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Anyone with myofacial lumbar issues?

cjperkccjperk Posts: 77
edited 06/11/2012 - 9:01 AM in Lower Back Pain
Does this even exist? What would you do? I know there are so many people way worse off on here. Some of you are very experienced with pain mgmt, I'm just so confused on what to do...

I've had lumbar pain for 8 years now. When it began I did not have insurance and dealt with it. It was manageable with exercise, stretch, etc.

Fast forward to 2008, I developed a cervical bulge which I could not ignore. Sleep issues, spasms, etc. The cervical issue further exacerbated the lumbar issue until I had a MRI done last year. The MRI revealed a bulge, but the doctor thought my problems were muscular. I didn't believe him and never went back. I was dead-set in believing that the pain was caused by a bulge shown at L5/SI. The treatment for the c-spine issue was helping the lumbar, so not an issue, right?

Now I feel I've got a real handle on the cervical issue and the lumbar region is killing.

Today I finally went to another pain and spine doctor. My sleep is being interrupted and nothing I'm doing is relieving.
He looks at my films and says the exact same thing. He also said that the condition is very difficult to treat because they're not sure of the underlying problem. He obviously knows I'm not making it up, every muscle in my low back is tense and knotted... But he did not really give me a clear plan of treatment either. I liked him as a person, not that impressed with his plan.

I'm not entirely convinced that I'm having some muscle issue. I'm in pain 24/7 from the lumbar region. It's horrible, I can only imagine what some of you are going through. The sleep loss is getting out of control and I do not know what to do. I want my life back, or at least whatever I can get back to with this condition. Lying around all of the time in pain is not living.

In my mind there must be an underlying condition. A damaged nerve, something? Should I get another opinion? I'm not going to take 'suffer' as an option, and I feel like that's what I'm in for. When this first began I had a bad habit of carrying entirely too heavy of a backpack hiking multi-mile trips.

Sorry for the rant, I just don't know what to do at this point. See someone else? Stick with this guy a while? I'm really getting the feeling that pain is the most difficult thing to be treated for. They cannot see what a person goes through, etc. I live a fairly normal life outside of this. I'm getting at my wits end with the back pain... :(

First month treatment plan -
Ordered Chiropractic to stretch me / massage
Cymbalta 60mg once daily. (this stuff scares the crap outta me)

Thanks guys/gals for any info

My symptoms are -

Chronic low back pain - burning, dull, aches
Intermitent sciatica
Rare numbness in left foot
Rear thigh pain when walking

Anytime I lay for 6+ hours I'm stiff as a board when I wake. I can't even get to a 90 degree angle stretch without 30 minutes of movement.

If the wrong weather system moves in, I'm hurting. Carrying mud or heavy shoes flares the pain.


  • Pain stinks. I had to say it.
    Now, that I got that out of the way, I feel your frustration.

    I'm no doctor but I do see a few things in your post that I can relate to. Mind you my situation is very different on what led me to my pain and I had a very distinct ruptured disc.

    But here's what caught my eye.
    1 - Help with neck was helping lumbar - I believe this. The body compensates so perhaps you were compensating with your lower back when you had neck issues.

    2- the doctor is being truthful that it is hard to treat something that is not showing on an MRI or another similar test. I think what he is saying is surgery is risky even when you know the cause. So not knowing it makes it more difficult.

    3 - good news? he believes you. Some doctors will say "there is no way you are hurting based on what I see". That's a doctor to just politely say thank you and leave.

    4 - now, the last observation...and please take this with a grain of salt b/c it may be because it's my most recent relevant issue.

    You are losing sleep and you say if you lay down too long, you have trouble standing upright. Interesting (b/c I can relate)

    Once you are upright an moving a bit, do you start to feel a bit better? If so, it would further confirm the muscular issue.
  • Ok, now that I posted that long post.
    Myofacial issues can and do exist.

    Normally I'd wait to see your response but because I am not on here much, I won't wait.

    I have had 2 lower back surgeries and was doing well up until about 6-7 months ago and was finding that I was not sleeping, every time I would try to move while sleeping, I was be in tremendous pain where I'd just grit my teeth and try to re-adjust myself, and when I tried to get up, the pressure on my lower back was so bad, my legs would often buckle and I would be bent at a 45 degree angle for at least 15-20 minutes.

    MRI confirmed no drastic changes.
    I was at a loss. But luckily between my Neurosurgeon and GP, I was referred to a Physiatrist who is a muscular/skeletal doctor (more than just a PM doctor).

    He evaluated me and confirmed I had very tight muscles and that I needed to get some motion in my lower back.

    Long story short, I had compensated to protect my back for 2 years and as a result, I became very stiff. I was strong and protected my back but at the cost of losing mobility in my lower back.

    I'm through 4-weeks of PT that includes
    - Special stretching (Similar to a chiropractor stretch but with PT)
    - Special stretching (for home exercises)
    - Special exercises to try to help my relative left/right pelvic/hip strength be more balanced. I'm strong physically but they explained how it is about relative strength when talking about posture
    - TENS type machine (Stimulator) that tries to re-teach the muscles)
    - deep tissue type massage from the PT

    After 4-weeks I was making very limited progress.
    There are myofacial injections (Trigger point injections or dry needling) which are sort of like Accupuncture. The body will react after surgery or injury or to protect the body but sometimes, the muscle knots up and forgets to relax. The TP injections I had were no medication but were to try to get the muscle to twitch (e.g contract and then relax) in hopes that this would force the muscle to 'restart' and not re-knot up. I just had them last week so too soon to really tell if they worked.

    My advice? Talk to your doctor about a physiatrist (Fa-zye-a-trist). These are doctors who can also prescribe medication.

    Hopefully this gives you another idea. Maybe your current PM doctor is one of these. NOTE - mine did not mention the injections right away and I appreciated that. I had a follow up with him 4-weeks after PT to say I was not seeing a change and did he think PT would help if I just stuck with it. This is when he said I might want to consider the TP injections but that by no means was it a medical treatment but more of a way to try to expedite what I was doing in PT).

  • Thank you SO much for the reply.

    I'll address #3 first -

    Yes, I believe he believes me. In fact, I believe it's impossible he couldn't. He could tell by touch I wasn't BS'ing. The PM didnt touch me like the Chiro did so I hope the Chiro forwards what he found to the PM. I was sent to the Chiro by the PM. In a round about way, the Chiro said my back was a mess and that both cervical and lumbar issues were related / cycling off of the other. I developed the lumbar issue almost 5 years before the cervical bulge. There's no denying the cervical bulge. I've got a very clear 3-level bulge with C5/C6 being the worst (and only one touching). I have numbness, etc associated with the bulge. I'm not a big fan of Chiropractors because when I first got the 'crick' that became my bulge, I had a Chiro make it worse.

    Now for #4 -

    Sometimes movement does help the issue. Sometimes it doesnt. If I'm carrying weight (or mud) on my work boots it makes it hurt worse. It really depends on the day. Standing or sitting for 15 minutes or so makes me want to do the opposite.

    Some weather - hot, humid days or stormy weather makes it burn worse. Burning, aching, dull pain is what I deal with lumbar wise.

    I'm 32 now, was 25 when this started, and I'm really wondering if I don't have some sort of nerve damage. Possibly from an 80lb backpack on a multi-mile hike or something...

    One side of my 'L5 area' is more tense than the other. What's funny is while my right side is more tense, I have more pain/neuro issues on my left thigh/foot.

    Best put, if any doctor touches my back, they can feel I'm not pulling wool over anyone's eyes. I have no history of addiction, etc which would make them think otherwise. I just want some relief, however it comes. A cure would be better, but it doesn't look good.

    One last thing, the PM thought trigger points would flare it worse. I'm just really confused this evening. I left his office with more questions than answers.
  • I might add that I just bought a 1400$ bed. Should be here tomorrow.

    Also, sleeping with legs elevated and pillow between the legs can help, also cannot. This seems relevant because they say legs elevated with disc issues should relieve. It doesnt always. Thanks again! About to read the long one.
  • Well, I personally would be cautious of chiropracters for backs. Yours sounds like a good one who wants to work with your doctor.

    If you find a Physiatrist, he will work with various doctors to help you. Not sure if he'd include a chiropracter but he might. At least you'd be under the supervision of a medical doctor but that's just me. My Physiatrist uses his PT to do similar chiropractic stretches (from what I can tell)

    I have the temperpedic bed, pillow under my knees, etc. Not sure if it helps or not. But I do like it.

    I can't tell what causes my increased pain either - no rhyme or reason other than I have a bad back and 2 surgeries.

    What I do like is that the Physiatrist and PT (same practice) are working with me. We work in increments. PT is 2 days/week with the expectation I do the 'homework' 3x/day. The Physiatrist is once every 4 weeks to see if we need to change course.

    Keep me posted. I hope you can get some relief.
  • Hi again,

    This morning my neck felt different in a worse sort of way. I'm terrified this guy is going to make the c5/c6 bulge worse. Not a fan... I feel no different, stiff as a board when I woke up, etc. If anything my upper back felt worse. This guy tried to 'adjust' me several times to no avail. I would not pop and it hurt like hell. I expressively told him no messing with my neck. I felt him trying to pop the thoracic region was scary enough.

    As much as I hate to say it, I'm not convinced about this controversial diagnosis. I read up on MPS today. It sounds like a great way to not be taken serious by a doctor to me.

    I called my PT office and am going armed with their findings next visit. You cannot fake the constant tension, knotting, and fatigue from a back problem. Thinking back on the visit, I believe he believed me, but I do not think he took my pain level seriously. The sleep loss I'm experiencing is getting ridiculous. Before back problems I slept like a baby, easily 9-10 hours. Now I'm lucky if I can sleep 5-6 un-interrupted.

    I completely understand doctors must go by what they see, but I'm not convinced they're missing something. There is a cause of this - My right side is knotted worse than the left, sometimes sciatica, sometimes left foot numbness.

    I'm not going to take 'suffer' as an answer. I'll move on if needed and I want to do whatever proactive approach necessary. These guys are supposed to be there to help you.

    Thanks for the suggestion on the dry needling, etc. I read up on it today and it seems like a great start.

    To my dismay, I tried the lower of the two doses of Cymbalta today (30mg). I was given 2 trials and a script if I like. So far nothing except sweating, feel anxious, and some mild nausea. I also feel kind of weird. I'm scared to try the 60mg during the work week. I cannot risk going to work further zombified. I already feel like the 30mg dose is making me anxious enough I won't sleep well.

    I called an anesthesiologist acquaintance of mine and he said if this guy is accomplished, give his treatments a shot. He also said a couple of guys in his group would be more than happy to stick a needle in my back.
  • It's 1:30am right now, I've been lying in bed trying to fall asleep. I keep feeling all of this stuff going on that I don't normally feel. It feels like sore bones or something. Sore vertebrae it feels like. I keep getting pain pulses, and I've never ever had T spine pain - I keep getting this pulse in the center of my back. My neck is feeling weird too, but not as bad as the center of my back. The connective tissue on the right side is extremely stiff on my neck.

    I'm so frustrated right now, my left foot is tingling with numbness! I've never had numbness in my foot while lying down. I put my trust in this guy and he sends me somewhere that makes me worse. I've got work in 5 hours I cannot express my frustrations.

    I cannot believe I let myself get suckered in to visiting a chiropractor. I've been warned and I still bit. The Pain/Spine doctor sent me to get worse. Wow, this is so ridiculous. I want to scream I'm so angry, I should have listened to my own voice. Had this PM not recommended this, I would have never went to a Chiropractor.

    What in the heck is making my foot go numb if I do not have something touching a nerve? My big toes is the numbest, then moving back toward my heel, kind of on the outside, up my calf, but on the backside. This guy has to be wrong about something.

    Sorry i needed to vent, just really questioning what I've done to myself. I should have never went to a Chiropractor. Dumb
  • Hey there,

    I would not automatically think the Chiropractor is a bad choice. Stress and worry can cause more pain. I know, not what you wanted to hear.

    Have you considered looking for a referral from your primary care physician to see a new orthopedic spine surgeon or neurosurgeon?

    I'm not suggesting surgery, I'm just suggesting maybe a professional medical re-evaluation would ease your mind. And, your chiropractor sounds like he wants to work with the PM doctor so wondering - have you visited the PM Doctor again?

    I sense you just haven't found a medical doctor that you trust just yet. Just keep in mind, most will not even suggest surgery so you may get re-referred to PT again but it's good to start building a relationship with a specialist now. If he says there is nothing he can do, ask if he can help you make a plan. Such as - try PT for 6 weeks, then what? Most will be able to guide you.
  • I did a consult with an Ortho surgeon in 2009. He said no surgery at that time, but he thought I'd be back someday.

    Yes, while I am very stressed out right now, the sleep loss is making things worse. No doubt I feel like I've been stabbed in my thoracic spine and my left foot is numb. Also I'm having spasms all over my back for no good reason. I called PM this morning and demanded (in the nicest possible way) they send me to PT ASAP. It's prescription only in my state. I'm hoping to reverse whatever this Chiropractor did.

    No, you're right - I do not trust this PM right now. He sent me to become 5x worse. I had a darn good handle on my neck pain beforehand, now I feel like it's been reamed. You know the feeling, like your bones are grinding together or something. I went there to consult for Trigger point injections in my Levator scapulae and lumbar region. I have bad trouble with the levator spasming and the lumbar region has been causing elevated pain this past month. I'm kicking myself in the rear because I should have known better.

    Only a few times have I ever hurt as bad as this. Each time the neck was the culprit. The neck and lumbar seem to cycle off of each other. The pain and spasms are slicing through the medication(s). If I don't sleep again tonight tomorrow will be worse. I've got to function for work and it's pertinent that I find a plan of action. I feel like I took 3 steps back this week. I'm really getting the feel that my significant other is sick of hearing about this nonsense.

    Ok, so I'm crossing my fingers that whatever stabbing feeling is going on in my thoracic region is acute. I'm praying that the chiropractor trying to manipulate me didnt make something else bulge or worse. I'm not kidding or exagerating saying it feels like I'm being stabbed. It's very sharp. The crick-like pain in my neck is sharp sometimes too, but in a different way.

    Explaining pain is difficult at best. Each pain type feels different to me. Some pulses, some nerve type, etc. Above is the best way I can describe it.

  • ^^ I'm sorry I know I'm rambling. It's the 3 hours of sleep last night.

    So Tuesday before I went to the PM and Chiropractor, the worst I was having was dull, burning, achey, sore low back pain. Yes it was bad, but nowhere near what's going on now.

    Now I'm experiencing things I've never felt along with spasms seemingly in the both deltoid regions and spread allover in the lumbar region. My foot is numb, it was not Tuesday. I have stabbing pain almost dead center of my spine, slightly higher than center. It's directly in the vertebrae area.

    I'm much worse than when I went in, no exaggeration. I did not start feeling this bad until last night. I slept ok directly after the Chiro visit, though I felt slightly off.

    I might add I'm feeling no benefit from the Cymbalta I've added to medication. It's making me feel slightly anxious.

    Hopefully you can decipher this better than the nonsense above. Please excuse me, I'm low on sleep and extremely frustrated.
  • Do yourself a favor, call your primary care physician or general practioner and ask for a referral to a spine doctor. If you don't need a referral for the spine doctor, call the one you saw in 2009 if you felt like he was good. You can always get a 2nd opinion but 2009 was quite some time ago.

    I think it would help you ease your mind if you saw a spine doctor again.

    I have to say, lack of sleep is painful.
    I have been struggling for 7 months and I just recently started getting a solid several hours (4-6) and it has made a HUGE difference on my ability to concentrate during the day, my ability to remember to stretch during the day, motivation to walk, which in turn helps me sleep better.
  • This is a cut/paste from another thread, but it's my brief medical history. I will look in to going to see a neurologist or spinal surgeon. Someone must have a better idea for a treatment plan.

    Also, after seeing PT on Friday, I'm already feeling 100x better. I'm getting close to getting back to my baseline pain level. PT said he thinks chiro adjustment caused my back to think injury and guard. He said my entire back from neck to butt felt "super tight". He also said he thinks some muscle is super tense and compressing sciatic nerve making my feet go numb. Anyways, that's good news as it sounds like I'll get back to where I was (which wasnt good, but wasnt nearly as bad as last week).

    I'm going to have to address the CP somehow. The lumbar pain was causing sleep loss before the PM/Chiro debacle. I'm giving this PM one more APPT. before I decide to look elsewhere for treatment.

    Oh and I totally feel you about the sleep loss. I'm lucky if I can sleep 4 hours uninterupted anymore. I'm also lucky if I get 6 hours total. I used to sleep 9+ and feel best getting 9 hours sleep. It's unbelieveaable how lack of sleep can make you feel.

    So here's a very breif medical history. I left out treatments, but this gives you an idea of what I've already done. Thanks again, CJ

    Med History
    07/2004 Lumbar pain begins. Didnt have insurance, but it was manageable through PT like exercises.

    12/2008 Developed crick in neck. Crick never went away. Went to a Chiropractor, made me worse. Finally went to the doctor - MRI showed 3-level bulge, c5/c6 being worst. Tried PT several rounds (not sessions). Pain is manageable. Arm pain disappears.

    06/2009 Consult with Interventional PM and also Ortho surgeon. Surgeon tells me C-spine bulge is bad enough that he didnt think I should get injection. Come see him if I want operation. I didnt.

    2009-2010 Much conservative treatment. Insurance bought a "brand name" home traction unit. It works well for stretching,etc. Pain is maneageable and I finally get a handle on dealing with the numbness.

    06/2011 Something happened and all of a sudden my whole back goes in to freak mode. I deal with it for a week, then make appt. with Injection doctor. He orders a Lumbar MRI to see what's going on. MRI reveals a L5/SI bulge, but doctor thinks something else is going on. Orders more PT. I do the PT but PT person tells me otherwise. I never return to PM. doctor.

    01/2012 Cervical pain is manageable, lumbar pain really starts bothering me. I deal with it a while. Levator muscle begins spasms again, my whole back goes in to bad mode again. I decide enoughs enough and I'm going to go consult for injections again.

    03/06/2012 I go see PM on Tuesday. He looks at my films, tells me Lumbar is caused by MPS - Disc is not making this pain. Also tells me he thinks injection in to levator muscle will further flare it. Go see Chiro for stretch on special table. Have them do soft tissue work. I do exactly what he said and this guy hurts me. I call Thursday morning and tell them what happened, I demand (in nicest possible way) that they get me in to PT ASAP to try and fix whatever happened. I was not taking no for an answer. I'd have been on the horn with PCP if they said no to PT.

    3/9/2012 - Went to PT, already feeling better since Tuesdays debacle.
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