# Back Pain (aaargh)



## constable (22 March 2007)

Well this will be a hit with all you cashed up retirees!!
Anyway Ive had some reasonable back pain for the last week or so with no specific occurance to attribute it to. Anyway the last two  days it had become unbearable so much so that yesterday morning at 5am we ended up at the Ballarat emergency hospital because i literally couldnt walk (collapsing in spasms whilst going to the toilet. Came very close to calling an ambulance, believe you me.
After being treated with the standard level of contempt (it would seem) the young doctor decided i was legit and gave me a shot (that turned me white as a ghost) some valium and a prescription for a variety of pain killers. Although the injury is non spinal but a periphial muscle tear in my lower back i am expected to be semi cripled for the next week or so.
 Although feeling a little better now, if anything ive posted tonite is off track im using the painkillers as a scapegoat!!


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## coyotte (22 March 2007)

If it's muscular try "LINSAL".

Used to be available from chemists. 

Infrared lamp can help --- you got to keep the blood circulating at a high velocity.


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## constable (22 March 2007)

coyotte said:
			
		

> If it's muscular try "LINSAL".
> 
> Used to be available from chemists.
> 
> Infrared lamp can help --- you got to keep the blood circulating at a high velocity.



Trying Voltaren emulgel at the minute ... doesnt seem to do much at all!
As for the lamp I remember my parents had one of those, god knows where it is now!


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## Julia (22 March 2007)

Commiserations, Constable.  It sounds awful.  And when that happened, the last thing you needed was the contempt of some arrogant baby doctor.

I've found those topical anti-inflammatories marginally helpful in minor things, but doubt they would help your level of pain.  If you can get a seat into the shower, and alternate very hot and then very cold water on the affected area, that can be really helpful.  (Don't know if anyone has actual cold water in their taps in summer - we certainly don't in Qld.)  Alternatively, a cold pack followed by a hot pack would probably achieve the same thing.

Probably everyone is different, but I've found paracetomol in adequate doses, i.e. two every four hours is just as effective as the narcotic analgesics, though doesn't produce the same "well, I don't care about the pain anyway" effect.

The other thing which could help is valium in its capacity as a muscle relaxant.  This can definitely help when you are getting any sort of muscle spasm.

Take care.  Do hope you feel better soon.

Julia


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## constable (22 March 2007)

Julia said:
			
		

> Commiserations, Constable.  It sounds awful.  And when that happened, the last thing you needed was the contempt of some arrogant baby doctor.
> 
> I've found those topical anti-inflammatories marginally helpful in minor things, but doubt they would help your level of pain.  If you can get a seat into the shower, and alternate very hot and then very cold water on the affected area, that can be really helpful.  (Don't know if anyone has actual cold water in their taps in summer - we certainly don't in Qld.)  Alternatively, a cold pack followed by a hot pack would probably achieve the same thing.
> 
> ...



Ta Julia appreciate that.


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## wayneL (22 March 2007)

constable said:
			
		

> Well this will be a hit with all you cashed up retirees!!
> Anyway Ive had some reasonable back pain for the last week or so with no specific occurance to attribute it to. Anyway the last two  days it had become unbearable so much so that yesterday morning at 5am we ended up at the Ballarat emergency hospital because i literally couldnt walk (collapsing in spasms whilst going to the toilet. Came very close to calling an ambulance, believe you me.
> After being treated with the standard level of contempt (it would seem) the young doctor decided i was legit and gave me a shot (that turned me white as a ghost) some valium and a prescription for a variety of pain killers. Although the injury is non spinal but a periphial muscle tear in my lower back i am expected to be semi cripled for the next week or so.
> Although feeling a little better now, if anything ive posted tonite is off track im using the painkillers as a scapegoat!!



OMG as an ex-farrier I have lived through this more times than I can count.

Nothing works!!! (apart from masking it with analgesics/corticosteroids) Though Julias suggestions will certainly help to soothe it.

Pass on the steroids (cortisone etc), it will mess with your immune system.

Just have to let it heal.


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## pacer (23 March 2007)

I ruptured a disc 4 years ago and since the operation I have weak muscles in that area and quite often tear something.

You need muscle relaxants if it's that bad and what I do is a cold pack straight away to reduce swelling, then a hot water bottle on the area for hours at a time, which relieves the pain and makes the blood vessels expand and blood flow to the area, which encourages healing. You must rest it till fully recovered or you may dammage it further. It's pointless using a cold pack hours/days after the injury.

If you have pain, cramps, numbness or tingling in your legs, then you have probably ruptured a disc which buldges out an presses on nerves causing this, and it's called ciattica (ciatic nerves), and can cripple you if not treated.

I had to give up work, and now I trade for a living. Be verry careful from now on...you realy don't want to end up like me....it's not the work I miss, it's the fun things I miss most and having to rely on others to do any heavy lifting.

BEND YOUR KNEES, NOT YOUR BACK!

Bourbon isn't too bad a muscle relaxant....lol.....Best of luck mate.


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## ducati916 (23 March 2007)

constable said:
			
		

> Well this will be a hit with all you cashed up retirees!!
> Anyway Ive had some reasonable back pain for the last week or so with no specific occurance to attribute it to. Anyway the last two  days it had become unbearable so much so that yesterday morning at 5am we ended up at the Ballarat emergency hospital because i literally couldnt walk (collapsing in spasms whilst going to the toilet. Came very close to calling an ambulance, believe you me.
> After being treated with the standard level of contempt (it would seem) the young doctor decided i was legit and gave me a shot (that turned me white as a ghost) some valium and a prescription for a variety of pain killers. Although the injury is non spinal but a periphial muscle tear in my lower back i am expected to be semi cripled for the next week or so.
> Although feeling a little better now, if anything ive posted tonite is off track im using the painkillers as a scapegoat!!




When exactly did you first notice the pain?
What activities had you participated in 2/3 days prior?
As it worsened, what activities had you participated in 2/3 days [with initial pain]?

Where is the pain exactly?
Does the pain travel anywhere [buttocks, hamstrings, calf, foot, toes] or up higher into the back, or into the groin?

Nature of the pain
Sharp stabbing on movement, but not too bad if at rest?
Or, constant pain, increasing on movement and certain positions?
Does the pain vary by time [worse in the morning easing through the day for example?]

What relieves the pain?
Position
Movement
No movement
Heat 
Cold
Analgesics
Nothing
Other

Any previous history of back pain.
If yes details. [as per all the above questions]

Any medical history of note including family [if sensitive PM me]
Cardiac
Neurological
Gastrointestinal
Musculoskeletal
Immunological
Hepatic
Renal
Pulmonary

Medications using.

Any information that may be relevant.
You can be my first online patient.

jog on
d998


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## petervan (23 March 2007)

Can feel for you constable.I have 4 vertabrae fused together thanks to those nasty motorbikes and  have visited my local chiro twice this month after over doing the jogging.One of the worst things for backs is sitting so if you can lay by your computer that will be better.Get well soon


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## petervan (23 March 2007)

whatever you do DON,T TRADE ON DRUGS.


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## constable (23 March 2007)

ducati916 said:
			
		

> When exactly did you first notice the pain?
> What activities had you participated in 2/3 days prior?
> As it worsened, what activities had you participated in 2/3 days [with initial pain]?
> 
> ...



Ducati you must be a chiropracter? 
Pain started as a stiffness in the lower LHS of spine (approx week ago)
Did do a small amount of bricklaying at home while stiffness present (quite stupid really but you know what its like when your close to finishing a project!)
Anyway pain several days after became quite serious so went to a Osteopath.
She pushed and pulled said it was non spinal massaged a bit and took my money. I left there a lot worse! That was monday the following day was extremely painful and then the episode wednsday morning where i went to hospital barely capable of walking.
Pain exist only in lower back nothing in legs or anywhere else . No real history of back pain before and no ongoing ailments, of any sought (including neurological although last correction did cause some stress!)

Sitting down is when it feels the best but i pay the price when i have to get up. Pain whilst attemting to stand can be quite serious.
Pain type is a constant dull ache that can turn into a sharp stabbing pain when standing and walking (was enough to drop me to the floor wednesday morning) and you can forget about leaning forward or to the RHS.

The hospital doc said the same thing that it is non spinal and associated muscles are injured . Gave me a shot of god knows what,as my main focus was on the syringe! I think it was some sought of muscle relaxant and also gave me some valium and a prescription for Codapane forte and diazepam.
So far so good the drugs are doing a marvelous job! Yesterday pain was fairly masked but i have noticed this morning the pain although still there , has subsided somewhat and havent taken any medication yet. 
Hope you can go easy with your charges!


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## happytrader (23 March 2007)

Hi Constable

Try EFT. Head to the website www.emofree.com, go to search and type in backpain. Its free, quick and easy to learn and often works. On another note, I wonder if these market conditions have brought a lot of neck, shoulder and backpain to the fore?

Cheers
Happytrader


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## constable (23 March 2007)

petervan said:
			
		

> whatever you do DON,T TRADE ON DRUGS.



This sounds like very good advice peter, although I did trade a profit yesterday I was guilty of hitting the submit button on a trade that exited me at cost rather than the one next to it which would have placed my order on the otherside!!


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## ducati916 (23 March 2007)

*constable*



> Pain started as a stiffness in the lower LHS of spine (approx week ago)
> Did do a small amount of bricklaying at home while stiffness present (quite stupid really but you know what its like when your close to finishing a project!)




Thinking back to say 2 weeks ago, had you done anything unusual, moved house, new sport, heavy lifting, lot's of gardening, dancing, sex, etc prior to feeling the stiffness?



> Sitting down is when it feels the best but i pay the price when i have to get up. Pain whilst attemting to stand can be quite serious.
> Pain type is a constant dull ache that can turn into a sharp stabbing pain when standing and walking




How does it feel first thing in the morning?
As you get up and move......better or worse?

wheelchair on
d998


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## wayneL (23 March 2007)

ducati916 said:
			
		

> wheelchair on



That made me laugh.

Empathetically of course Constable.


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## constable (23 March 2007)

ducati916 said:
			
		

> *constable*
> 
> 
> 
> ...



I cant really attribute one particular instance or any particular event (haha no dancing or bedroom experimentation in the last 2 weeks). In the morning first getting up is painful and as I get moving the pain reduces.


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## ducati916 (23 March 2007)

*constable*

Here is the diagnosis;

You have a minor annular tear [sprain] of the lumbar disc [most likely L5]
This would have occurred normally under load, or fast movement.

The L5 annular fibres are connective tissue composed of glycosaminoglycans and are in 5 layers surrounding the nuclear pulposus.

When you damage these tissues, the body will create an inflammatory response which is how the body heals.

The dull aching pain is the chemical nature of the inflammation irritating the nociceptors [pain fibres] the increasing pain on movement is aggravation of the damaged tissue, the bricklaying would have caused the progression from chronic to acute

This has 2 consequences;

The first is that due to the chemical irritation of the nociceptors, the muscular system will create a chronic contraction to protect the area. This adds a second component to the pain, ie. muscular pain.

The second consequence is reduced bloodflow to the area.
Arteries are high pressure vessels, veins are low pressure.
The elevated pressure from the chronic muscular contraction compresses the venous system, thus there is no drainage.

The inability to drain deoxygenated blood from the area with the build up of metabolic byproducts [HCl acid CO2 etc] further irritates the nociceptors magnifying the muscle contraction and pain.

In extreme cases [not herniated] the contraction becomes so severe that the nerve foramen become comprimised with attendant neurological symptoms presenting.

I'll pause there for questions, and then move onto the treatment.

jog on
d998

The first is the dull ache


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## constable (23 March 2007)

ducati916 said:
			
		

> *constable*
> 
> Here is the diagnosis;
> 
> ...



Wow! No questions.


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## CanOz (23 March 2007)

Dr. Duc, I can't wait for the disclaimer!

Cons, Go see Ian Newlands at the Ballarat physio clinic, always did wonders for me, and no drugs needed.

Cheers,


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## 2020hindsight (23 March 2007)

sheesh, my doc would ask "ever had this before",  "yes",  

"well, in that case ... (pause, looks through a couple of impressive looking books, folds em up confidently, turns and sez)

.. you've got it again !!! - that'll be 30 bucks."


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## ducati916 (23 March 2007)

*constable*

Ok here's the treatment;

No heavy lifting period. [at least 6 weeks]
No maintained posture, you cannot sit for more than 15mins without getting up and walking about for 5/10mins.
Sit in a chair that provides good support
Walking on the flat [not up/down hills stairs etc]
No long car trips without stopping to walk about.

Heat applied to the area
NO ANTI-INFLMMATORIES [inflammation is the healing process of the body]

Passive stretching.
Lay flat on your back
Draw your knees to your **** [keep them, feet on the floor]
Get wife to face your feet 
Place hands on one knee and gently start pushing the knee away from her, in a rhythmic motion.

If the muscular contraction is acute [which it will be] there will not be much movement, persevere, DO NOT FORCE IT.

Alternatively, laying on your back, draw knees to chest, and again in a rhythmic motion hug...release....hug....release
DO NOT FORCE

Why rhythmic?
The intra-muscular nerves or spindle cells register acceleration and range of movement, the on/off motion resets them through a reflex arc in the spinal cord, thus releasing the contraction of the postural muscles [multifidus etc]

This muscular relaxation combined with regular movement creates blood flow around the disc.

Discs do not have a direct blood flow and rely on a sponge like effect to passively suck in and squeeze out blood.

Herbal medication;
Gotu Kola 
Stimulates the fibroblast which is the cell responsible for synthesizing glycosaminoglycans or connective tissue and prevents to a degree the formation of scar tissue, but this is also why movement is important, the tissue [new] must be created in a functional pattern as the strength of connective tissue is logitudinal.

2 capsules taken with food 3/day

Time;
Approximately one month.

You will need to be careful for at least a further 6 weeks after ALL pain has gone.

jog on
d998


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## macca (23 March 2007)

Hi Duc,

My wife gets muscle spasms in the sciatic area weekly, that exercise sounds like it would loosen up the same area.

Would it be worth her trying it or could she do some damage?


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## constable (23 March 2007)

Duc I really appreciate your detailed responses, and will endeavour to try your exercises in between trades! Thankyou once again and I will keep you posted
... now will that be cash chq or credit card or do you bulk bill


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## ducati916 (23 March 2007)

constable said:
			
		

> Duc I really appreciate your detailed responses, and will endeavour to try your exercises in between trades! Thankyou once again and I will keep you posted
> ... now will that be cash chq or credit card or do you bulk bill




No problem, just be careful as it can get much WORSE if you HERNIATE the disc, then you really have a problem.

Drop a few pennies in the RSPCA or your equivalent.

jog on
d998


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## ducati916 (23 March 2007)

macca said:
			
		

> Hi Duc,
> 
> My wife gets muscle spasms in the sciatic area weekly, that exercise sounds like it would loosen up the same area.
> 
> Would it be worth her trying it or could she do some damage?




Cannot say with limited information.
See the questions posted for Constable, get all the answers [or as many as possible] and come back to me.

jog on
d998


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## Kimosabi (23 March 2007)

Well this is my formula for treating/preventing back pain that I've found to be effective in the following order.

- Acupuncture (Found it to be good at treating muscle spasm and pain)
- Massage (Loosens everything up and gets rid of of any knotted up muscles, etc)
- Chiropractor (Straightens everything out)

Regular Acupuncture/Massage Sessions help keep the back muscles nice and loose which significantly reduces any visits to Chiropractor.

I've found that the above kind of work on there own, but when combined are far more effective.


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## wayneL (23 March 2007)

ducati916 said:
			
		

> *constable*
> 
> Ok here's the treatment;
> 
> ...



I'm impressed.  ***takes notes for next wheelchair episode.

I've paid copious amounts of money to chiropractors and never got this sort of advice. Particularly like the (non)medicinal suggestions.

I'll be dropping a few pennies into the RSPCA as well.


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## ducati916 (24 March 2007)

*enzo*

The power of Fundamentals [anatomy & physiology] almost Balance Sheet and Cashflow Statement.

jog on
d998


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## chops_a_must (24 March 2007)

wayneL said:
			
		

> OMG as an ex-farrier I have lived through this more times than I can count.
> 
> Nothing works!!! (apart from masking it with analgesics/corticosteroids) Though Julias suggestions will certainly help to soothe it.
> 
> Just have to let it heal.



Not necessarily, see below.


			
				ducati said:
			
		

> Here is the diagnosis;
> 
> You have a minor annular tear [sprain] of the lumbar disc [most likely L5]
> This would have occurred normally under load, or fast movement.



I disagree totally Duc. Constable is reporting absolutely no referral, so the problem cannot be disc related. If the L5 disc had been damaged (in any way) you would expect pain in the adductors along the line of the obturator nerve in most cases, and in all cases, referral into the glutes.

Instead, it has been assessed as a lower back muscle tear/ other injury, with no vertebral involvement.

As a massage therapist, this type of injury or associated injuries take up the majority of my time. So this is the treatment plan that I give to all of my clients, as I have found it to give the best results.

Step 1) See a good physio. That's the best chance of an accurate diagnosis. In a week and a half, they should give you all of the stretches and exercises that you will need to do throughout the treatment period. Note: the majority of physios are useless, so make sure you find a good one, otherwise there isn't a point in going. And if they aren't telling you to go elsewhere after a few treatments you must become suspicious as to their confidence in their own assessments, and ability to get a new clientele through this skill set.

Step 2) See a good massage therapist. As physio appointments reduce, top them up with massage visits. If the pain is caused by inflammation, the Vodder technique is most effective. If the injury is muscular, the massage should concentrate on Deep Tissue and Trigger Point techniques. However, if the injury is disc related, Vodder, Trigger Point and Myofascial release are most effective. Note: you will most likely end up sore from the first few treatments of Deep Tissue, if you aren't used to it. This is in no way a reflection of the effectiveness of the treatment (obviously, the deep tissue techniques become more vigorous as the condition improves and a good therapist will be able to adapt to the situation).

Step 3) See a good chiro. Chiros shouldn't treat within two weeks of an acute injury around the spine. By this time however, physio treatment should have ceased. By far the most effective method for maintaining spinal health is combining regular massage with regualr chiropractic visits.

I understand the choices are limited in country areas, but do your best. The last thing you want is a muscle spasm in your back "bulging" out a disc or some such injury.

Cheers,
Chops.


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## CanOz (24 March 2007)

chops_a_must said:
			
		

> Not necessarily, see below.
> 
> I disagree totally Duc. Constable is reporting absolutely no referral, so the problem cannot be disc related. If the L5 disc had been damaged (in any way) you would expect pain in the adductors along the line of the obturator nerve in most cases, and in all cases, referral into the glutes.
> 
> ...




Now thats my kind of advice...well said. Your not so bad after all Chops!

Cheers,


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## wayneL (24 March 2007)

*Duc*

(off topic)

A guest spot on "The Fly"?


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## ducati916 (24 March 2007)

*enzo*

Yes indeed, you must obviously read "The Fly" he cracks me up!

jog on
d998


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## wayneL (24 March 2007)

ducati916 said:
			
		

> *enzo*
> 
> Yes indeed, you must obviously read "The Fly" he cracks me up!
> 
> ...



The master of the disclaimer. 

Developing...

hehehe


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## 2020hindsight (24 March 2007)

chops - ..(deleted ) ..can the missus not fill in for some of the massaging? (after all she probably contibuted to your bad back in the first place )


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## ducati916 (24 March 2007)

*Chops*

I see this is going to develop into a full-blown discussion.



> I disagree totally Duc. Constable is reporting absolutely no referral, so the problem cannot be disc related. If the L5 disc had been damaged (in any way) you would expect pain in the adductors along the line of the obturator nerve in most cases, and in all cases, referral into the glutes.




Incorrect.
There can be disc involvement without neurological signs or symptoms.

With reference to the *adductors* the nerve supply to the adductors is via the Obturator nerve L2, L3.

An L5 disc lesion would effect nerve roots L4, L5, S1, S2
Therefore anatomically you are incorrect.

As for referral into the glutes; again incorrect.
The dermatomal supply to the gluteal area are from L4, L5, S1, S2, S3, S4, S5
L4, L5, supply predominantly the PSIS region [dermatomally.]

The L5 disc is the disc predominantly injured. Many clinical studies have referenced this finding.

As to a consultation with a Chiropractor [or any manipulative practitioner] this should be avoided for the following clinical reason;

An HVT [High Velocity Thrust] or manipulation provides treatment in the following way;

The speed of the thrust exceeds the muscular reflex arc that travels the spinal cord. Thus the zygopophyseal joint is gapped, releasing NO2.

NO2 is a muscle relaxent it binds to receptors within muscle tissue causing relaxation.

That's exactly what you want isn't it?
Well yes, but there is a serious consequence, and that is;

The disc is the last tissue in the body. The thrust is normally into rotation, thus the disc will absorb excess velocity.

In an already damaged disc, this is the LAST outcome you want to see.
You can take a sub-clinical disc and make it acute just in this way.

I suggest you get the books back out.

jog on
d998


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## 2020hindsight (24 March 2007)

chops_a_must said:
			
		

> 1.By far the most effective method for maintaining spinal health is combining regular massage with regular chiropractic visits.
> 2. I understand the choices are limited in country areas, but do your best. The last thing you want is a muscle spasm in your back "bulging" out a disc or some such injury.



 chops , and duc  - brilliant discussion you blokes, thanks
1. chops, you're obviously talking about post injury (?)
but - In the "prevention-better-than-cure" sense - do any of us do enough exercise for our backs?  face down of the floor, arch with head and feet raised? arms right out, swing heel and twist to touch opposite hand - etc etc.  Or lol, do we all stop doing that when we stop playing adolescent sport?   

Even for those cases where there has been an injury, I personally think that if people really DID the exercises (that the nice physio/ masseur / chiro told them) it would help heaps. 

Surely TV and computers (and lack of exercise) are partly to blame for the high incidence of bad backs?

(another example - when I eat my sandwiches at work I try to (i.e. sometimes) do it with toes on a step, doing calf raises - above and below the 90 degrees - maybe help to avoid achilles problems )

2. you're right, it doen't pay to put your back out in the out back. 

PS


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## ducati916 (24 March 2007)

wayneL said:
			
		

> The master of the disclaimer.
> 
> Developing...
> 
> hehehe




If you buy this stock, your mexican illegals will dig up your orange tree, and you may lose money.

That's the Fly Guy!!

Anyway, I am receiving the Roman minimum wage for my efforts!

jog on
d998


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## Smurf1976 (24 March 2007)

Julia said:
			
		

> I've found those topical anti-inflammatories marginally helpful in minor things, but doubt they would help your level of pain.  If you can get a seat into the shower, and alternate very hot and then very cold water on the affected area, that can be really helpful.  (Don't know if anyone has actual cold water in their taps in summer - we certainly don't in Qld.)  Alternatively, a cold pack followed by a hot pack would probably achieve the same thing.



Been there with this one and it's not good. It was to the point that it took literally 45 minutes for me to get out of bed and walk 5 metres to the toilet. Not good...

Everything felt fine until it just happened sitting as a passenger in a car (not on a bumpy road) one afternoon. 

I found that heat helped a LOT. I remember quite well spending literally half the day in the bath (makes your skin go a bit funny but that goes away pretty quickly). I basically just lay there and the missus came and let some water out and topped up with hot water whenever it started to get a bit cold. I felt virtually no pain at all whilst lying there which was truly great.

Once it got better and I was able to walk around etc. I found that the heat was still helpful. So I would just stand in the shower for literally 45 minutes or so twice a day with the water as hot as my skin could stand. I had the shower head aimed directly at the lower back whilst I leant against the wall.

I don't know why it helped but heat was a damn good thing in my situation.


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## 2020hindsight (24 March 2007)

then there's swimming - must be good for you (maybe next summer) 
http://www.clicksmilies.com/





	

		
			
		

		
	
  patience required?
lol, some good emicons on that site (thanks Wayne) :-


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## chops_a_must (24 March 2007)

ducati916 said:
			
		

> I suggest you get the books back out.



Hahaha!


			
				ducati916 said:
			
		

> *Chops*
> Incorrect.
> There can be disc involvement without neurological signs or symptoms.



Very, very very unlikely. If there is a disc injury, the inflammatory process is massive given the enclosed space it is in. And there is no "reserve" room between the disc and the nerve that comes from that vertebra, that's why a disc injury will cause referral from that nerve effected. It is actually used as a diagnostic tool, and remember, this referral can be present either with or without palpation.


			
				ducati916 said:
			
		

> With reference to the *adductors* the nerve supply to the adductors is via the Obturator nerve L2, L3.
> 
> An L5 disc lesion would effect nerve roots L4, L5, S1, S2
> Therefore anatomically you are incorrect.



Nope.
The origin of the obturator nerve is irrelevant in most cases. What is relevant is the proximity of the obturator nerve to the effected intervertebral disc. If you notice the obturator nerve runs very close to the other lumbar nerves, so any inflammation along the L4 or L5 nerve is likely to effect the obturator nerve as well. That's why I said "in most cases", but certainly not all, and usually it is only a secondary complaint. Just another diagnostic tool as to the severity of the problem.







			
				ducati916 said:
			
		

> As for referral into the glutes; again incorrect.
> The dermatomal supply to the gluteal area are from L4, *L5*, S1, S2, S3, S4, S5
> L4, L5, supply predominantly the PSIS region [dermatomally.]



What the hell are you talking about? Lol! The PSIS forms one of the borders for the gluteus maximus origin. Lol!








			
				ducati916 said:
			
		

> The L5 disc is the disc predominantly injured. Many clinical studies have referenced this finding.



So you make a diagnosis over the computer, without seeing the patient, without any specific symptoms, based on the majority of disc injuries? Whilst a disc injury has been ruled out by someone who has seen the person effected? (Although a disc injury may be the case.) Past performance is no indication of future performance.

Why not a large bone spur causing massive spasm in the lower back? Why not subluxation of the sacro-iliac joint? Why not a massive difference in leg length? (Sorry Constable, not insinuating you are some kind of freak.) Or perhaps the most simple conclusion, and one that was supported by more than one person who has assessed him in person, a bad muscle tear in the lower back?



			
				ducati916 said:
			
		

> As to a consultation with a Chiropractor [or any manipulative practitioner] this should be avoided for the following clinical reason;
> 
> An HVT [High Velocity Thrust] or manipulation provides treatment in the following way;
> 
> ...



This is why you do not see a chiropractor in the acute phase. This is why you get a diagnosis before you advance treatment. I dont think it is inconsistent with what I have said.

Cheers,
Chops.


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## chops_a_must (24 March 2007)

2020hindsight said:
			
		

> chops , and duc  - brilliant discussion you blokes, thanks
> 1. chops, you're obviously talking about post injury (?)
> but - In the "prevention-better-than-cure" sense - do any of us do enough exercise for our backs?  face down of the floor, arch with head and feet raised? arms right out, swing heel and twist to touch opposite hand - etc etc.  Or lol, do we all stop doing that when we stop playing adolescent sport?
> 
> Even for those cases where there has been an injury, I personally think that if people really DID the exercises (that the nice physio/ masseur / chiro told them) it would help heaps.



Well, I am talking about post-injury/ rehab and prevention.

And as they say, you can lead a horse to water...




			
				2020hindsight said:
			
		

> chops - ..(deleted ) ..can the missus not fill in for some of the massaging? (after all she probably contibuted to your bad back in the first place )



Lol! What the hell are you talking about? Although, if she wanted to, she could become a very good massage therapist.


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## ducati916 (24 March 2007)

*chops*



> Very, very very unlikely. If there is a disc injury, the inflammatory process is massive given the enclosed space it is in. And there is no "reserve" room between the disc and the nerve that comes from that vertebra, that's why a disc injury will cause referral from that nerve effected. It is actually used as a diagnostic tool, and remember, this referral can be present either with or without palpation.




Not at all, very common in fact.
You seem to be confusing a herniation with annular tearing. Annular tears can be, and often are central, and minor. You seem also to be confusing *referred pain* and nerve root pain. The two are very different. Nerve root pain will present in distinct myodermal distributions. Referred pain travels in the dermatomal distribution. Compression of the nerve root, as you are referring to, will be myodermal in distribution, not *referred pain*.



> Nope.
> The origin of the obturator nerve is irrelevant in most cases. What is relevant is the proximity of the obturator nerve to the effected intervertebral disc. If you notice the obturator nerve runs very close to the other lumbar nerves, so any inflammation along the L4 or L5 nerve is likely to effect the obturator nerve as well. That's why I said "in most cases", but certainly not all, and usually it is only a secondary complaint. Just another diagnostic tool as to the severity of the problem.




The anatomical origin is the crux of the matter.
Thus if it is an L5 lesion, the only nerve roots that could affected would be L4, L5, S1. As L4 is above L5, L4 nerve root compression is rare in even herniations, not impossible, but rare. 

Since the Obturator is formed from L2, L3, L4 and lies medial side of iliopsoas and passes anteriorly into the pelvis prior to passing through the obturator foramen into the medial compartment of the thigh. Thus while *possible* to become involved in a pain syndrome, rarely does it happen unless the damage to the disc is on the anterior surface.

If this is the case, the signs and symptoms are different from those described by constable.

There will be no inflammation *along the nerve*
The inflammation is at the site of injury, the annular portion of the disc.



> What the hell are you talking about? Lol! The PSIS forms one of the borders for the gluteus maximus origin. Lol!




As stated, the dermatomal distribution as opposed to the myodermal distribution. L4,L5 supply the dermatomes in the vicinity of the PSIS. His pain was described as being felt in this area.



> So you make a diagnosis over the computer, without seeing the patient, without any specific symptoms, based on the majority of disc injuries? Whilst a disc injury has been ruled out by someone who has seen the person effected? (Although a disc injury may be the case.) Past performance is no indication of future performance.




He has all the symptoms of an annular disc lesion.
He had already seen someone, and had not been helped.
I accept that a clinical examination would definitely be useful.



> Why not a large bone spur causing massive spasm in the lower back? Why not subluxation of the sacro-iliac joint? Why not a massive difference in leg length? (Sorry Constable, not insinuating you are some kind of freak.) Or perhaps the most simple conclusion, and one that was supported by more than one person who has assessed him in person, a bad muscle tear in the lower back?




Lack of trauma.
The onset was relatively benign.

Leg length differences would [should] have been picked up.
No diagnosis from the medics that he has already seen, have indicated that as a possibility to him.

A bad muscle tear.
I don't think so, with the lack of any reported trauma?
It was simply a cop out diagnosis.

jog on
d998


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## Julia (24 March 2007)

Differential diagnoses aside, how are you feeling, Constable?


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## pacer (24 March 2007)

As one whom has had both mucle tears and disc herniation (including an operation) I can honestly say that Ducati sounds like the winner (no offence Chops), especialy since my Doctor and the Chiro/manipulation/massage specialist, that I first went to see, had no idea what was wrong as I had no back pain just a cramp-like hip pain when trying to straigten out my leg.

I went to another doctor as the pain got worse who was shocked (along with my operating specialist, later) that it hadn't been diagnosed and that any manipulation was carried out at all, and there was a possibility I could have ended up crippled from any manipulation.....and only a cat-scan will be able to determine whether you have disc problems, but are very expensive....Xrays ect , are a waste of time.

My advice is be careful who you ask, with back pain...very careful...I'm too scared to have anyone but my physio go anywhere near me these days, and even him I'm scared to go to.

Stiffness in the morning is common to all back strains...I quite often get up in the mornings and fill the jug for a coffee, and fill the old hotwater bottle at the same time, and sit there for 15 mins stints (over 1-2 hours or longer sometimes.) with it wrapped in a towel an sitting on the sore area, untill I can comfortably move again....sometimes it's so bad I just go to bed with the hotty and lay on it....perhaps you could get the missus to boil you one before you get out of bed...I think it's the best way to go.

Before getting out of bed in the morning try lying on your back with knees raised, feet toghther, and move knees slowly back and forth for a few minutes to 'wake up and relax the muscles', then knees to chest a few times to strech the muscles. as you can make it worse just jumping out of bed...also you should swing you legs off the side of the bed and use your arm to push yourself into a sitting position (it takes the strain off the muscles, arch your back slightly so it is straight with shoulders back and use your legs to raise youself...it takes the strain off your back doing the work. ....standing from a sitting position should always be done like this and a similar stance taken whenever you are lifting something. dont bend your back....bend your knees!

AND GIVE UP SLOUCHING.....good posture will provde its rewards here.

Get a good comfortable chair with good lumbar support that tilts back, you wont regret that either...a rocker rather than a recliner is best.

Experience has taught me well....I hope it's helpful.


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## Smurf1976 (24 March 2007)

pacer said:
			
		

> AND GIVE UP SLOUCHING.....good posture will provde its rewards here.



Strongly agreed. The average lounge room furniture is the worst thing out IMO. Make sure you've got a decent mattress too.


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## AnalysisParalysis (24 March 2007)

Avoid doing Capoira.


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## chops_a_must (24 March 2007)

ducati916 said:
			
		

> Not at all, very common in fact.
> You seem to be confusing a herniation with annular tearing. Annular tears can be, and often are central, and minor. You seem also to be confusing *referred pain* and nerve root pain. The two are very different. Nerve root pain will present in distinct myodermal distributions. Referred pain travels in the dermatomal distribution. Compression of the nerve root, as you are referring to, will be myodermal in distribution, not *referred pain*.



True. But even very minor disc injuries will elicit a referral when palpated.

There are two types of referred pain:
1) Nerve pain and;
2) Diffuse or non specific, muscle or fascia originating pain.

Not all nerve pain is nerve root oriented. Scalene impingement and piriformis syndrome are two such examples. What you are suggesting is an absolute fallacy.

And not all diffuse referred pain is felt on the skin. From some areas it can be quite deep, into joints and other areas.



> The anatomical origin is the crux of the matter.
> Thus if it is an L5 lesion, the only nerve roots that could affected would be L4, L5, S1. As L4 is above L5, L4 nerve root compression is rare in even herniations, not impossible, but rare.
> 
> Since the Obturator is formed from L2, L3, L4 and lies medial side of iliopsoas and passes anteriorly into the pelvis prior to passing through the obturator foramen into the medial compartment of the thigh. Thus while *possible* to become involved in a pain syndrome, rarely does it happen unless the damage to the disc is on the anterior surface.



This is not true, and I will explain. It is actually quite a common occurence.

Nerve entrapment can happen anywhere along the nerve, and give exactly the same symptoms as a nerve root problem (but can't cause pain above the entrapment). Piriformis syndrome and thoracic outlet syndrome are two such examples.

Nerve entrapment can be caused by muscle spasm, acute inflammation and other factors. That's why referral into the adductors is used as a measure of severity. The worse the injury, the worse the inflammation. And the inflammation from the lumbar area naturally tries to drain through the area where the obturator nerve is located. That's why it can become a problem, but usually only a secondary one.



> There will be no inflammation *along the nerve*
> The inflammation is at the site of injury, the annular portion of the disc.



You've got to be kidding surely?

Tell that to my clients who get "mysterious" swelling in their calfs, ever since back surgery. Or perhaps people with cervical disc injuries with strange swelling in their hands. Swelling, inflammation, lymph MOVES. It can cause problems when it does.


> As stated, the dermatomal distribution as opposed to the myodermal distribution. L4,L5 supply the dermatomes in the vicinity of the PSIS. His pain was described as being felt in this area.



He described pain in his "lower back" not near his sacrum. Many other conditions can cause pain in this area as well.



> He has all the symptoms of an annular disc lesion.
> He had already seen someone, and had not been helped.
> I accept that a clinical examination would definitely be useful.




It is just impossible to diagnose disc injuries without doing a variety of contraction and movement tests on the spot.



> Lack of trauma.
> The onset was relatively benign.
> 
> Leg length differences would [should] have been picked up.
> ...



Severe bone spurs can present without any previous pathology. Doesn't have to be a traumatic cause. If the osteo stuffed up the manipulation, problems in  the SI joint are also possible.

Repetitive micro-tears in postural muscles may not be noticable whilst occuring. Same principle with gym exercise. May not be sore then and there, but the next day... DOMS

I was just using leg length as an example of something you wouldn't be able to detect unless you were assessing the client in person.

Personally, I think it is highly highly irresponsible to be diagnosing and prescribing exercises over the internet, without actually seeing the person involved.

It is highly possible that the initial problem was muscular. Then manipulation under these circumstances, with little previous treatment, is likely to have exacerbated the problem. And it is possible that it has created a new problem. And like I have said, manipulation in the acute phase of an injury is a big no no.

I'm not disagreeing with your diagnosis, I am just saying that it is impossible to rule out other things from afar. Only with hands on assessment and scans would we know for sure.



			
				pacer said:
			
		

> As one whom has had both mucle tears and disc herniation (including an operation) I can honestly say that Ducati sounds like the winner (no offence Chops), especialy since my Doctor and the Chiro/manipulation/massage specialist, that I first went to see, had no idea what was wrong as I had no back pain just a cramp-like hip pain when trying to straigten out my leg.



None taken.

But that pain in your hip would mean "hands off" for me until I got a diagnosis from someone. Like I said in my treatment plan, some people are not even worth seeing. And manipulation is an even bigger no no until you get a diagnosis.

You could always come and see me Pacer. I know you live close to my work. I promise you wont feel a thing. Well, at least that's what my ex-girlfriend said about it. Lol!


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## constable (24 March 2007)

Julia said:
			
		

> Differential diagnoses aside, how are you feeling, Constable?



I am actually feeling better! Today was the first day i havent taken any medication and although this afternoon i was getting soreness again it has been nothing compared to what it was b4.
Have been exercising as per duc's recomendations and getting up from the computer every half hour or so during market time.
Tell you what though i have never slept so good taking all these painkillers!! 
Thanks again guys ....i have a funny feeling my back will be better b4 the debate finishes!!


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## ducati916 (25 March 2007)

*chops*



> But even very minor disc injuries will elicit a referral when palpated.




Not always.
An annular tear that is not on an outer layer, but closer to the centre will not elicit a patient response. So I will simply disagree.



> Not all nerve pain is nerve root oriented. Scalene impingement and piriformis syndrome are two such examples. What you are suggesting is an absolute fallacy.




What I am suggesting is relevant to the case at hand, not a blanket statement. If you find where I posted that *all nerve pain is nerve root generated then find the direct quote.*

If not, then cease misquoting me.

Piriformis syndrome is a controversial syndrome, that as the name implies, compression of the extraspinal nerves that form the *sciatic* nerve by the piriformis muscle.

The sciatic nerve passes through the greater sciatic foramen in close proximity to the piriformis muscle.

The fibro-osseus tunnel through which the nerve passes is the site of compression.

Aetiologies;
*Sacroilliac disease
*Inflammatory disease of muscle, tendon, or fascia of piriformis
*Degenerative deformities
*Abnormalities of neurovascular bundle 
*Direct trauma

So on this example, viz. *Piriformis Syndrome* direct nerve compression within the fibro-osseus tunnel *IS* a major contributing factor.

Therefore, we have nerve compression generating signs and symptoms.
Unfortunately we are not discussing a piriformis syndrome are we.

If you remember, I asked constable if he had pain other than in his lower back, for the very reason that I was interested in neurological involvement.
None was reported.



> Nerve entrapment can happen anywhere along the nerve, and give exactly the same symptoms as a nerve root problem *(but can't cause pain above the entrapment). *Piriformis syndrome and thoracic outlet syndrome are two such examples.




You contradict youself immediately.
See highlighted text.

That is the differential.
That nerve entrapment can occur at a number of anatomical sites was never disputed, just misquoted by yourself.

That *nerve root* entrapment was a factor in this case was eliminated, as there were no reported symptoms. Clinically signs might be elicited at extreme ranges of motion.

That *nerve entrapment* was a factor, could be considered unlikely due to the fact the pain was localised to the lower back without any other pain being reported by the patient.

*Nerve entrapment can be caused by muscle spasm, acute inflammation and other factors. That's why referral into the adductors is used as a measure of severity.*

Which is fine as far as it goes.
But so can pain in the plantar or flexor surfaces of the foot, pain in the leg, pain in the thigh, etc.

Had he reported groin pain, or any pain in that anatomical vicinity, I would have taken that into consideration.



> Tell that to my clients who get "mysterious" swelling in their calfs, ever since back surgery. Or perhaps people with cervical disc injuries with strange swelling in their hands. Swelling, inflammation, lymph MOVES. It can cause problems when it does.




Again you are confusing physiological processes.

You seem to be alluding to *axoplasmic flow* which I am well aware of, and fully agree.

Axoplasmic flow, is not; lymph nor inflammation.

*He described pain in his "lower back" not near his sacrum. Many other conditions can cause pain in this area as well.*

Yes he did.
The superior aspect of the sacrum is where?
The Sacro-illiac joints are where?

Exactly, in the low back region.

*It is just impossible to diagnose disc injuries without doing a variety of contraction and movement tests on the spot.*

I do agree, and have maintained under ideal circumstances that this is far more professional.

However, he has already been to the *professionals* and I use the term lightly, and been misdiagnosed. I would be interested to hear from constable the number of clinical exams actually completed I bet hardly any.

Why?

The normal appointment would range from a very aggressive 10mins, to a more conservative 30mins.

Taking a conservative 30mins, to take a full history, and perform a full clinical examination easy 30mins...........no treatment.
How many patients would sit still for that?
Therefore practitioners *short-cut* and eliminate much due diligence.

Annular tearing is one of the most misdiagnosed lesions today.
You also have very little understanding of the lesion.



> Personally, I think it is highly highly irresponsible to be diagnosing and prescribing exercises over the internet, without actually seeing the person involved.




Again to a point I agree.
However, as I understand the limitations, my prescriptive exercises *would do no harm*

Constable would not suffer any adverse consequences should my diagnosis prove incorrect or inaccurate.

Should I prove correct, it will prevent further damage to the tissues involved, and allow the healing processes of the body to complete the healing process.

In other words, the prescription is not the cure, it simply lowers the barriers to the healing process. Anti-inflammatory medication on the other hand will impede the healing process while masking the *pain*



> It is highly possible that the initial problem was muscular. Then manipulation under these circumstances, with little previous treatment, is likely to have exacerbated the problem. And it is possible that it has created a new problem. And like I have said, manipulation in the acute phase of an injury is a big no no.




Of course it was *possible*
I checked for evidence that this might be the case, viz. sports, moving house, heavy lifting, kinky sex, etc.

None was reported.
Thus, how did the initial *professional* come to a muscular diagnosis?
Simple, she didn't have a clue, and wanted her fee.
Fraudulent.



> I'm not disagreeing with your diagnosis, I am just saying that it is impossible to rule out other things from afar. Only with hands on assessment and scans would we know for sure.




Of couse you are.
But that is fine and as it should be.
When all think the same, no-one thinks at all.

jogging along
d998


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## ducati916 (25 March 2007)

constable said:


> I am actually feeling better! Today was the first day i havent taken any medication and although this afternoon i was getting soreness again it has been nothing compared to what it was b4.
> Have been exercising as per duc's recomendations and getting up from the computer every half hour or so during market time.
> Tell you what though i have never slept so good taking all these painkillers!!
> Thanks again guys ....i have a funny feeling my back will be better b4 the debate finishes!!




Glad to hear you are feeling some improvement.
Keep with it, it takes time due to the poor vascular supply [blood supply] to disc tissue, it is an  imbibatory mechanism [sponge like]

jog on
d998


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## noirua (25 March 2007)

Some back pain advice. This link is very useful if you can't be bothered reading or infact can't read: http://www.nlm.nih.gov/medlineplus/tutorials/howtopreventbackpain/htm/index.htm


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## Builder Dave (30 August 2009)

avoid back pain !!!

gentle regular exercise and
stretching


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## wayneL (30 August 2009)

Builder Dave said:


> avoid back pain !!!
> 
> gentle regular exercise and
> stretching



A timely necrobump.

My back is giving me **** at the moment.


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## Chris45 (30 August 2009)

Have you tried some simple twisting exercise like this:


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## wayneL (30 August 2009)

Chris45 said:


> Have you tried some simple twisting exercise like this:




No, but done lots of this sort of thing:


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## wayneL (30 August 2009)

Another stretching exercise I've done before as well:


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## Chris45 (30 August 2009)

Hey! They look like good neck exercises.


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## wayneL (30 August 2009)

Chris45 said:


> Have you tried some simple twisting exercise like this:




They have a lot in common when you analyse it:


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## Chris45 (30 August 2009)

wayneL said:


> They have a lot in common when you analyse it:




That last one looks like an end-of-5th-wave-crash correction.  Ouch!!!


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## awg (30 August 2009)

anyone had a MRI scan on their back?

What does it involve?

I have a referral from Doc, as I have quite severe pain in lower right back

longstanding problem, that has recently been aggravated, as I had a problem with my foot that caused a major limp, and off my feet for a few weeks.

I thought this was the cause, as the muscles have definitely wasted.

have started "soft" Chiro treatment, at first he thought things were ok, but the treatment is having no effect.

last treatment, he did a leg compression which caused me to actually scream in pain...he said go get that MRI scan


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## Builder Dave (30 August 2009)

intercourse is good exercise for your back but you have to keep the RPM low to get the full theraputic benefit. think about it !!! have you ever heard a dog complaining of a sore back


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## plankton (30 August 2009)

awg said:


> anyone had a MRI scan on their back?
> 
> What does it involve?
> 
> ...




Stop the chiro asap

You should have no treatment till you have the MRI, if the results show any impingement on your nerves the GP will refer you to a neurologist who will assess the mri results and advise you on a treatment course. If no nerve damage then you can continue with manipulation therapy ie physio/chiro.

Personally mine was facet joint injections (cortisone injections into the spine under a CT scan so they can see where to inject) and an exercise program swimming pilates etc. I am lucky my herniated disk is only irritating the L5/S1 nerves not impinging on them. 

Worst case scenario they do nerve root sleeves or back fusions.

i am not a docter only a patient.


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## donteventryit (31 August 2009)

This thread is getting good ...


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## noirua (25 September 2022)

If you have trouble with back pain sitting down then here is the answer - most probably perhaps maybe. Sometimes referred to as an Ergo Sitting ball or Exercise Ball.
Sitting on an exercise ball can *improve your stability and balance*, as you must constantly engage the core abdominal muscles to stay upright. A stronger core helps protect the lower back and promote better posture.
According to the Centre of Research Expertise for the Prevention of Musculoskeletal Disorders, “*The use of stability balls as a chair may actually increase the risk of developing low back discomfort and may increase the risk of sustaining an injury due to the unstable nature of the balls*.”
Benefits of Sitting on a Stability Ball at Work​








						5 Benefits of Sitting on an Exercise Ball at Work | AFPA Fitness
					

Thinking of switching your office chair out for a better option? Explore the benefits of sitting on an exercise ball and see healthy back exercises.




					www.afpafitness.com


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## noirua (25 September 2022)




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## macca (26 September 2022)

Until they burst ! I know a person who sat on one of these at a very modern office, it burst, they landed on their tail bone and have been in agony for about 10 years


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