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Low back pain

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I have been experiencing low back pain for several years now. I am obese, so I know that doesn't help any at all. I have fallen on my tailbone before. My doctor says it is a muscloskeletal issue. Back in 2010 I took physical therapy for a weak back and the low back pain. It didn't help so much as far as I remember. Maybe in a way it did. A few months or so after therapy, I experienced some stiffness in my lower back, like my movements from turning side to side were very limited. And I would feel like I need to sit down to get relief. This happened after me standing for 30-40 minutes or so. My legs would also shake or tremor after bending over for a length of time. Say I was bathing the dog the other night in a tight sized shower, and afterwards I can feel like my legs would tremor if I tried relaxing them when I sit down. I don't really know why this had started when it did a few years ago, but the leg tremors, like I said, only happen after bending over for a length of time. I don't feel any numbness or anything else. No pain down either leg. So do you think its a pinched nerve in my lower back? What about spinal stenosis? Is spinal stenosis a possibility? What can cause a pinched nerve? I can do some housework and I can feel the pain or ache in my back, it will start acting up and so I would need to sit to get relief. So what what do you think could be going on? I know my back is probably weak again for one thing.
One other symptom I have experienced has been at the mid spine area I have had some numbness from there & a little lower.

Category: Family Physician-GP

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Category: HIV- AIDS Specialist
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Thank you for choosing DoctorSpring

I understand your concern and will try my best to help you.
I would like to know some additional details so that I can provide a more solid opinion

1. I understand that there is no numbness . But is there any difference in sensation ? Like a decreases sense of touch in lower limbs ?
2. Do you have any bladder symptoms ? Like hesitancy ? troubling initiating urination ? trouble in controlling urination ?
3. Do the legs feel stiff in general ?

You can reply as a followup
Thank you

Patient replied :

When I do have numbness in my mid spine on downward, it's after I have lying down for a bit or upon awakening. It comes a goes ever so often. I am a side sleeper, I usually wake up on my left side with my left arm under my pillow. Not sure if being on one side could make my spine numb or not.
I don't have any bladder issues other than once in a while I can have a sense of urgency to urinate. And also to have a bowel movement. My bowel movements sometimes can be or seem really urgent.
My legs don't feel stiff. Bending over for like 2-3 minutes & then I can sit on some steps and my legs would shake/tremor. That has been happening off & on for like 2-3 years. I'm not so active as I should be. I am more sedentary. It's either numbness or a tingling sensation in my back (mid to lower back).


Thank you for the additional details

The tremor or the shake in the legs are suggestive of a stretched nerve in the lower spine, possibly between the vertebrae or disc. This makes me suspicious of a lower lumbar canal (spinal stenosis) stenosis as you rightly suspected.

But other features of spinal setonsis are conspicuously absent. This make the clinical diagnosis bit difficult. The numbness on the lower spine is not corelating (you should be getting the numbness more lower done on the legs and toes). The pain is vaguely suggestive though. There is only one sure shot way there and that is to get an MRI of the Lumbo sacral spine

Physical therapy can be give you good pain relief and if done properly almost complete resolution in some cases. Do you have acess to a Physical Therapist ? I can suggest some back strengthening exercises , but those are done in consult with a Physical therapist after an MRI diagnosis. Before that I would like to know how long are you able to walk in a moderate pace, on a level surface without any pain or discomfort . (to give me baseline )

Thank you

Patient replied :

I'm able to walk pretty good at a moderate pace. It's mostly after doing some housework, sweeping & mopping , whatever. Standing at the kitchen sink doing dishes it can aggravate my lower back.

In that case you can begin some mild back strengthening exercises or extension exercises.

This is best done under the care of a good physical therapist. You can begin with small ones like this : v

and then gradually step up. Once the back muscles (the extension muscles) are strong this will bring in more core stability and improve the symptoms.

And from this moment you should stop bending over directly. Instead kneel down. Avoid arching your back at any cost. There are a lot good posture and movement recommendation for low back pain in the internet. You can refer some of those. Postural modification and Back exercise can bring in a surprisingly big change.

I will keep this consult open. In case if you have further queries at any point of time feel free to ask

Thank you

Patient replied :

I have another question for you. Is a stretched nerve in the low spine the same as a pinched nerve? Is the stretched nerve a complication of my back being weak? I would probably think so. I may see about an MRI sometime to see what the issue is.

Stretched nerve and pinched nerve are similar . Stretched nerve is a nerve that get compressed / stretched on bending movements etc. Pinched nerve on the other hand is 'pinched' always. (has pain always, might have increased pain with movement )

This is NOT due to weak back muscles, but weak back muscles can be one risk factor. So back muscle strengthening can help.

Thank you

Dr. Jaydeep Tripathy
Category: HIV- AIDS Specialist
MBBS from Sri Ramachandra University in December 2011
M.Med (Family Medicine) - TNMGR University, Chennai
MBA-MPH in Public Health in March 2016, SRM University
Finished AFIH in March 2016, SRM University
MRCP ( UK ), Internal Medicine, Royal College of Physicians, June 2016
Fellowship in Diabetology from Martin Luther University in January 2017

Currently Resident Physician, in MD Radiodiagnosis - Kamakshi Memorial Hospital, Chennai
Dr. Jaydeep Tripathy and 4 other Medical Specialists are ready to help you

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