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Treatment for dull low back ache with leg numbness.

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Male, 5’9”, 175 lbs, 22 years old, athletic, years of heavy weight lifting, no allergies

Father – history of gout and kidney stones

Paternal grandfather – died due to kidney failure and enlarged prostate

Maternal grandmother – died due to heart attack/high cholesterol/heart disease

Mid-August 2013 – I was weight lifting, performing the deadlift movement with a heavy weight. I was also purposefully hyperextending my back when performing this movement which was out of the ordinary. Later that night and the next morning, I woke up with extreme low back pain in left, middle, and right sides and inflexibility. Throughout the next week, I also felt a lot of numbness on the outside of the upper right hip, right inner quadriceps (near the knee), the arch of the right foot, and the right inner quadriceps (near the groin). The numbness persisted for approximately one week. The low back pain persisted, sometimes feeling more pain on the left side than the right and vice versa, though the pain had been more dominant on the right side. There was no visible swelling or inflammation identifiable from the surface of the skin on the low back.

In between this period, I rested and refrained from weight lifting and all types of rigorous exercise.

November 2013 – By this time, most of the low back pain had subsided but I still experienced pain in certain positions and did not have my full strength back. I felt pain when I bent down forward and when I extended backwards. I also feel considerable pain on the right side of my lower back, right above the hip, when I bend at the hip towards the left side. I would describe the pain as a dull ache. Pain subsides when laying down on the back; pain flares up when laying down on the stomach. Sitting is comfortable but back becomes burdensome after sitting for a long time. I also noticed that the pain becomes less intense when I run around, for instance when I play shoot around in basketball. The pain mostly subsides for a couple of hours after playing then returns. I visited an orthopedic and received a prescription for physical therapy. I was not consistent with the physical therapy because the low back became sore the day following physical therapy. Orthopedist soon ordered MRI of lumbar spine to rule out disc herniation.

December 2013 – MRI of lumbar spine without contrast was performed. There was no evidence of fracture, spondylolisthesis, spondylolysis, focal disc herniation, or spinal stenosis. There is early degenerative loss of T2-weight disc signal at L2-3 and L3-4 as well as Schmorl’s node formation inferiorly at L2 and superiorly at L4. Orthopedist recommended continuation with physical therapy and a visit with a Neurologist for EMG test if physical therapy does not help.
Low back pain has slightly improved up to a point, but is no longer improving. Physical therapy causes soreness, and the back heals and goes back to “normal” after a few days.
March 2014 – I visited a Neurologist, who performed EMG test. EMG test yielded nothing out of the ordinary except for muscle spasms, and prescribed more physical therapy as a result. Neurologist also ordered blood tests.

Performed physical therapy more consistently over the next month. Physical therapist noticed extreme tightness in hamstring and glute muscles so therapy aimed to loosen up these muscles and to strengthen the core muscles. I experienced less soreness as a result of physical therapy, but experienced no noticeable difference in low back pain. Blood test results indicated vitamin D deficiency (18 ng/mL), low testosterone (380 ng/dL), and slightly elevated uric acid levels (6.0 mg/dL).

April 2014 – I’ve refrained from weight lifting and have instead attempted to stay active by playing basketball by briskly shooting around. On a different day, I decided to play an intensive game of 2 on 2 basketball and experienced extreme lower back pain on the right side as a result. The pain could not be attributed to a single movement during the game, but I felt the onset of the pain when I stopped playing and laid down; I did not notice the pain while playing. Pain was very intense (9/10) and I felt it during all movements such as sitting, standing, laying down, and trunk rotation though laying down on the back was more comfortable than sitting or standing. I could not stand up completely straight as a result of the pain. I also felt a numbness on the outside of the right hip (upper leg). Over the next few days, the extreme pain quickly subsided to “normal” levels of back weakness.

Doctor prescribed allopurinol, colcrys, and testosterone cypionate. Previously, I experienced minor diarrhea due to the drugs. On April 23, I had a very bad reaction to the drugs. I was experiencing very bad stomach pains, nausea, vomiting, diarrhea, and dizziness. My diarrhea and vomit were both almost completely water by the end and I could tell I was dehydrated. I tried to drink water to combat the dehydration but I could not keep it down. I eventually went to the emergency room where they gave me saline solution, morphine, and a drug to combat the nausea. They also performed a blood test and an ultrasound to rule out gallbladder stones. I was then released. The following day, I experienced uncontrollable, watery diarrhea for the entire day as well as a headache. I also had bad knee pains (more on the right than the left side) and a sharp pain on the right side of my lower back. I also have very little energy and slept very much throughout the day.

June 2014 - Next I sought the help of a physiatrist with a specialty in pain management and rehabilitation. He ordered a moving x ray in which I bent forward and extended backwards to perhaps expose a fracture that was missed in the MRI. There was no fracture detected. Next, the physiatrist prescribed dexamethasone (tapering dose) to relieve inflammation. The drug worked perfectly at first. Within 1.5 days, my lower back was nearly 100% better. I felt no pain at all during extension, only a slight bit of pain during forward flexion, and a moderate amount of pain when I slid my left hand down to my left knee (pain was felt on the right side of the lower back above the hip). On the first day of medication, I also felt the “bruising” sensation on the outside of my upper right thigh. In the next couple of days, I felt bad side effects from the drug and the low back pain slowly returned. After the side effects started wearing off, my low back pain had returned to its “normal” levels before I started taking the drug. When the lower back pain was back to its “normal” levels, I again felt the bruising sensation on the outside of my right thigh very clearly.

Side effects from drug:
Increased appetite
Upset stomach
Fluid swelling
Weight gain
Headache
Dizziness
Mood swings
Muscle weakness and bone pain
Blurred vision
Abdominal swelling/bloating
Rapid weight gain
Buzzing in ears
Acne
Mood changes
Easy bruising

Approximately two weeks after stopping the medication, my lower back has returned to its “normal” level of dull, aching pain. There has been very little, if any, improvement since taking the dexamethasone. As a matter of fact, my low back is nearly exactly the same as it was since November.

Category: Orthopedic Surgeon

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Category: Spine Surgeon
 25 Doctors Online

Hello.
Thank you for your query at DoctorSpring.com.
I have gone though your history with diligence.
It looks that your back pain did not start without reason. You were all right before the trauamtic episode while lifting heavy weight. The trauma was the inciting event to a start cascade of events.
The backache although brought about by trauma did not result in any major spinal issue. The pain you have is mechanical and due to the muscle strain since the MRI and X-Ray have ruled out any damage. The fact about lower backache is, it is highly troublesome and diificult to control initially, even for a year or two. However, the good thing is with passage of time and a good regimen, you will be free of it soon.
You do not need to take the Dexamethasone. After keeping in mind all your details, I advice you to follow this regimen:
-Avoid movements or activities such as intense sports etc, which can initiate the pain.
-Take an anti-inflammatory analgesic medicine like OTC Ibuprofen 400 mg twice daily, with food, for a few weeks(2-3) continuously.
-Take some supplemental compounds which include sodium hyaluronate and Vitamin C. These help in chronic cases.
-Take pineapple juice which is itself has anti-inflmmatory analgesic properties.
-Continue with physiotherapy. Involve a good expert for this.
-Daily warm fomentation over back, at least three times a day.
-Wear a protective lumbar corset during walking or movement.
Please follow these measures strictly and you can find relief by 2-3 weeks.
I hope this was helpful to you. Feel free to ask queries.
Thank you.


Patient replied :

Doctor Tiwari,
Thank you for your quick reply and for your medical advice, but I have a few questions about your treatment plan:
The purpose of taking the Dexamethasone was to relieve the inflammation around the lower back, which it did relatively well at first. If a powerful prescription drug proved ineffective in the long term at relieving the inflammation, why would OTC anti-inflammatories or pineapple juice prove effective?
Also, if this is indeed a chronic muscle strain, then why hasn't physical thearpy proved effective for me in the past? The exercises included stretches that helped loosen up the leg muscles, specifically the hamstrings and calves. The exercises also emphasized core stability and hip mobility. I did these exercises religiously for a month and noticed minimal improvement, if any.


Hello.
I have suggested that you do not take the Dexamethasone since you were not tolerating it. Otherwise it would have been a good option. I want your treatment to be wholesome, where even your diet should contain something of benefit to your condition, so I suggested the pineapple juice because of its inherent anti-inflammatory and analgesic properties.
Regarding the OTC inflammatory and analgesic, you should know that a drug is available OTC not because it is less potent. It is because it has a well established safety profile even when used extensively by the general public on their own discretion, without significant risk of misuse. Although NSAIDs like Ibuprofen are not as powerful in their anti-inflammatory properties as steroids, they are potent analgesics unlike steroids. So I do believe this will help you more than Dexamethasone.
Chronic problems take time to heal. This is a reason why I had told you to not to give up. Even minimal improvement is significant and you should persevere with the physical therapy. It may take upto 3 months for good relief.
Let me know if I can assist you any further.
Thank you.


Patient replied :

Doctor Tiwari,
It has been a while since we last spoke and there have been some developments in my case:
My physcian (physiatrist with certification in pain management and rehabilitation) ordered a bone scan to check to see if there was a small fracture in my lower back that was missed by the moving x-ray and MRI images. The test has come back and there is no sign of a fracture, yet my physician still believes that the hyperextending movement during weightlifting caused the facet joints in my lower back to crunch together and cause stress. He has recommended a facet joint injection to confirm/deny that the facet joints are the source of the pain and to also treat the area with a steroid if that area is indeed the source of the pain.
As I wait for the injection, I'd like to hear your thoughts. It makes sense that my facet joints were affected due to the hyperextending nature of the weightlifting movement, but I'm still amazed that there are no abnormalities in the imaging tests. In addition, I feel pain in my lower back both when I bend downwards and when I extend backwards, instead of only when extending backwards as is the common case with facet joint fractures.
I'm also wondering why physical therapy is not helping me. The more I learn about low back injury, the more I realize that physical therapy is the standard non-surgical treatment option. Why hasn't physical therapy been helping me? I've seen no improvement whatsoever after approximately a month of consistent therapy, following the therapist's advice perfectly. In case you're curious, the therapist has provdied exercises that stretch the hamstrings, glutes, quads, and hips...and provided exercises that strengthen/stabilize the core muscles. I've found that my back usually feels less tight immediately following/during running, physical therapy, and the elliptical machine and I experience a better range of motion. Similarly, the pain subsides with a heat pad on the back. However, within a few hours the pain slowly returns and I feel the same tightness/dull aching. What do you recommend? Is it possible that my problem is purely muscular and the physical therapy needs even more time?
Thank you for your advice.


Hello,
Thank you for the follow up.
The nature of your complaint shows that there is relief in stiffness after having warm fomentation,exercises & stretching.This shows that there is paraspinal muscle spasm.This spasm may have a central cause(most commonly stress is one of the factor) or it may have a peripheral cause like a old injury,infection,arthritis,etc.Strengthening the muscles with stretch exercises will obviously help you.You may have a central muscles relaxant like tramadol for relief.
Feel free to discuss further,
Regards.


Dr. Mukesh Tiwari
Category: Spine Surgeon
Experience: 
Fellowship - Khandaka Hospital, Jaipur
Residency - MS, Rabindranath Tagore Medical College, Udaipur, 2000
Medical School, Internship - MBBS, SMS Medical College, Jaipur, 1995
Dr. Mukesh Tiwari and 4 other Medical Specialists are ready to help you

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