When or should I see a ortho for my back?

To start off, my father was a MD. So I'm very much biased against them. Don't like'em don't care for them mainly because I realized early on that MD's really don't have any more clue than you or me. Also I was warned about many of the surgeries as not permanent, meaning you have to have it redone every few years.

Now my back problem. It is getting a little bit ridiculous. It's been out since end of June.

Couldn't ride in Manhattan beach crit, though I was really tempted.

Rode on a very lucky 7-7-7 date at Tour of Three Harbors in Ventura County. I opted for the 35 flat miler to save my back. Had a setback from that ride. And start seeing my really wonderful chiro.

Then just two weekends ago I tried the Holestein ride and ended up dumping the 60 miler. This bugs me a great deal. 60 miler really shouldn't be a big deal but it was. My back is once again screaming with jolts of excrutiating pain when I move the wrong way. Still doing the Chiro. Still doing the Gyrokinesis (similar to Pilates) and the jolts are still occuring.

I don't trust MD's. And if I see one what can they do anyway?
"Lets fuse two of your vertabrae" I understand its a loooong recovery and its only good for about 5 years. Then what.

"Steroids?" hmm I don't want to have that puffy moon face and what about my liver??

"Stop riding a bike" I've been told that by a neurosurgeon after my last major accident. This is not an option for me. I would rather bike and die doing the thing I enjoy in life. Yes its selfish.

What else can I do?? Oh am I just too jaded? Do I need to put my biases of MDs aside and go see a orthopedics specialist? I would like an opinion from all the wonderful PT ladies on this board. I'm just going totally batty and in a bit of cabin fever frenzy..

Are there any PT work that can be done for my back?

smilingcat

exercise? physical therapy? Postural exercise? there's lots that you can do without any drugs at all.
you can heal yourself.
They did a study on people who got their spins fused
and those that didnt' and i think after 6 months
the same percent of each group was feeling better.

I've had a chronic neck problem for several years. I went to see an orthopedic surgeon. After reviewing my MRI, he told me surgery wasn't indicated and prescribed physical therapy. it wasn't a particularly touchy-feely experience, but I felt that he understood the issue and treated me appropriately. The PT took care of the acute pain, but I was left with some minor chronic pain that never really went away - I assumed I'd always have it.

Recently, I had a recurrence of the problem - acute pain for days. I went to my GP and she checked my range of motion and felt that there was no need to go back to the orthopedist. Instead, she prescribed another round of PT and referred me to a chiropractor. I've been doing both and feel like I'm making progress for first time in over 5 years - I have virtually no pain in some ranges of movement and am making progress on the rest.

Good luck!

Smilingcat, maybe you should see an M.D., just to get a diagnosis. there are so many causes of back pain. It could be related to disc problems, or something else altogether. You really need to know what the source of the problem is so you can make a choice of treatment. You don't necessarily have to go with the physician's suggersted treatment, but at least you will know what the cause of the problem is and then search out treatment alternatives. Just IMHO.

I highly recommend a McKenzie PT. Give them a chance. I've seen some amazing results. (I start my McKenzie training in 2 months, so I don't know enough to give helpful hints at this point.)

It's all about mechanical issues of the spine, and the evaluation protocol with McKenzie will immediately determine whether or not you are a candidate. They won't keep you for therapy if you aren't appropriate.

McKenzie PTs are PTs who've gone on for advanced training.
Your ideal would be to go to a McKenzie certified clinic (there are only about 25 of them in the US) or to go to a McKenzie Diplomate therapist. Next is a Certified McKenzie therapist. Someone who has simply taken a few classes but never gone thru the certification or the diplomate programs would be better than nothing.

http://www.mckenziemdt.org/ Try the website and search clinics, diplomates, and certs in your area.

Just ran a quick search: there is only one McKenzie certified Clinic in California, and it's in Sacremento.

Here's a list of Dip and Cert therapists in California. If you go to one of their clinics, make sure you see the McKenzie therapist themself, and not just someone else who works in the clinic. http://www.mckenziemdt.org/therapist...95865E4FF21987

Doctors can be very helpful. They're most helpful when you can be specific about what hurts, what triggers pain, and what your goals are. Specialists (podiatrists, orthopods, obstetricians etc) tend to be more useful than a GP if you've got a problem in their area. They're also much more useful when you do your own research on your problems. That said, I've had bad specialists :).

Some structural repairs like hip replacements work pretty well. A *lot* of structural repair surgery is very experimental. If the doctor suggests a particular surgery, it is well worth doing your own research on it. My podiatrists have always been good about taking "no" on surgery seriously. The length of time a structural repair surgery lasts varies based on the surgery. Also, most doctors consider repair duration a very important thing to improve. Surgical repair is not (at present) a good treatment for my structural problems, but everyone's body is different.

It is *good* to be a suspicious patient. The doctor does not live in your body. The doctor cannot read your mind. And the doctor is not perfect. But a good one has more tools (drugs, knowledge of the human body, mechanical aids, surgery, physical therapy) than an ordinary person.

There are doctors who bike out there. It might be worthwhile to find one who does, even if he or she is not the specialist you need, and ask for their advice on which specialists are likely to be supportive. Doctors are just like regular people, and some of them don't take exercise and physical activity seriously. Others are bike commuters *g*.

Find a doctor who specializes in sports injuries. If you already have a chiro or PT you like, ask them for a recommendation.

Another thing you might look into is ART. A good ART therapist can do amazing things.

I have found using a variety of treatments, ie medical massage therapy, physical therapy and chiropractic care, helps me. If I had access to a reputable acupuncture clinic, I would probably incorporate that too.

I also use small yoga balls--the kind that is about the size of a softball--to help with my joint pain. It gives me relief as well.

Thank you,

I will be making an appt with my GP and have him recommend me a specialist for my back. Like to know how much my discs have deteriated... If it isn't too bad then I might go for Rolfing for deep tissue massage and definitly some PT work. I need to spend sometime to learn about what McKenzie PT is all about. Sounds interesting.

I looked into the Mckenzie certified PT's. They are located close by :D :cool: At this point, I'm willing to try something new.

smilingcat

McKenzie's been around since the 60's, but more popular in countries with socialized medicine. (cuz for your standard disc issues it gets people out of treatment in 4 to 6 visits. Great for socialized medicine, but not so popular for the profit-driven systems where you keep a patient for much much longer and make more money off their insurance.)

It works very well for specific disc issues, and if your back doesn't respond like one that McKenzie works for, you'll know at that first visit. Your cert or dip PT would tell you if your back is appropriate. No wasted time/money.

The basic idea is that you put your back out, you can put it back in. (as long as the disc hasn't fragmented or hasn't caused cauda equina damage. if that is the case you are sent back to your doc.) The PT helps you figure out which movements put your disc back in, you do those every 1-2 hours, and after a week or so of no pain you are tested thru movements to see if the disc has healed into place. If it has healed then you begin careful stretching exercises for the disc so it is flexible and less likely to bust open/"go out" again.

There is a book "Treat Your Own Back" by Robin McKenzie that might be worth looking over.

I go to a chirpractor on occasion. Try one. Not any one, but a good one. I asked for a lot of opinions before I let someone mess with my back. Life has been a lot better ever since.

However....some people require more. Steroid injections are typically done under CT and are quite successful. If all else fails, don't be afraid to go down this path. :-)

Again, thank you all for your kind comments.

I know I have bone spurs on two of my vertabrae. It's been there since I nearly broke my back over 30 years ago from a bad, bad, really bad head plant while doing aerials on my skiis. I'm still amazed that I didn't break my back then. Anyway, couldn't remember which two it was. Yesterday, I went to my weekly chiro since June and had him pull out my old x-rays from about 14 years ago. Yup its there on L3 and L4. and that is where my back is out. major OUIE!!!

Making an appt for MRI to see how much it has deterriated.

not looking forward to the bad news.
Smilingcat

I was going to suggest an MRI to see what is going on. I had a cervical fusion 1.5 years ago when one disk had slipped & was impaling itself into my spinal cord. No fun.

Now, I'm having lower back issues too. All docs agree that neck & low back pain go hand-in-hand. My ortho did an MRI & said discs are bulging. I've just started to see an acupuncturist who is helping.

Caution about chiro's - be sure you have a good one. I saw a chiro before an ortho & I believe that the chiro might have made things worse. He didn't have an MRI to consult, so it wasn't really his fault.

I had a cyclist for my PT after my cervical fusion. He prescribed exercises that I could do at stoplights. Looks a little weird, but gives people something to talk about! "Hey Mildred - look at the crazy woman doing a turtle thing with her neck! HA HA HA!"

I finally threw my towel in saw my doctor yesterday. He didn't think I needed to see an orthopedicist but he wanted to see X-ray images first. From what I told him, he said that the bone spur may be irritating the muscles in the back... Anyway I'll find out what I need to do next. One nice thing about living in LA is I can be referred to someone who has worked for US Olympic team as either as a doctor, chiro, massuese...

Depending on what he sees, he'll recommend what he think is appropriate. Also had my basic health check done. same old same old. except my heart rate had climbed to 72 resting and my bp was 110/8?. This was like minute after I had another moment of YYEEEOOUUCH! down my back. getting out of my seat.

Well I'm thinking maybe hey, I'll go get my back ROLF'ED or look for McKenzie trained PT's. I'll ask my doctor about that too.

Yes my back is still giving me grief. grrr...

smilingcat

I'm sorry to hear you're in pain. I know that kind of pain well. It SUCKS!

Hope you get some relief soon.

Karen

Smiling, I'm sorry but I haven't read through the whole thread so I may be giving you some information that has already been put out there.

It sounds to me like a functional stability problem, likely in your sacroiliac joint. I just took a course this weekend on specific diagnosis of functional instabilities in this area and treatment. The treatment is very specific and requires a therapist that is familiar with the exercises. They are different than your standard pilates exercises but similar in principle. In pilates they have you work hard on your "power house" which is the equivilent of the transversus abdomenus contraction that we use in physio to try to get people controlling unwanted movement in the low back. Pilates also works on some of the larger prime movers of the hips (glute max, med, hamstrings etc) but it doesn't target smaller muscles around the hip and pelvis that we have more recently found out are really helpful in these types of injuries. The muscles that need to be targeted are often the deep sacral fibres of glute max, pelvic floor (sometimes this is counter productive), psoas (using an isometric compression type contraction), multifidus and the diagphragm. The hard part if figuring out which of these muscles does the trick and in what position. That takes some good evaluating and experimentation with exercise.

I'm going to see if I can find some helpful links to some of these concepts later today. I'm not confident tho, this stuff is pretty new. I'll be back.....

. . . or try a physiatrist (MD who specializes in physical rehab). As they are not surgeons, I felt more confident re their suggestions.

Xrays are only good if you think you acutely broke a vertebrae or have a condition where one vertebrae has slipped out of position relative to the rest in the column -- or if there's a concern about cancer. Since this is the minority of back pain causes (most are discs or soft tissue, not bone), an xray will only do you so much good.

Neurosurgeons like to operate, so you already know the bias there. Some orthopods, too.

I think you'll get the most bang for your buck from a primary care sports medicine doctor. These folks don't operate, but they know their functional physical medicine better than most "carpenter" doctors and work much more closely with their PTs and community providers. This sort of doc may not be who your GP refers you to -- and if not, find one on your own and then phone your GP for a specific referral. The chances you'll get a better diagnosis and route to treatment are way higher.

Smiley - It is good to go to an ortho to see what is going on? Then, if you don't opt for surgery, but at least you know what is going on. It sounds like you did that so here is my 2 cents worth. I have been suffering from a bad back since I was in my 20's so I have a lot of experience. I did not have surgery and still do not plan to. Mine is lower back.

So I am religious about stretching (yoga type stuff is best for me); also core strengthening cannot be overdone, unless you try to increase your workouts too quickly! For me, I have learned that no matter what I am doing, strength training, riding, tennis, etc., if I increase activity too quickly, i.e. doing 20 mile rides and then increasing to 60 or 80 too soon, I will be in trouble. If I climb too much after not climbing much, same thing. So, small increments of increase in your activity is key. What I think this does is gets your muscles stronger without straining the back and causing inflammation. Then, as you increase, you muscles compensate and your back does not and then does not get inflamed.

The core workouts are key because the abdomen takes over with the strength of the core rather than the back, thus less back pain. I do have to take ibuprofen for inflammation when it gets bad - so you might call me an addict, but I do try to not take it when I do not need it. Which if I am a good girl and do all the above, I don't need as much.

Incremental increases in work is very hard to do, but it is very key. I know that life gets in the way and you don't get to train, but you have a long ride planned - and sorry to say, I do it too. I go out and do too much and then I suffer - but at least I know that if I was a good girl this would not happen. You learn what you can and can't do - and adjust your workouts accordingly. This does not mean you can't do a lot! I have raced mountain bikes, road bikes, done 4 person 24 hour races, hillclimbing races, played tennis, softball, and hiked the grand canyon. So, don't give up hope, it just takes a little more planning!

All my support is coming your way! It is not easy, but I know you can do it!

jan

Thank you Wahine, maryellen, Dr. Mc Ninja and to jan.

I've had back problems since my 20's too. I did way too many "egg beaters" down the ski slope, and just too many high speed impact on my skis.

And I'm no spring chicken even though sometimes I still think I am. Haven't had a followup with my doctor yet, got yanked into jury duty and wasn't sure which day I had to report. So tomorrow, I will be making my followup visit with my doctor (I was picked for jury pool. another whole story in itself).

Anyway, Wahine, my doctor is thinking on the same line as you. So he is thinking of sending me to a PT who specializes in sports/athletes. He used to work for US Olympic team :D

Did try to ride this past weekend. slow and easy. still had issues with my back. I think I wrote here somehwere... comparing to Lance Armstrong trying to ride while on chemo and being passed by "little old lady" I've got that feeling..:(

Now just have to wait for the air to clear... Still so smokey, my eyes are burning. From my office, I can see the Santiago fire in Orange county (yesterday). Its only 6 maybe 7 miles away. Today, the visibility is less than a mile so I can't see the fire.

Smilingcat

SC - I tried to find more online info about the stabilization treatment that I learned about and I came up empty handed. A good sports PT should be able to help. You might even want to look into getting a SI Belt for temporary management of the pain when you're having an acute episode. You don't want to use them all the time but they can be helpful when the pain is so bad that you can't really function, or sleep. In rare cases, once the SIJ is lined up properly, I'll put my clients in one for 6 weeks to try to give the joint a chance to stabilize itself. The PT should be able to help you figure out if that will help you.