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
<[email protected]> 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 <[email protected]> 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 <[email protected]> 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
>> > <[email protected]> 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 <[email protected]> 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
>>
>> >>> <[email protected]> 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 <[email protected]> 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
> >
>
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