TYPO:
"Okay…
The neutral foramen are the holes through which the nerve roots
pass..." should read "neural" NOT neutral :^|
On Oct 21, 10:47 pm, "LyleBogart{AT}gmail.com" <lylebog...@gmail.com>
wrote:
> 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
>
> ...
>
> read more »
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