture, and incorporating low-impact aerobic activities (like walking or swimming) can help. Mindfulness practices, such as meditation or yoga, may also assist in managing pain perception and reducing stress.

In conclusion, while your symptoms may initially appear to be related to a simple muscle strain, the persistence and nature of your pain warrant a more in-depth investigation. It is essential to communicate openly with your healthcare provider about your concerns and advocate for the necessary diagnostic tests to rule out more serious conditions. With the right approach, there is a good chance for improvement and a return to your normal activities.

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