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Weird Case of Lower Back Pain that Simply WILL NOT HEAL - Suggestions Please!

Hello all, my name is Casey Brown and I have been suffering from debilitating back pain since about Jan. 2012, or about 10 months. The nature of the original injury is unknown - could be due to training martial articles where I might have hyper extended the joints of the spine, not quite sure.

Anyway, my case is quite weird because according the MRI, my spine is nearly perfect, except for some "mild facet joint athropathy" - basically, the lower three facet joints on both sides are very irritated and inflamed, giving symptoms similar to arthritis (I'm 24 years old btw). According to the MRI, the irritation was "mild", and everything else seems to be tip-top - the discs are great, no ligament or muscle damage, etc. However, the pain is QUITE SEVERE. I can't sit or stand for more than about an hour without experiencing a huge flare up of pain and inflammation, as well as a reactive muscle spasm.

As I said earlier, the first onset of pain was back in Jan. 2012. From Jan to Feb I kept on with my daily activities, and kept training martial arts.I gave up martial arts and stopped working out altogether for the next four months (probably a very bad idea but I didn't know any better), and began resuming light to moderate exercise in July to present (approx. 3 months ago).

I have done EVERYTHING in my power to fix this, but it just refuses to get any better. I've seen personal trainers, physical therapists, 2 orthopedists, 2 chiropractors, regular doctors, and even tried acupuncture. I am doing all the proper corrective exercises and stretches I know of, and keep good posture throughout the day and when seated, but alas, nothing ever gets any better.

I did a round of facet blocker injections in my back yesterday to see if RFA (radio frequency ablation - a procedure that kills the nerve endings in the fact joints so they can't send pain signals) would be a good option, however, sadly, the injections provided little to no relief, meaning the RFA wouldn't help much. I am stilling considering going through with it, because some of the pain I felt after the injections could of just been skin pain at the injection site, but I dunno - I am pretty depressed because I thought this was the answer.

What should I do? Has anybody else had a "mysterious" case of lower back pain that just simply would NOT go away no matter WHAT they did? I am losing my mind here - I just want to move on with my life so badly. It's so hard, I want to give up sooooo badly. Every single day I am in pain. I can't work, I can't go out to bars, clubs, etc. and be a regular kid - the pain is too severe after about 30-45 minutes, there is always a HUGE flair up of pain. I need to ice/lie down within an hour max of any activity.

I'm at a loss - should I do the RFA? Would that be a waste of time? The ONLY thing that looks wrong is the facet joints, yet they just seemingly WON'T HEAL. This is the only thing that gives me SOME hope that RFA will work, even though the results from the injections didn't seem to help much at all.

Suggests and advice welcome! Thanks.


  • Hi Casey, you have arrived in the right spot. There are so many people on this site that will share their knowledge and experience with you. I can tell you through my own experience that not everything shows on an MRI...your body is the best indicator of pain. I had many things show on my MRI's over the years...but I can tell you that my surgeon was totally floored when he got in...the entire right side was a mess, my discs were mush at 3 levels...none of this showed on any of the MRI's, and I think there were 3 in the previous 18 months. Do your research, find good doctors willing to listen to you and not just read a diagnostic test to you. I am fairly new to this site...I have an ounce of knowledge and/or advice compared to what you will find on here. Stick around, read posts and article, something might click...again, your body and pain is the best indicator of a problem....I wish you the best in finding a solution! Peace, Ellen
    3 level fusion L3-S1 July 23, 2012
  • brvsfan99bbrvsfan99 Posts: 113
    edited 10/05/2012 - 3:01 AM
    I agree with Ellen. Be persistent. Not everything always shows on the MRI as my discogram proved. My MRI said no tears in any discs and my discogram with CT showed that my disc had both anterior and posterior tears and was almost non-existent. Something is causing you pain. I don't think you are making it up. Well maybe you are, I don't know. Just kidding. ;) ;-) :wink:" alt=":wink:" height="20" /> Hopefully I got a smile out of you. Keep doing your research and reach out to people on this site. We are more than willing to share our experiences, both good and bad with you.

    Single level L5/S1 360 fusion with 6 screws and a rod (10/29/12)
    Diagnosis: Grade 1-2 spondylolithesis, Pars Defect, L5/S1 disc tear anterior and posterior, DDD, spinal stenosis
  • MballardMMballard Posts: 101
    edited 10/05/2012 - 8:31 AM
    My buddy, Ellen, summed it up pretty succinctly. Keep pushing for answers. Don't give up. I'm thinking maybe if those facet joints are inflamed, it could be what's irritating those nerves at those levels. I didn't get much relief from the facet blocks, but I went ahead with the RFA anyway, in the hopes that it would do something. Sadly, it didn't work. But I'm still glad I did it. Maybe a provocative discography would help to pinpoint the exact location and nature of your pain?

    I know it can be incredibly frustrating not having answers. And when doctors imply that you are faking it because they are too inept or too lazy to keep digging, well, it just sucks. If you need to go to another doctor to get somebody to take you seriously, do it. Be your own advocate. You know something is off, so don't give up until you find out what it is!

    Best of luck to you, dear!
    L5-S1 Fusion, Discectomy on 7/10/12
    Herniated Discs at L3-L4-L5-S1, Spondylosis, Spondylolethesis at L5, DDD, Partial CES, Lumbar Facet Arthropathy
    Chronic back pain since 12/2010 (slip and fall on ice)
  • I already love this forum because here I can find some of the few people in this world who truly understand. Thanks for the support.

    I opted to go through with the RFA which I will have in about 5 days (I'll keep a journal of my experience for other members) anyway on the simple premise that things can't really get any worse. I hear that the nerves feel "sunburnt" and really hurt for about a month but that won't be anything out of the ordinary. I'm going in with low expectations so like I said, if it doesn't work, no biggie.

    Should I opt to have a CT scan as well? And a discography? Already had an MRI and x-ray.... I'll ask them about it. Although my pain management guy is kind of a prick (short, non-sympathetic, attitude, etc.) but my orthopedist seems a little more understanding, so we'll see what happens... Wish I knew what the problem was!
  • DaveFusionDDaveFusion Posts: 476
    edited 10/05/2012 - 8:39 PM
    Similar to what's been said, my mri's did not show all that the surgeon found during surgery. MRI also require very skilled radiologists to interpret them properly. I once had a very skilled surgeon seek a second opinion from a trusted radiologist colleague because he said that they can sometimes be difficult to read and wanted confirmation.

    Additionally, one should be able to trust and work cooperatively with ones Drs. If one can't then it might be time to move on to find a better one. Your PM doesn't sound ..... Hmmm, cooperative.

    So keep researching the subject, so you can interact effectively and keep seeking Drs that are willing to keep working with you until the solution is found.

    All the best,
  • Just be prepared if you do go through with this test or it is ordered, it is going to hurt. Between that test and the CT that was done after, a more complete picture was produced of exactly what is going on inside my back. I hated it but I know that having it done has and will assist my surgeon.

    I didn't mention in my other post that I also had RFA. For me it worked for about a month. After that the pain came rushing back, more extreme than before :( But everyone is different and I hope it works for you. Keep us updated.

    Single level L5/S1 360 fusion with 6 screws and a rod (10/29/12)
    Diagnosis: Grade 1-2 spondylolithesis, Pars Defect, L5/S1 disc tear anterior and posterior, DDD, spinal stenosis
  • I backed out of the surgery (RFA) to give a little more time to heal naturally and also try an alternative treatment, prolotherapy. Lot's of people on this board have probably heard of it, but in case you haven't, prolotherapy is procedure where they inject some kind of "irritant" that triggers the bodies natural inflammatory and healing processes, geared towards repairing soft tissues such as ligaments, tendons, cartilage, etc. that under normal circumstances, take FOREVER to heal due to lack of good blood supply. It's efficacy is controversial, but it is very low risk (the only thing it can hurt is your wallet). I am currently in the process of trying to get insurance to pay for it. We'll see what happens and I will update this thread with new developments as they occur! Thanks for the support guys and gals :)
  • Be interesting to see how this goes with you.
  • I definitely want to hear how this works out for you! Keep us posted and good luck!
    L5-S1 Fusion, Discectomy on 7/10/12
    Herniated Discs at L3-L4-L5-S1, Spondylosis, Spondylolethesis at L5, DDD, Partial CES, Lumbar Facet Arthropathy
    Chronic back pain since 12/2010 (slip and fall on ice)
  • Hi Michelle ! Hee hee ! lol I don't mean to follow you around but you're everywhere! :)

    Finding the proper care is very important. If you aren't getting good vibes from someone , try to move on. There are many good therapists out there but some not so good.
    Your back problem sounds unique where nothing is showing up on the tests so far, but don't give up !
    If you want to talk about pain, this is definitley the place! It does help to tell your story and hear others......Good luck to you!

    Different degrees of back pain since 1994
    Cortisone shots Jan/09
    Discectomy and lamenectomy April/09
    L5 - S1 spinal fusion July.13th/12
  • Sally711SSally711 Posts: 156
    edited 10/10/2012 - 8:53 AM
    I have L5-S1 issues. I had two MRI's, *(laying down), which showed not too much. words like "mild" were in the final report- and my GP didn't think I should be in the pain I was/am.
    So, I found out about another MRI machine, called "Dynamic" MRI- basically, it does the imaging while standing or sitting- hence showing the actual compression of my injury....
    This Dynamic MRI showed a large herniation, compressing in bad spots which my GP then believed! After 2.5 yrs of crapolla... another story!
    So, just because an MRI doesn't show a 'real' problem, it could be there.. just not when you lay down.
    Hope that all made sense!
    I am interested in the prolotherapy too- and very hopeful for you! Getting early treatment is key to overcoming injury. One thing I sure wish I listened too.. MY BODY! It told me, over and over, by pain.. that things were not good. I didnt' listen.. I pushed, and pushed myself... and now get to pay the piper. Great analogy! lol.
    As others have said, this is the right place to be for information and support. Best of 'luck"... don't know what else to say there.. but thinking of you, and all on here, and so hopeful something works for ya! Keep positive!!!!
  • If only this method was more widely available! Many back issues would be diagnosed earlier and better. It's good to hear that Sally got a good result from it - although very late.
  • Casey BrownCCasey Brown Posts: 8
    edited 10/11/2012 - 12:22 AM
    Yikes - Okay, this worries me. Why are doctors so clueless as to the causes of back problems? And why do they think it's mild, despite what we tell them, just because the MRI doesn't show much - even though it should be common knowledge that what an MRI's reveals is FAR from the fully story?

    I'm going to call my doc first thing tomorrow and order up a dynamic MRI. Sheesh, is this all I needed to do back in February to convince them that I was, in fact, in pain?

    Sally - did you have symptoms of sciatica? Because I never get any shooting pains down my leg/buttock, but prolonged periods of sitting are the WORST.... I'm thinking this points more to a disc issue than ligament issue? Lol I'm getting paranoid...

    I'm so confused now - facet joints, discs, ligaments - what the heck could it be? At least if I KNEW what the problem was, that would make me feel better! Here are my symptoms:

    -Pain is worst when sitting
    -Activity seems to relieve pain
    -Prolonged standing in one spot causes back to slowly "go out", resulting in painful muscle spasms, etc. kind of like sitting but takes longer
    -Frequent muscle tightening/muscle spasms
    -Really stiff in the morning
    -No shooting pain/sciatica issues...
    -Flexion seems to bother me more than extension - although stretching with flexion (i.e. knees to chest) when the muscles are tight feels good, but bending to pick up an object doesn't feel so great.

    Doctors seem to think it's musculoskeletal issue (for what that's worth, lol) and all the MRI shows there is some "arthritis" in the lower lumbar facets (I'm 24 btw)...

    The plot thickens. Hoping to one day get to the bottom of this mystery some day...

  • It's hard to diagnose back problems because the spine is a complex beast. So many issues have symptoms that mimic or overlap with other conditions, that even with the best imaging tests it can still be hard to pinpoint one problem. My neuro decided to attack the worst of my 3 herniated discs with surgery, but wanted to just stick with a one level fusion and discectomy; he warned me, though, that it might not actually be what looks like the worst level that's causing all of my pain, and there would be a possibility of having to open me up again to fix the other 2 levels at some point in the near future.

    You'd be surprised at how bad that arthritis can make you feel, so I wouldn't rule it out just yet. Even though you're young, you can still have a bad case of arthritis. Does the dr have you on any kind of anti inflammatory med to see if that might help? Might be worth a shot, and definitely way less invasive than surgery or injections. Just a thought.
    L5-S1 Fusion, Discectomy on 7/10/12
    Herniated Discs at L3-L4-L5-S1, Spondylosis, Spondylolethesis at L5, DDD, Partial CES, Lumbar Facet Arthropathy
    Chronic back pain since 12/2010 (slip and fall on ice)
  • PostACDFPPostACDF Posts: 23
    edited 10/11/2012 - 10:31 AM
    Hello Casey,
    Im sorry about your suffering. Sounds to me you should try to find the specialist that can find or pin point the source of your suffering.
    Sometimes injuries in the upper spine/neck can sent pain to the lumbar area without any major symptoms in upper body.
    Your lumbar spine might not be the only pain generator even thou it feels horrible. Many times drs will not tell you about other injuries that could be contributing to your low back pain unless You report it to them as symptomatic. Its frustrating to say the least, but maybe finding good spine specialist or neurologist who would not simply pick up from where last dr left you but start over with proper tests, and reviewing actual MRI scans and not just the report. I hope you feel better soon, and good luck!
  • You need to be sure to report all symptoms, even if you don't think they're related. I waited weeks before telling the dr about my leg pain because I thought I was causing it by the way I was walking to guard my lower back. Turns out it was nerve pain from the back injury. I had no idea at that time that a back injury could cause pain in my legs and I thought it was totally unrelated, especially considering the fact that I also sprained my knee when I fell and messed up my back.
    L5-S1 Fusion, Discectomy on 7/10/12
    Herniated Discs at L3-L4-L5-S1, Spondylosis, Spondylolethesis at L5, DDD, Partial CES, Lumbar Facet Arthropathy
    Chronic back pain since 12/2010 (slip and fall on ice)
  • CoyoteCCoyote Posts: 120
    edited 10/11/2012 - 2:40 PM
    Hi - I wanted to ask a few questions about your situation -
    You said in your first post that you just had "a round of facet block injections YESTERDAY" - do you mean facet joint STEROID injections. I ask because I have had the facet joint steroid injections, and I wanted to let you know what my Dr told me about these. Were these done with fluoroscopy (I believe this is a kind of "live" x-ray, that guides them when they put the needles in)? Also, usually these injections are done at multiple levels (although my damage is only at L4-L5, they gave them at three levels, a level above and a level below. They also usually give them on three separate occasions, spaced out a week or two in between. When you have the steroid injections, it can often take 2-3 days for the steroids to kick in (and it took me several days to recover from the injections themselves). I was told that whenever people have steroid injections, to try to be as still as possible for a couple of days afterwards, so that the "medicine" can bathe the affected structures better. Anyway, that was what I was told - so I'm confused about what you said about having them YESTERDAY, and they hadn't helped you. The pain management dr who did my injections said that after all this had been followed, they would determine the effectiveness of the injections, and then consider RFA.

    For people who have mechanical pain (exacerbated by pressure - standing, sitting; or movement), particularly when they haven't worked out the cause of the pain, I would also steer clear of chiropractors (adjustments - and even massage), and also be careful about physical therapy. I have had severe, chronic, intractable pain for 5 1/2 years now - and had four sets (4 x 10 sessions) of physical therapy - and because my pain is made worse by repetitive activity - I always found physical therapy just made my pain worse. The best exercise for me is walking (short walks - with rest periods), floating in the water (swimming hurt my back), a few stretches (without repetitions).

    Anyway - all the best - keep searching to find out what works best for you - to improve your condition, to manage the pain. That's the other thing - if you can't find answers right away from surgeons etc, I recommend a pain management doctor in the interim. And the spine is extremely complex - like a primitive brain (and not so primitive really) - like staring into the universe. Pain pathways are possibly the most complex of all - that's why many of us are here - for all the treatments and surgeries there just haven't been any answers (but you do learn to manage things, using multi-modal approaches). Sorry - don't mean to be a bummer - you are young, and many people have found answers. I'm a chronic, and I'm older than you - so - don't give up hope! Be careful, and look after yourself. Keep optimistic! And for all my pain, my life is not "hell" - I still enjoy my life, and so can you. Take care.
  • Maybe fluoroscope is only for ESI
  • @Coyote

    The facet injections were guided via fluoroscopy, however, they were not STEROID injections - merely lidocaine.And yes, they were done at multiple levels. It didn't really work very much at all, which is why I decided not to do the RFA. And I like your positive outlook. I know I am not handling as well as I could be. It's just really tough to find joy in life when you basically can't leave the house. But I guess I should count my blessings - things can indeed be much worse.


    I have some pain in my right knee as well that is exacerbated by running/walking as well. I think I am out of alignment, my posture has been poor for so many years I am probably putting a lot of undo stress on other parts of my body to compensate for the poor posture. I'll be sure to mention it next time. The body is one kinetic chain - everything affects the other.
  • Exactly how do you do that? How do you work if you cant walk? Im pretty much stuck in the house because i can't even go to class. (not to bee too dramatic)

    Also did the L4-L5 injections help you a lot? for how long? I have DDD in my L4-L5 and was considering getting them but don't have insurance so not sure. If i get them will I be able to walk (really walk) again? I cant walk up hills either did that happen to you? As well as pain going down legs?
  • @jaimee

    How do I do what? Run/walk? Actually, movement feels really good (up to a point) and it's sitting or standing in one position that makes it start to flare up. Everyone's case is different, but I think this is actually MORE common than the opposite (which would be activity/movement making the symptoms WORSE).

    Anyway, the injections didn't do much at all. MAYBE a 25% reduction in pain but that could be placebo. Plus the skin hurt at the injection site, and nerves felt a little "irritated". These were injections only to a few choice nerves in the facet joints, not to the discs. If you have DDD, they don't do this kind of procedure, they do something else, like an epidural, etc. GET HEALTH INSURANCE ASAP! If you can't even go to class I'd get this handled ASAP. My pain, AS FAR AS I KNOW, is not discogenic - meaning I don't get sciatica, etc. And walking feels good. You really should get insurance and look into the McKenzie method for disc related pain. Also, get MRI's and some GOOD doctors who actually show compassion.
  • I too had an MRI that didn't reveal much. My neurosurgeon ordered a discogram and that gave him a much clearer understanding. Long story short, after nearly 6 years of excruciating pain I had a three-level lumbar fusion L3-S1 on 10-03-12! I knew when i woke from the anesthesia that the Dr. had fixed me! I would be happy to talk more about it, if it would help you! Hang in there...you know your body the best!
    2007 and 2010 L4-S1 Microdiscectomies; helped for a total of 3 years between the 2 of them.
    08/2011....pain returned.
    10/03/2012....back reconstruction L3-S1...large titanium "seperators" were put at each level with synthetic bone graft material.
  • Jerome001Jerome001 Cocoa Beach, FloridaPosts: 118
    Casey, I would ask the docs to try all the less invasive options including the burning of the nerve roots, there is also the freezing of the roots options and I'm sure lots of others that I don't recall. I am not a doc but what you describe sounds similar to pain I've experienced and was told it was nerve related. Unfortunately, a lot of the procedures that may offer relief end up not providing any relief but they do help the docs to rule things out and determine the cause. Yes, it is frustrating, especially so I imagine at your age. Getting better will take lots of patience. Best of luck to you. Jerome
  • Casey BrownCCasey Brown Posts: 8
    edited 10/17/2012 - 10:33 PM
    Thanks again all for the support and helpful advice.

    I don't want to jynx it, but I took a young lady out to dinner the other night and made it half way through the date before I broke down and had to pop a norco (painkiller)!

    For some reason I have been feeling better lately - I attribute this to meticulously watching my posture and stretching the lower back (flexion), which seems to control the muscle tightness/spasms. My new theory is there was a hyper extension of the lower back which strained the ligaments and/or other soft tissues, particularly the ones that connect the facet joints, and because I stopped all activity for nearly 4 months, the ligaments have started to heal in a tightened state. This makes me prone to tight, painful muscle spasms that start as nagging and annoying but steadily grow to be excruciating if I refuse to lie down and ice.

    Anyway, there is still some damage to the lower back area and I certainly don't want to jynx it, but I feel I may finally be on the mend. Will schedule prolotherapy for Monday, and I'll probably create a new thread to keep as a journal of my experience.

    Thanks again everyone, and I shall keep you guys updated!
  • He used Kinesio Tape. It's a very stretchy elastic tape, and it's applied stretched out while you are flexing/stretching the damaged/weak muscles. So then when you un-stretch, the tape contracts, thereby contracting the muscles. Might be something to look into - apparently its used a lot in sports medicine.
    L5-S1 Fusion, Discectomy on 7/10/12
    Herniated Discs at L3-L4-L5-S1, Spondylosis, Spondylolethesis at L5, DDD, Partial CES, Lumbar Facet Arthropathy
    Chronic back pain since 12/2010 (slip and fall on ice)
  • I have used KT Tape on my lower leg and ankle. I haven't tried it on my back but I can tell you it helped me alot with my soleus (sp?), the part of your calf that runs down the outside of your shin bone. It calmed it down therefore when I did do some exercising it did not tighten up nearly as bad.

    Single level L5/S1 360 fusion with 6 screws and a rod (10/29/12)
    Diagnosis: Grade 1-2 spondylolithesis, Pars Defect, L5/S1 disc tear anterior and posterior, DDD, spinal stenosis
  • MballardMMballard Posts: 101
    edited 10/22/2012 - 6:51 AM
    Got some fresh K Tape on my back today! Last time the PT applied it in sort of an "H" shape; today we tried an X with a horizontal piece through the middle. Already this new pattern feels tighter, so hopefully this will help with stabilizing those lumbar muscles. It's really fascinating stuff, this kinesiology...the more I research it, the more it makes sense.
    L5-S1 Fusion, Discectomy on 7/10/12
    Herniated Discs at L3-L4-L5-S1, Spondylosis, Spondylolethesis at L5, DDD, Partial CES, Lumbar Facet Arthropathy
    Chronic back pain since 12/2010 (slip and fall on ice)
  • My story is basically the same as yours Casey. I don't know what to do. RFA hasn't worked.
    Has anything helped Casey???
  • straccmsstraccm Mississippi Posts: 1
    I have very similar symptoms (26 years old as well). Nothing helps, it won't heal, physical therapists and chiropractors don't know what to do. Curious to hear if you recovered. 
  • rickerwrrickerw IndonesiaPosts: 1
    I have exactly the same symptoms as Casey and have had on and off for many years. Usually my back heals in less than a week but this time it is taking longer. Exercise used to help but I am not sure about that anymore other than walking and stretching. These issues are so strange I find, so complex. But when you live in fear of your back the quality of your life suffers...
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