Leaning to the left too much
- 06-23-2014, 07:07 PM
- 06-23-2014, 08:43 PM
I hope you that this wasn't an orthopedic surgeon. Unfortunately the consensus is they typically spend little time with you. If you do not appear to be a surgical candidate this is often the case (your story). I'd explore other options especially if you are not considering surgery.
06-23-2014, 09:46 PM
To the OP ------ Regardless of what anyone is saying in here, without an MRI, it's all guesswork.
If you can afford the copay on an MRI, may as well do it. Don't let anyone force you not to do it for whatever reason. It's one of the best imaging methods out there. Why not use it... It is far beyond me why anyone would so strongly advise AGAINST an MRI... geeez.. to go to the trouble of typing all that up to be SO against an MRI is completely overkill. If you can afford it and have insurance, you may as well get a better look at what's going on
Even better though, definitely make an Ortho appointment
06-23-2014, 10:28 PM
Because its the erroneous thought that an MRI takes all the guess work out of a diagnosing someone,especially with back pain. Furthermore I will reiterate the fact that an MRI is typically necessary only if it dictates conservative treatment.
For example, Jimmy walks into clinic with moderate back pain at L3-L4 with mild symptoms traveling distally into the posterior left hamstring. He presents without red flags (reflexes intact, intact bowel/bladder, without unrelenting pain, fevers etc).
From here Jimmy can proceed down two paths:
a. Jimmy receives MRI, has mild disc herniation (which is suspected via physical exam) jimmy gets NSAIDs and gets referred to PT
b. Jimmy doenst get MRI, receives NSAIDS gets referred to PT.
PT will treat symptoms, NOT MRI findings, pending in person physical exam and will most likely base treatment off symptom free movement patterns. In end, jimmy ends up in same place minus saving us (taxpayers), 2 grand
As information provided above has shown, many of jimmy's symptoms may not correlate with MRI findings. He could have a number of issues:
a. Overweight/high BMI resulting in anterior displaced moment arm which causes increased flexion moment and dull achy back pain
b. Leg length discrepancy
c. Poor overall endurance in conjunction with core deconditioning
d. Piriformis syndrome
e. improper lifting technique (abdominal bracing)
f. Postural dysfunction
g. Flexibility issues
h. Not to mention symptom free movement patterns will dictate treatment regardless of findings
Not to be rude but evidenced based practice is important, and is highly regarded on this forum for all the ingredients in the supplements we promote here on the forums. Try and look at this topic objectively, not subjectively. MRI is 2 grand, OP has 0 red flag signs hence why Ortho gave him muscle relaxant and sent him home. MRI is used for a surgical consult and/or red flag items, thats standard protocol.
Its a huge public misconception that MRI's are this magical diagnostic tool. MRI's need to be read, which brings in a huge human element, a good radiologist makes an enormous difference. Lastly, I am NOT advocating so hard against MRI's. I am merely pointing out why an MRI appears unnecessary at this specific point in time based off OP's report here, but again this is the internet and there is no way anyone in here can make that call either way. This is merely my opinion. In the end the physician has this call, he writes the script and that is why they get paid the big bucks.
My original post states:
"Honestly I would recommend against jumping to this conclusion at this point," (and henceforth stated let the medical professional decide, which he did, as suspected, against)
I will reiterate clinical guidelines:"Given that many asymptomatic adults have abnormal findings on lumbar spine magnetic resonance imaging, this modality generally should not be performed for nonspecific chronic low back pain in the absence of red flags. Whole body scanning is not supported by current evidence"
If this was me in this position, I would go to a respected Physiotherapist( via direct access) or chiro and begin now while waiting for another appointment with a surgeon. But that's just me.
My final point is a subjective one, In my experience, it has benefited me greater seeing a Physical Rehab Physician for issues that are not clear cut orthopedic surgery cases (in which case a rehab physician will refer you to one). In my experience, rehab physicians tend to spend more time examining you as well as have more time to answer questions. They also have the ability to order MRI if they feel the need. Ortho surgeons can have monster case loads and are in and out in less than 5 mins in the times I have interacted with them .
06-23-2014, 11:29 PM
Too long, didn't read.
An MRI is a great diagnostic tool, period. I did not say it is all he requires to figure out what's wrong, but it sure is better than just an x-ray.
I would only choose a good sports therapy clinic and not just any chiro. Chiro's can do more damage. I've been to plenty. All I use chiro's for is their TENS unit, some A.R.T. and some other things. I do not believe in spinal manipulation whatsoever.
OP - if you decide to seek some treatment, be careful what you do. If you have muscular pain, a TENS unit, A.R.T, and massage will work wonders.
A good Yoga class will do MUCH better for the spine than a chiro. Take it from someone with long term practical experience in this.
06-23-2014, 11:33 PM
06-23-2014, 11:35 PM
06-24-2014, 07:39 AM
@Gutterpump i agree with you MRI is the king of imagining, it shows EVERYTHING.
I didn't get too technical with my statements but,
Jimmy walks in to the ER with pain in the lower back with accompanied sharp pain in the outer quad and hamstring area. Jimmy has has no history of trauma. the doctors assume that he is having symptoms from a moderate disk bulge they give him muscle relaxers and NSAIDs symptoms subside in 2 weeks
Jimmy is back in the ER same issues they perform MRI and found a tumor jimmy is now in for surgery and it was not a disk.
what I'm getting at is an MRI will show everything and yes a human has to read the image but this point also states that a human can miss a diagnoses a physical exam too, since there are so many variables and with out a proper images its nothing more than a crap shoot.
OP, get a damn MRI push with your primary care get a clear cut image of whats going on it it makes you feel better its the only way to clear the mind sometimes
06-24-2014, 12:56 PM
First of all, the question isn't whether MRI or MRA is a good imaging device. Its whether it is indicated in this particular case, notice how you provide an example of someone going to the emergency room for back pain, which is a red flag. As far as we know OP is in abscence of any red fflags, which is in accordance for clinical guidelines against imaging of low back pain. In addition although MRI may show abnormalities, often these abnormalities are not the source of pain as in someone whom may have a minor disc issue but is actually suffering from piriformis syndrome.
Again, I will state it is up to the medical professional to decide, not the am forums and with that I am unsubsribed to this thread, nothing personal I just don't see any thing changing in this discussion.
07-03-2014, 11:29 PM
There are several things that needs assessment. Something is likely pulling your sacrum out of balance, and it could be lack of transversus abdominis activation (very common), way tight piriformis, dysfunction of gluteus medius (and quadratus lumborum substitution) amongst others.
Also check whether you're pronating or supinating your feet, and whether you're in an anterior or posterior pelvic tilt.
My bet is TrA and/or GM dysfunction. Strengthen them, and work on diaphragmatic breathing and core activation in your daily life.
Hope this helps!
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