Hi Nathan,
Thanks for the info... Your lumbar scoliosis points to the right
(dextroscoliosis) and is a compensation for an upper left-pointing
(levoscoliosis) scoliosis. Here's my best (and briefest!) assessment:
With the symptoms you've described ("...a combination of sharp pains
in my lower left back, glute, upper thigh (front and back), groin,
back of the knee, and occasional shooting/tingling pain starting at my
lower back and ending at my knee. General sciatica symptoms... mostly
achey but sometimes sharp, and also occasionally tingling. It usually
lasts for a few hours and tends to be worse at night..."), I'm
inclined to think your symptoms are not, at least not entirely, caused
by your disc bulge.
The groin and front upper thigh symptoms would not be caused by a disc
bulge at L5-S1, but would have to come from L1-L4 if they were caused
by your spine directly… so we can say with certainty that that
component of the problem arises from other than the disc at L5-S1. If
I understand correctly, the onset of these symptoms was more or less
at the same time. That being the case, it would be curious, though not
impossible, for the symptoms not caused by an L5-S1 disc lesion to
occur at the same time as the symptoms possibly caused by the L5-S1
disc if in fact they were caused by the disc, unless there were some
sort of trauma involved (and it does not sound as though that's the
case). So…
Let's consider the scoliosis. Your upper scoliosis points to the left
and will have caused (typically) left rotation of the affected portion
of the spine causing you to develop a left-sided "rib hump" (when you
bend over to touch your toes, your left ribs will appear higher or
more prominent than your right ribs, although, because your upper
scoliosis is low with the apex at T12-L1, ther might not be much of a
rib hump at all). Conversely, your lumbar spine curves to the right
and so we can expect that your lumbar spine is also rotated to the
right. Also, the apex of the rightward curve in your lumbar spine is
at L4. Interestingly, the transition from apex of the upper curve to
the lower curve occurs over the span of just a few vertebrae (L1-L4).
Okay…
The neutral foramen are the holes through which the nerve roots pass
as they leave the spine. The foramen, though "holes," are not of
constant diameter or shape. This is because the top half of the
foramen is created by a semicircular notch in the vertebra "above" of
the nerve root, while the lower half is created by a semicircular
notch in the vertebra "below" the nerve root (make sense?). The
diameter of the foramen increases ("opens") with spinal flexion
(bending forward to touch your toes or while riding a bike). The
foramen opens on the right and closes (diameter decreases) on the left
in LEFT sidebending (standing erect and sliding your left hand down
your left leg is a left side bend). Extreme rotation in either
direction can close the foramen. Now then…
I'm going to hazard a guess, and I look forward to your findings when
you do this. First, you know those points on the right and left sides
of your pelvis which are prominent when you lay flat on your back? I
suspect that, if you stand in a "natural stance" with your toes
against a wall or toes on a line on the floor, the point on the left
will be more prominent (further forward) than the point on the right,
even if only slightly (millimeters do matter :) ). If this is the
case, then the rotation (rightward) of your lumbar spine has continued
down through the pelvis. I will presume that this is the case, in
which case the following occurs: On the left, in typical weightbearing
activities (standing , walking, etc.) your left hip is relatively
externally rotated (external rotation of the hip occurs when you point
your toes outward by rotating your entire leg in that direction), and
that's okay most of the time, except that chronic external rotation of
the hip leads to shortening of certain muscles in the posterior hip,
most notably for us right now, the piriformis muscle…
The piriformis has a medial attachment on the front (belly side) of
your sacrum (the large flat bone which forms the back of your pelvis
and from which hangs your coccyx or tailbone), passes through your
pelvis and attaches to the top rear of your femur (thigh bone). This
muscle is a hip external rotator and overlaps a smaller muscle called
the superior gemellus. Passing over the superior gemellus and
underneath the piriformis is the sciatic nerve. If the piriformis is
excessively tight, the sciatic nerve can become impinged between the
two muscles with sciatic symptoms resulting. But you don't, if I
understand it correctly, have symptoms when you're up and around
walking and the like (correct?). That's because you're most accustomed
to being in that position (or even in similar positions) AND your
pelvis is not "fixed"--it can rotate left and right and can tip
laterally as well as front and back as needed.
However, sit on a bike seat and now the pelvis is fixed and has much
less freedom for rotation. Also, if your left knee and foot are going
to point more or less straight ahead while riding, your hip now must
be internally rotated (given the fixed pelvis), which places the
(shortened due to chronic external hip rotation) piriformis muscle on
stretch which may compromise he sciatic nerve causing sciatica pain
and symptoms. You can easily test if the piriformis is involved: lay
on your back, ideally with both legs straight. Using both hands, pull
your left knee up and across toward your opposite shoulder. Is there a
very strong, possibly painful, pulling sensation in your left buttock?
Does this worsen the sciatica? If so, then you have both the culprit
and a remedy!
Here then are the suspects: closed neural foramen (hence, nerve
impingement/irritation) on the left at the vertebral levels which can
account for the groin and anterior thigh symptoms coupled with what is
known as piriformis syndrome on the left, as described just above.
Okay… it's late here and I need to get to bed… let me know if your
pelvis is also rotated (standing with toes against a wall or on a line
on the floor); let me know, too, the results of testing your
piriformis (pulling the left knee up and across to the opposite
shoulder). I'll offer a few suggestions on how to fix the problem,
what the future may look a bit like given the scoliosis, and, if the
piriformis and/or pelvis appear not to be the culprits, I'll offer one
more non-disc possible explanation for your symptoms. There's a lot of
information here, so don't be shy about it if it doesn't all make
sense :)
G'night!
lyle
On Oct 21, 7:45 pm, nathan spindel <nath...@gmail.com> wrote:
> Sorry, here's more on the scoliosis and I may have the 'point' flipped:
>
> "There is a levoconvex thoracolumbar curvature with the apex at
> T12-L1, and a compensatory dextroconvex lumbar curvature with its apex
> at L4."
>
> -nathan
>
>
>
> On Wed, Oct 21, 2009 at 7:36 PM, nathan spindel <nath...@gmail.com> wrote:
> > I don't have that information on hand, but my scoliosis 'points' to my
> > left side and as far as I know I don't have another up my spine.
>
> > What is your suspicion?
>
> > -nathan
>
> > On Wed, Oct 21, 2009 at 7:05 PM, LyleBogart{AT}gmail.com
> > <lylebog...@gmail.com> wrote:
>
> >> Thanks for the info, Nathan!
>
> >> Which side does the disc bulge toward. Also your scoliosis adds an
> >> interesting twist (no pun intended) on things. To which direction does
> >> your lumbar scoliosis point? Also, do you have another scoliosis
> >> further up your spine for which your lumbar scoliosis is compensating?
> >> Based on the information you've provided so far, I suspect there's
> >> another cause of the back pain other than the disc bulge, but I'll
> >> reserve comment until I hear back from you.
>
> >> Very interesting :)
>
> >> lyle
>
> >> On Oct 21, 6:57 pm, nathan spindel <nath...@gmail.com> wrote:
> >>> Thanks for the followup, Lyle.
>
> >>> I'm 25 and have had lower-back scoliosis (currently at 24°) since I
> >>> was a teen. In late July I started noticing a combination of sharp
> >>> pains in my lower left back, glute, upper thigh (front and back),
> >>> groin, back of the knee, and occasional shooting/tingling pain
> >>> starting at my lower back and ending at my knee. General sciatica
> >>> symptoms. Over the past couple months the pain has waxed and waned,
> >>> with a few days of exceptionally bad pain (an increased amount of the
> >>> above) every couple weeks. The pain is mostly achey but sometimes
> >>> sharp, and also occasionally tingling. It usually lasts for a few
> >>> hours and tends to be worse at night. But it's always there, and I'm
> >>> painfully reminded of it every time I go from sitting to standing or
> >>> vice versa. It might be helpful to note that the best I ever felt
> >>> since the pain began was after the first time the PT did electric stem
> >>> therapy on the back.
>
> >>> I did 5 weeks of PT before they recommended I see a spine specialist,
> >>> at which point I got an MRI to reveal a 12mm herniation at L5/S1. The
> >>> trial statistic you mentioned was interesting - I hadn't heard that
> >>> before. Reading through all the herniated disk symptoms it definitely
> >>> seems like the cause of my pain. Does that sound likely to you?
>
> >>> -nathan
>
> >>> On Wed, Oct 21, 2009 at 6:23 PM, LyleBogart{AT}gmail.com
>
> >>> <lylebog...@gmail.com> wrote:
>
> >>> > Hi Nathan,
>
> >>> > Hmmmmm... herniated discs. As a PT, I am typically suspicious of
> >>> > diagnoses of back pain diagnosed with a herniated disc. Here's why:
> >>> > First, there are usually no "pre-injury" images (MRI) showing that
> >>> > there was no bulging disc previously. Second, and very much related to
> >>> > the first, the imaging evidence of a bulging disc does not mean that
> >>> > your pain is due to the bulging disc even if the image shows the disc
> >>> > pressing on a nerve. There have been several good randomised control
> >>> > trials which show that if you take 100 people with no back pain, no
> >>> > radicular symptoms (pain or numbness/tingling down the legs or
> >>> > elsewhere) and take MRIs of their spine, in 50-60% of the cases, there
> >>> > will be at least one bulging disc, often pressing on a nerve root.
> >>> > Third, I don't know what your age is, but age we age past 30, the
> >>> > nucleus pulposis (the liquid center of the disc) begins to desiccate.
> >>> > As we age, there is, practically speaking, less disc "to bulge." This
> >>> > disc desiccation is also why grandma and grandpa keep getting smaller--
> >>> > loss of fluid in the disc equals loss of disc height, leading to loss
> >>> > of overall height. Fourth, and this is at least as important as the
> >>> > other three points, that you sometimes experience reduced pain while
> >>> > riding points away from the disc as the culprit.
>
> >>> > So what...
>
> >>> > Without knowing a few more specifics, I can't really offer more than
> >>> > to say that there are several causes of back pain and radicular
> >>> > symptoms which are easily overlooked during the medical diagnosis
> >>> > process. If you can tell me, as near as possible (don't worry about
> >>> > correct terminology) where you feel your pain (other than "my low
> >>> > back"), what the quality of the pain is (sharp, dull, burning,
> >>> > throbbing, etc...) how often it occurs, how long it lasts, what you do
> >>> > to alleviate the pain, what your age is... just some more details,
> >>> > generally. Oh, and what you were doing when you first experienced the
> >>> > pain.
>
> >>> > Feel free, of course, to reply off-list though I'd bet many other
> >>> > folks could use this info too :) Oh and I'd say don't stop riding
> >>> > unless it hurts too much!
>
> >>> > Best,
>
> >>> > lyle f bogart dpt
> >>> > tacoma, wa
>
> >>> > On Oct 21, 5:01 pm, nathan spindel <nath...@gmail.com> wrote:
> >>> >> Forgive me if this is too far off topic, although it's related to
> >>> >> Rivendell's concerns of proper bike comfort, fit, etc.
>
> >>> >> After cycling 100-200 miles/week for 4 months on my Romulus I managed
> >>> >> to get a herniated disk. I'm not positive it was caused by cycling,
> >>> >> but it seems quite likely (my doctor thinks so too).
>
> >>> >> In my research I've found that some people with this condition
> >>> >> continue to cycle. After not riding for the first two injured months,
> >>> >> I began riding a little bit to keep sane and have found my pain
> >>> >> sometimes lessens while riding. Two doctors I've consulted with said
> >>> >> it might be okay to cycle if I'm okay with it, but they seem hesitant.
>
> >>> >> I'd like to hear any anecdotal stories you have about this (or
> >>> >> healing/treatment as it pertains to cycling). I really have grown to
> >>> >> love riding bikes and would hate to stop (but of course I'll stop when
> >>> >> appropriate). Feel free to reply off-list.
>
> >>> >> -nathan
--~--~---------~--~----~------------~-------~--~----~
You received this message because you are subscribed to the Google Groups "RBW
Owners Bunch" group.
To post to this group, send email to rbw-owners-bunch@googlegroups.com
To unsubscribe from this group, send email to
rbw-owners-bunch+unsubscr...@googlegroups.com
For more options, visit this group at
http://groups.google.com/group/rbw-owners-bunch?hl=en
-~----------~----~----~----~------~----~------~--~---
