When or should I see a ortho for my back?

[Tuckervill]

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

[Wahine]

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.....

[maryellen]

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

[ChickWithBrains]

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.

[spokewench]

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

[smilingcat]

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

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

[Wahine]

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.