Lyle: your suspicion was right, my left point is a couple mm more
prominent than the right point. What does that suggest?
Chris: your questions are answered in my prior messages. It's a lumbar
(L5/S1) herniation, and I got an MRI that shows a 12mm bulge on the
cord. I'm actually beginning pilates tomorrow.
-nathan
On Thu, Oct 22, 2009 at 6:55 AM, LyleBogart{AT}gmail.com
<lylebog...@gmail.com> wrote:
>
> 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 »
> >
>
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