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    Suggest treatment for severe lower back pain

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Posted on Thu, 2 Feb 2017 in Brain and Spine
Question: About 3 years back medium to strong lower back pain occurred (central spine area only, not left or right sides). It was not up to the extent that movement or daily life was stopped. However, due to it, it was not possible to sit on chair and work on computer for more than 15-30 minutes - I needed to break and take a walk. Pain was not felt in lying position.
That time it (the severity of pain) lasted about 1 to 1.5 months.
I did not consulted for it, that time, but I use to do few exercise step daily evening (during strong pain period). I do not know whether it helped in bringing pain level lower or it automatically reduced!

Since then, a mild pain use to be present in the area, which increases with certain sitting postures like sitting on chair with forward inclination (working on computers), doing something on ground after sitting on chair and bending from waist. The onset of pain sometimes is not felt so disturbing/ interfering with daily/ routine activities however sometimes it is felt more interfering daily/ routine activities.


It has been observed that as sitting (1. either on chair - for working on computers or 2. on bed - again on computers) postures is kept minimum, less pain is felt.
Sometimes (during walking particularly) the highlighted portion of spine do give strange feeling like vertebras have rubbed over one another, however this is not painful, but happens occasionally.

I do not get involved in physical activities due to above - whether physical activity (including cycling) will deteriorate the condition or will have no effect at all or should I involve actively in physical activities!


I have undergone MRI (self) for lumbar spine, images and report of which are shown in attachment.
Thereafter, I consulted to physician and after consultation with physician, he asked me to do two steps (a) stand straight and then bend down and touch toes (done without any difficulty) and (b) lay flat and move leg upside without support of hands one leg at a time (each leg reached up to 90 degrees pointing upward).

His observation was that agility and extent of bending do indicate that there is no issues w.r.t. MRI reports (disc bulges) and therefore other possibilities need to be explored. However he didn’t saw the plates/ images, only report he had seen.
Afterwards he advised to go for X-ray (LS Spine Skiagram AP Lat view) which is also shown in attachment.
After looking at X-ray it was told to me that it is case of Lordosis of lower spine. Doctor then advised me to do some 6-7 exercises for reverting the curvature of Lordosis and to normalize it and to continue the exercises till one month and then report back with progress.
Currently, I am not confident about the situation and therefore not doing the exercises as advised, and want to take further advice from another expert of spine.


With above, now I need advice for:
1.     What is the cause of the strange pain (sometimes no pain, most of the times mild and occasionally medium to medium strong)
2.     Will it las t forever or temporary due to my careless lifestyle and will not continue to exist with change in lifestyle
3.     What care/ precaution to be taken care of in lifestyle
4.     What activities are banned/ prohibited in this case
5.     Physical activities should be done or not in my case like exercises, cycling, swimming etc and what exercises I should do if to be done
6.     What dietary care/ precautions to be taken care of
7.     Any medication to be taken, if any!
8.     Which expert to be consulted in case if further diagnosis is required to come to a concrete conclusion
9.     Any other input from Doctor side which I missed to ask and is to be followed/ taken care of by me

I have added images separately for clear view ..
May please refer accordingly ..

Not able to upload 3 more images, perhaps limitation on server ..
doctor
Answered by Dr. Ajay Panwar 13 hours later
Brief Answer:
Disc bulges with nerve radicle compression may cause pain.

Detailed Answer:
Hi,
Thanks for being on healthcaremagic.com.
I am Dr.Ajay Panwar,a neurologist, here to answer your query.

I have gone through the MRI and X-ray images which you have uploaded.You have disc bulges which are most prominent at L4-L5 and L5-S1 regions. Disc bulge is causing nerve exit foraminal narrowing at L5-S1 more on right side.This is likely compressing your exiting nerve radicle and hence is the cause of pain.

Please find answers to your query serialwise as-
1)As I told,nerve radicle compression is the cause of pain.Intensity can of course vary at times.
2)It should improve with medicines and appropriate spinal exercises.Exercises with wrong technique can further aggravate it.
3)Posture care is to be taken.Its better to sit straight while on computer.Its better to sleep on a flat surface.Pillows should be avoided.Excessive weight bearing should not be done.
4)As I told, the above precautions should be taken care of.Excessive biking(even cycling) and any other activity which puts your spine in a compromised position should be minimized.Weight loss is must in obese individuals.
5)As mentioned above.
6)Nothing specific dietary precautions.Get your 'serum 25-oh-vitamin d levels' checked from a reputed lab.If vitamin D deficiency is present,supplement with vitamin D.Along with calcium and vitamin B12(methylcobalamin) supplementation is also crucial.
7)A sample prescription- Tab. Pregalin-M once a day,Tab. Duloxetine 60 mg once a day,Tab. Shelcal twice a day, Tab. Flupirtine 100 mg twice a day for 5 days-will help.HOWEVER,TAKE MEDICINES UNDER A PHYSICIAN'S GUIDANCE.
8)Neurologist consultation.
9)Everything comprehensively explained above.

Hope that helps.If you have any further questions,I shall be glad to have you in follow-up.

Regards
Dr.Ajay Panwar,
MD,DM(Neurology)
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ajay Panwar 32 hours later
Thanks.

Does it look like case of lumbar lordosis as suggested by physician and should I continue/ start the exercises suggested for straightening of lordosis curvature?
doctor
Answered by Dr. Ajay Panwar 18 hours later
Brief Answer:
Lumbar lordosis is not a major issue.

Detailed Answer:
Hi,
Thanks for being in follow-up.

Disc bulges are actually causing the problem and not the lordosis. Lumbar lordosis is not a cause of concern.

You should learn the spinal exercises from a good physiotherapist. Spinal extension exercises will help.I just don't know that what exercises you have been told,so I can't comment upon them.Otherwise,every good physiotherapist will tell you appropriate spinal exercises for disc bulges.

Hope that helps.If you have some further questions,I shall be glad to have you in follow-up.

Regards
Dr.Ajay Panwar,
MD,DM(Neurology)
Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
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Follow up: Dr. Ajay Panwar 12 hours later
Hello Doctor,

Thank for response.

Just wanted to correct one sentence in original query
"Sometimes (during walking particularly) the highlighted portion of spine do give strange feeling like vertebras have rubbed over one another, however this is not painful, but happens occasionally."

Above sentence should be read as
"Sometimes (during walking particularly) the highlighted portion of spine do give strange feeling like a crackling sound, however this is not painful, but happens occasionally. It is something like when we make popping sound on finger joints after certain period of inactivity"


I have uploaded the exercises advised by physician. Need to know whether they are ok or not, for starting exercises! He had told to do all on flat surface only like on floor, not on bed.

Please suggest.


doctor
Answered by Dr. Ajay Panwar 30 hours later
Brief Answer:
Spinal extension exercises

Detailed Answer:
Hi,
Thanks for being in follow-up.

It does not matter whether whether you have a rubbing or a crackling sound.That does not change your pathology over here.

I have gone through the exercises.You have to focus on spinal extension exercises, like the first one in chart which you have uploaded.Hitting Youtube with search term 'spinal extension exercises' will give you a better idea.

If you have any further questions,you are most welcome else please close the thread,rate it and write a review.

Regards
Dr.Ajay Panwar,
MD,DM(Neurology)
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
Answered by
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Dr. Ajay Panwar

Neurologist

Practicing since :2007

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