Lower Back Pain

[metisdead]

Posts containing personal details have been removed.

[wjmark]

Pilates is very useful for sciatica and many other issues.

There is a small Pilates studio in Chiangmai - search for

"Pilates-Chiangmai"

Thanks, Mark

[funcat]

Some really good responses. I would only add my own personal observation, which is that you need to be conscious of anything you might be doing to aggravate the condition.

For me, I have found that the type of mattress is important, not so much for when I'm laying on it, but for when I get in and out of bed. Those few moments where you transition from lying down to sitting up and then standing up and perhaps the most stressful your back will experience during the day. If the mattress gives at the wrong moment, it can strain muscles in the back that don't get used often.

The worst mattress in this regard is a water bed. I would only recommend these types of beds for the most physically fit. Best is a toss-up between a hard, firm mattress, and an air mattress that isn't inflated all of the way (because then when you get on your hands and knees they reach through to the bottom and provide good support). Hammocks can be excellent too, provided they are at the right height.

Barring some sort of spinal injury, I think most back pain will resolve itself over time, but we end repeating the same motions that cause it in the first place so it never goes away. A good thing to do if you can is to mentally preflight your activities around the house. Going out isn't so much of a problem since you're usually either walking or sitting upright in proper chairs, like at a restaurant. It's at home when we're reaching for things on the top shelf, or navigating the bathtub, or vacuuming or hanging the laundry or even cooking in the kitchen where issues can arise because there are many opportunities to move in unusual ways.

The info above is very important to remember,every out of balance move can make a future problem.

About getting out of bad,I always do some stretching before I step up....very important...and the proper pillow,of course.

[boomerexpat]

I had some really bad bouts of lower back pain. I went to see a massage guy named Sing Chai. He was recommended by an American who comes every year to study with him, He gets lots of farang practitioners who come to study with him. Worked for 35 years at Suan Dok hospital. I will PM you contact info.

OP - I am intrigued by this sentence;

"I had an MRI last year but the doctor said he didn't see anything serious enough to require an operation".

So, my question is, what DID he see?

He must have seen 'something' it's just that what he saw he didn't think was serious enough to warrant an operation (your words).

Thus ends your story regarding the doctor, who I presume was a specialist that you sought out, who ordered an ordinary x-ray first, before concluding you needed an MRI to clarify what he thinks he saw on the first x-ray. You don't say what treatment he then recommended i.e. physiotherapy, medication or perhaps even a cortisone injection.....rather, all his investigative work halts abruptly and you do the rounds of acu, chiro, self meds and massage......ending up on TV for advice.

uptheos, I would have thought that you were a proctologist, not a back specialist. The tone of your response sounds as if you think I have no right to ask for help on a public forum. I don't believe you really feel this way, just comes off that way. This may be your normal style but I found it a bit on the rough side.

I apologize for not giving you enough details to begin with. However, I know that lower back pain is very common and was simply seeking to find out what others have done to find some relief. Thank you to everyone who offered some suggestions.

"So, my question is, what DID he see?"

It's been a little over a year but I am pretty sure the specialist at Suandok Hospital said to me what I wrote in my original post.

"Who ordered an ordinary x-ray first, before concluding you needed an MRI to clarify what he thinks he saw on the first x-ray."

The doctor ordered an ordinary x-ray first, couldn't see anything so he ordered the MRI.

"You don't say what treatment he then recommended i.e. physiotherapy, medication or perhaps even a cortisone injection."

He ordered traction 2 or 3 times a week, medication and that I wear a back brace that looks like a corset everyday for the rest of my life, or until the pain stops, whichever come first. The traction helped a bit but I can't go so often because of my work. For the benefits I was receiving from it was not worth missing or leaving work early so often.

I did acupuncture, chiropractor and massage before seeing a specialist.

"Rather, all his investigative work halts abruptly and you do the rounds of acu, chiro, self meds and massage......ending up on TV for advice."

I have been able to find a wealth of useful information on Thaivisa and other forums like it. And I believe the responses that I've read thus far prove this point.

Where is Sing Chai based at?

Thanks

[boomerexpat]

I had some really bad bouts of lower back pain. I went to see a massage guy named Sing Chai. He was recommended by an American who comes every year to study with him, He gets lots of farang practitioners who come to study with him. Worked for 35 years at Suan Dok hospital. I will PM you contact info.

OP - I am intrigued by this sentence;

"I had an MRI last year but the doctor said he didn't see anything serious enough to require an operation".

So, my question is, what DID he see?

He must have seen 'something' it's just that what he saw he didn't think was serious enough to warrant an operation (your words).

Thus ends your story regarding the doctor, who I presume was a specialist that you sought out, who ordered an ordinary x-ray first, before concluding you needed an MRI to clarify what he thinks he saw on the first x-ray. You don't say what treatment he then recommended i.e. physiotherapy, medication or perhaps even a cortisone injection.....rather, all his investigative work halts abruptly and you do the rounds of acu, chiro, self meds and massage......ending up on TV for advice.

uptheos, I would have thought that you were a proctologist, not a back specialist. The tone of your response sounds as if you think I have no right to ask for help on a public forum. I don't believe you really feel this way, just comes off that way. This may be your normal style but I found it a bit on the rough side.

I apologize for not giving you enough details to begin with. However, I know that lower back pain is very common and was simply seeking to find out what others have done to find some relief. Thank you to everyone who offered some suggestions.

"So, my question is, what DID he see?"

It's been a little over a year but I am pretty sure the specialist at Suandok Hospital said to me what I wrote in my original post.

"Who ordered an ordinary x-ray first, before concluding you needed an MRI to clarify what he thinks he saw on the first x-ray."

The doctor ordered an ordinary x-ray first, couldn't see anything so he ordered the MRI.

"You don't say what treatment he then recommended i.e. physiotherapy, medication or perhaps even a cortisone injection."

He ordered traction 2 or 3 times a week, medication and that I wear a back brace that looks like a corset everyday for the rest of my life, or until the pain stops, whichever come first. The traction helped a bit but I can't go so often because of my work. For the benefits I was receiving from it was not worth missing or leaving work early so often.

I did acupuncture, chiropractor and massage before seeing a specialist.

"Rather, all his investigative work halts abruptly and you do the rounds of acu, chiro, self meds and massage......ending up on TV for advice."

I have been able to find a wealth of useful information on Thaivisa and other forums like it. And I believe the responses that I've read thus far prove this point.

Any particular reason you can not share beneficial news with all of us.

would like to get his contact info too

[jackr]

Had a dodgy back/neck since mid-teens but only really plays up when out of shape. If I tighten up the abs, it does the trick, and a rowing machine works particularly well for that.

[changraider]

I also developed lower back pain a couple of years ago after doing something a bit silly while under the christmas influence. I expected it to just go away, but after a few months of anti-inflammatory painkillers it was still there so I went to the doc. She prescribed physiotherapy which included the exercises that @fishenough displayed. After 3 months twice a day of that I was good-as-new. If you decide to do those exercises it's important to stop any exercise that causes more pain.

[Gonzo the Face]

''''' when I came back,she has already died...I'm looking for somebody like that since...

...not to be a smartazz but you are looking for a dead masseuse???

Edited December 8, 2011 by Gonzo the Face

[kokesaat]

There are probably a million reasons for lower back pain and another million cures. Here's what worked for me.

First, I came to the conclusion that standing on my feet for 8 hours, twice a week, in a classroom, wasn't good for the back. Second, I slept with one of those long Thai pillows (the long rectangular one, not the long round one) between my knees at night while sleeping on my side. Third, using a thin rubber mat while lying on my back I raised both legs straight up, then lowered them as slowly as I could. That exercise helped to strengthen my lower back and helped to stretch out the knot that seemed to be there causing the pain.

That's what worked for me........maybe not for everyone.

[nikster]

Excellent tips here.

Just want to add my 2ct, even though it's unfortunately not a solution one can find in Chiang Mai - at least that I know of. Wife had severe back pains some years back; we were in Germany, went to the uni hospital where an X-Ray revealed that some fluid was coming out and pushing on the nerves. The surgeon said to us: Nothing we can do, surgery has serious side effects and there;s no guarantee it would work, and it might make things worse.

My father was learning Reiki at the time, so we went to his teacher for advice. In her 50ies, she had been practicing Reiki for over 20 years. She said well first let's look at her legs - lo and behold stretched out one leg was a bit longer than the other. She shook out the leg and after that it was the same length! (I was amazed but I have since heard that's what Chiropractors do, too). Then she did a 1 hour reiki treatment and said to my wife: It's going to be gone in 3 days. And so it was. It never came back, at least not in the last 7 years. And my wife isn't one to exercise...

I've been looking for a good Reiki place ever since so if you know one over here - let me know. The ones I've found - and I know there are many - are not trustworthy.

As for massage therapy - the one place I know that could possibly offer this is Mr. Baan Comfort Massage in Pai. Mr. Baan - about 70, but looking like 50 - came to Pai from Bangkok and he and his wife are doing serious health massage, the likes of which I haven't found in Chiang Mai (and I've tried tons of places). I don't know if he fixes lower back pain, but might be worth a shot.

Edited December 8, 2011 by nikster

[jsflynn603]

In answer to your query: Yes, I have had success after having a compressive injury to the lower back. I was a volunteer fireman responding to a fire call. As I lifted the 14' door just about neck high, the entire counterbalance system separated from the roof so that the weight of the door which was probably about 35lbs, increased suddenly to about 300lbs. This lead to chronic sciatica probably due to lumbar disk herniation which mostly resolved. Today, now 30+ years later I find that two factors or necessary for relief. The first (which will be of no use to you) is that at <180lbs I have no symptoms. At 200lbs I cannot sleep through the night without anti-inflammatory medication. (NSAID's) I have also found that between 180-200lbs that performing the standing hamstring stretch, done correctly (the image that Fishenough shows should include an arrow indicating that the foot must be held back and not be allowed to extend forward. (The written text for this image probably tells this). I find that if I perform this exercise three times a day properly (good form, stretch for 20-30 seconds, then relax, and stretch again, for three times; requiring about 4 minutes) this helps me immensely.

What I find interesting is that you mention that taking an anti-inflammatory + a muscle relaxer gives you a 70% reduction in pain in less than an hour. Since both meds have an onset of action of less than one hour we don't know if the relief is related to muscle relaxation, reduction of inflammation or both.

Therefore I might suggest that you try the muscle relaxer, be it Skelaxin, Flexeril, Soma or whatever without the NSAID (naprosyn or ibuprofin) and see if you gain relief. Then the next day try NSAID without the muscle relaxer. This might give you some insight. If the NSAID alone gives you this relief then stretches may not offer you much help. However if the muscle relaxer alone works to give you this relief I would suggest that you focus on stretches because if so, the problem is likely to be the muscle spasm. Consider that if one side of the back spasms a bit more than the other side, the vertebrae may be pulled sideways thus impinging upon one of the root nerves causing both inflammation and pain.

Regarding the discussion about what the MD saw with the radiograph my answer is that most likely he saw nothing at all. Patients do not like hearing "I see nothing wrong." Therefore doctors often respond with the better perceived bedside manner answer of "I see nothing that warrants surgery." It is a rare doctor who tells the whole truth--and often they are disliked, though often they are the best.

CT (Computerized Tomography) or MRI specifically MRN (Magnetic resonance neurography) will diagnose sciatica in about 95% of cases. But I must wonder if you suffer from sciatica since you do not tell us what the pain feels like and where you feel it. For instance vacationman describes his pain which identifies sciatic pain an comments about "removed the billffold from the back pocket." His description indicates likely sciatica with the possibility of Piriformis syndrome. About 15% of people have the sciatic nerve run through the Piriformis muscle, had he such symptoms without a prior back injury he may have no back injury but a primary Piriformis syndrome--removing the wallet relieves some pressure on the muscle which relieves pressure upon the large sciatic nerve. In this case since he says he had an injury it is likely that he has sciatica aggravated by nerve placement in the Piriformis muscle, and for him the Piriformis stretch and Extension exercises might offer some relief.

Do you develop pain in the butt, or along the thigh or elsewhere in the leg? If so it is likely that you have sciatica, if not then you probably do not have traditional sciatica.

One thing I hear from you which is a bit unique is that bending forward from the waist initiates the pain, if you have this pain without pain radiating to the buttocks and legs I would wonder if there is a possibility that you are feeling referred pain from a damaged facet joint.

Lower back pain is exceedingly frustrating, as an Occupational Health RN I have seen enough cases to realize a few things and these are simply my opinion, for I am not a medical practitioner and so ultimately advice must be sought from a practitioner, yet I will only share my thoughts.

First is surgery should be a last resort--period. Statistically though surgery often has a good one year relief rate, out to four or more years farther, the success rate in pain relief often drops to zero. Statistically cortisone injections do not show long lasting relief either. (Though I am not sure this is the case if it as a facet injury and there I might suggest that the patient ask the practitioner about iontophoresis instead of an injection. (Iontophoresis drives cortisone in by a minute electrical charge--literally the bandage which has the cortisone in it has a tiny battery). Spinal manipulation shows some benefits but again statistically the case is not strong. It is exceedingly frustrating to realize that in fact, when using a statistical database--nothing other than time (which has already passed for you, meaning that if your body could cure it, it would have done so long ago) is of statistical benefit.

After an acute injury involving lumbar disk herniation about 90% resolve spontaneously. Doctors know this and so often they seem to prescribe something which may or may not help but the real goal is to get you off their backs till the 90% resolve on its own. But what I have often seen is that during the acute period the sufferer will "guard" the back, and in a month or so, in some cases perhaps the muscles weaken or atrophy. This often leads to muscle spasms which lead to back pain which leads to more guarding which leads to tighter lower body muscles, thus increasing tension in the lower back leading to more spasm. You work out regularly yet you may unknowingly be guarding certain muscles.

If you were a worker that came to me with this issue I would ask you to (very gently--no pain) bend over and see how close you can come to touching your toes. If you can only get your hands down to your ankles than moe666's comment likely holds true and I would suggest that you work diligently on loosening your hamstring and buttock muscles (all the muscles of the back of the lower leg). I'd recommend diligent 4x@day standing hamstring stretches.

If however you can easily touch your toes the standing hamstring stretches is unlikely to help so I might suggest the others that are shown especially the extension (if it causes no pain). I'd also try to get you (remember these are Workmans' Compensation cases) some physical therapy sessions to see if that helps.

Again these are just thoughts and you should rely on a medical practitioner to decide what to do, but I hope that some of these thoughts might be helpful.

[chicagogato]

In answer to your query: Yes, I have had success after having a compressive injury to the lower back. I was a volunteer fireman responding to a fire call. As I lifted the 14' door just about neck high, the entire counterbalance system separated from the roof so that the weight of the door which was probably about 35lbs, increased suddenly to about 300lbs. This lead to chronic sciatica probably due to lumbar disk herniation which mostly resolved. Today, now 30+ years later I find that two factors or necessary for relief. The first (which will be of no use to you) is that at <180lbs I have no symptoms. At 200lbs I cannot sleep through the night without anti-inflammatory medication. (NSAID's) I have also found that between 180-200lbs that performing the standing hamstring stretch, done correctly (the image that Fishenough shows should include an arrow indicating that the foot must be held back and not be allowed to extend forward. (The written text for this image probably tells this). I find that if I perform this exercise three times a day properly (good form, stretch for 20-30 seconds, then relax, and stretch again, for three times; requiring about 4 minutes) this helps me immensely.

What I find interesting is that you mention that taking an anti-inflammatory + a muscle relaxer gives you a 70% reduction in pain in less than an hour. Since both meds have an onset of action of less than one hour we don't know if the relief is related to muscle relaxation, reduction of inflammation or both.

Therefore I might suggest that you try the muscle relaxer, be it Skelaxin, Flexeril, Soma or whatever without the NSAID (naprosyn or ibuprofin) and see if you gain relief. Then the next day try NSAID without the muscle relaxer. This might give you some insight. If the NSAID alone gives you this relief then stretches may not offer you much help. However if the muscle relaxer alone works to give you this relief I would suggest that you focus on stretches because if so, the problem is likely to be the muscle spasm. Consider that if one side of the back spasms a bit more than the other side, the vertebrae may be pulled sideways thus impinging upon one of the root nerves causing both inflammation and pain.

Regarding the discussion about what the MD saw with the radiograph my answer is that most likely he saw nothing at all. Patients do not like hearing "I see nothing wrong." Therefore doctors often respond with the better perceived bedside manner answer of "I see nothing that warrants surgery." It is a rare doctor who tells the whole truth--and often they are disliked, though often they are the best.

CT (Computerized Tomography) or MRI specifically MRN (Magnetic resonance neurography) will diagnose sciatica in about 95% of cases. But I must wonder if you suffer from sciatica since you do not tell us what the pain feels like and where you feel it. For instance vacationman describes his pain which identifies sciatic pain an comments about "removed the billffold from the back pocket." His description indicates likely sciatica with the possibility of Piriformis syndrome. About 15% of people have the sciatic nerve run through the Piriformis muscle, had he such symptoms without a prior back injury he may have no back injury but a primary Piriformis syndrome--removing the wallet relieves some pressure on the muscle which relieves pressure upon the large sciatic nerve. In this case since he says he had an injury it is likely that he has sciatica aggravated by nerve placement in the Piriformis muscle, and for him the Piriformis stretch and Extension exercises might offer some relief.

Do you develop pain in the butt, or along the thigh or elsewhere in the leg? If so it is likely that you have sciatica, if not then you probably do not have traditional sciatica.

One thing I hear from you which is a bit unique is that bending forward from the waist initiates the pain, if you have this pain without pain radiating to the buttocks and legs I would wonder if there is a possibility that you are feeling referred pain from a damaged facet joint.

Lower back pain is exceedingly frustrating, as an Occupational Health RN I have seen enough cases to realize a few things and these are simply my opinion, for I am not a medical practitioner and so ultimately advice must be sought from a practitioner, yet I will only share my thoughts.

First is surgery should be a last resort--period. Statistically though surgery often has a good one year relief rate, out to four or more years farther, the success rate in pain relief often drops to zero. Statistically cortisone injections do not show long lasting relief either. (Though I am not sure this is the case if it as a facet injury and there I might suggest that the patient ask the practitioner about iontophoresis instead of an injection. (Iontophoresis drives cortisone in by a minute electrical charge--literally the bandage which has the cortisone in it has a tiny battery). Spinal manipulation shows some benefits but again statistically the case is not strong. It is exceedingly frustrating to realize that in fact, when using a statistical database--nothing other than time (which has already passed for you, meaning that if your body could cure it, it would have done so long ago) is of statistical benefit.

After an acute injury involving lumbar disk herniation about 90% resolve spontaneously. Doctors know this and so often they seem to prescribe something which may or may not help but the real goal is to get you off their backs till the 90% resolve on its own. But what I have often seen is that during the acute period the sufferer will "guard" the back, and in a month or so, in some cases perhaps the muscles weaken or atrophy. This often leads to muscle spasms which lead to back pain which leads to more guarding which leads to tighter lower body muscles, thus increasing tension in the lower back leading to more spasm. You work out regularly yet you may unknowingly be guarding certain muscles.

If you were a worker that came to me with this issue I would ask you to (very gently--no pain) bend over and see how close you can come to touching your toes. If you can only get your hands down to your ankles than moe666's comment likely holds true and I would suggest that you work diligently on loosening your hamstring and buttock muscles (all the muscles of the back of the lower leg). I'd recommend diligent 4x@day standing hamstring stretches.

If however you can easily touch your toes the standing hamstring stretches is unlikely to help so I might suggest the others that are shown especially the extension (if it causes no pain). I'd also try to get you (remember these are Workmans' Compensation cases) some physical therapy sessions to see if that helps.

Again these are just thoughts and you should rely on a medical practitioner to decide what to do, but I hope that some of these thoughts might be helpful.

Edited December 9, 2011 by chicagogato

[Tonto21]

Just to add my experience of lower back pain, who know you may have the same thing.

For 2 years I suffered with lower back pain, it got pretty unbearable at times, I saw doctors….GP and bone, in the end I, by chance came across a chiropractor. He know his stuff and told me it wasn't my back, it was my pelvis, it was locked-up, I felt the pain in my lower back because it was having to do all the work my pelvis should have been doing!

It still locks up now and then but I've learnt to stretch and manipulate my lower back, pelvis and hip.

When it plays up, gardening will do it, I think it's all that squatting down. I do the 'Piriformis' (alternate legs) then after a good stretch. I stay on my back and pull both knees to my chest, (bring my hips up…as opposed to lifting my shoulders) I hear my hip and pelvis… 'Pop' Just like cracking a finger joint……..Instant pain relive and mobility.

Not for everyone, but might help someone else with this problem.

[Fishenough]

it was my pelvis, it was locked-up

Appropriate avatar Tonto

[binjalin]

Sarno's book is a revelation

[Tonto21]

it was my pelvis, it was locked-up

Appropriate avatar Tonto

Ha ha...

I do what I can when I can.....................With who I can!