Hi Nathan, Thanks for the additional information!
"...Based on your description I couldn't figure out which 'pelvis points' > you're referring to. Are they on the side of my upper thigh or are > they below my stomach? Can you point me to a diagram?" > http://en.wikipedia.org/wiki/Anterior_superior_iliac_spine easy way to find these points is to trace the inguinal fold--the crease in your lower abdomen which begins near your pubis (pubic bone) and rises up and outward towards your hips. "...I definitely feel the pain when standing > and walking (in fact a walk more than 4-5 blocks often makes it much > worse). I sometimes must limp while walking to mitigate the pain. I > also feel the pain when lying down..." and "There is also the inability to, when sitting in a chair or lying on my > back, fully flex my left leg so that it points 90° from the floor. I'm > able to do this easily with the right leg..." These make sense (I'll write more later about this...) and fit the picture nicely. Keep the info coming; this is looking less & less "disc-y". lyle... On Oct 22, 6:42 am, nathan spindel <nath...@gmail.com> wrote: > Sorry I wasn't clear before - I definitely feel the pain when standing > and walking (in fact a walk more than 4-5 blocks often makes it much > worse). I sometimes must limp while walking to mitigate the pain. I > also feel the pain when lying down. > > There is also the inability to, when sitting in a chair or lying on my > back, fully flex my left leg so that it points 90° from the floor. I'm > able to do this easily with the right leg. > > Based on your description I couldn't figure out which 'pelvis points' > you're referring to. Are they on the side of my upper thigh or are > they below my stomach? Can you point me to a diagram? > > When I lie on my back and stretch my knee like you said, I do feel > increased aching pain in my lower buttock / upper thigh. I'm not > currently experiencing the sciatica so I'm not sure if the stretch > increases it or not. > > -nathan > > On Wed, Oct 21, 2009 at 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, > > ... > > read more » --~--~---------~--~----~------------~-------~--~----~ 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 -~----------~----~----~----~------~----~------~--~---
