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avoiding pain and avoiding flexion

tknow1978ttknow1978 Posts: 30
edited 06/11/2012 - 8:44 AM in Lower Back Pain
Hi, I'm relatively new to posting here. I've commented on some others posts, but this is the first i've started.

I'm very frustrated after seeing the doctor today. I love my GP, but... Long story short I think he is afraid to send me to PT, which I can appreciate, but when I ask questions about appropriate types and levels of activity his response is to tell me to avoid anything that causes pain. So I tell him that if I do that then I will spend most of my time on the couch and I doubt that is doing me any good in the long run. So he then says well you need to be walking and I tell him that I get on the treadmill and can walk a bit then I get off and sit or lay down and then later try to walk again later. (BTW it takes me 10 min to walk 0.2 miles and I normally work as a nurse walking quickly up and down halls for hours so this is a huge decline in activity level)And so then he says he wants me to walk a lot, but walking is the most painful activity/position for me. I'm just confused. Avoid pain/activity or push it and work through the pain. The same goes with flexion. I'm told to avoid it, but if i stand up straight it really hurts. And as I walk farther i tend to lean forward or hunch over because then my leg hurts less. unfortuneately if i walk much bent forward then my back gets tighter and tighter. and by the way pain meds dont work much and certainly dont improve my level of function. My biggest fear is that i will do something to worsen my back, because i tend to push through the pain too much sometimes and pay for it. I've made myself start protecting my back, but im confused about what to do. I can't have surgery right now on my back. I have already had L4,5 microdiscectomy 09/08, L4,5 laminectomy 12/08 and my doc said he thinks i will have another failed surgery if i dont lose weight before i have a fusion. I have had multiple ESI's and I am prescribed percocet and ultram. Any advice would be appreciated.


  • My advice would be to seek a second opinion with a board-certified physiatrist. You're a nurse so you may be familiar with the speciality, and since you have had ESI's you may already have a physiatrist?

    I think a physiatrist could really help you by giving you more specific guidelines about activity and the do's and don'ts for your specific condition. Physiatrist are also usually excellent diagnosticians. I'm not sure if you know specifically what is causing the continuing pain, but I think narrowing that down so they know what they are treating would be helpful.

    A lot of times the more protective we get with our biomechanics the worse it can actually make things. Physical therapy has always helped me break out of that protective mode and helped me define what I can and can't do safely, so if your doctor thinks it's appropriate that could be a good idea. A physiatrist will also be able to help with non-surgical pain management to make sure your pain is adequately controlled. To me it just sounds like you need a plan for how to manage this, and I think a physiatrist would be able to help you with that.

    Good luck, and welcome to the boards :)
  • ok this probably sounds dumb, but what is the difference between a physical therapist and a physiatrist? Is a physiatrist a medical doctor or like a chiropractor? My pain management doc has a rehab person in his office but he never suggested this as an option for me. My GP and neurosurgeon both thought chiropractics to be a bad idea. My pain is from the L4,5 herniation. Thanks for your suggestion.
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  • Sorry to hear about pain while exercising. Yes a Physiatrist is a medical Dr. I was sent to a PT to help with strengthening exercises but just started aqua therapy with my PT and it's better to exercise in the water in a heated pool. Don't know if that's an option for you if you can find a rehab pool near you?

    At first when I had a herniation the Chiropractor wouldn't touch me except to do a TENs treatment or massage and some minor exercises. When I went to the Physiotherapist she told me I shouldn't be doing flexion exercises so I don't go to Chiro anymore. I hope your Dr. can get you a referral to a PT. What does your Surgeon think about Physiotherapy?

    I also use a cane while walking for exercise and for a time I used a rolling walker with a seat to take needed breaks while walking. Maybe shorter more frequent walks may be better than pushing yourself to walk too far. Just my opinion and not medical advice. Take care. Charry
    DDD of lumbar spine with sciatica to left hip,leg and foot. L4-L5 posterior disc bulge with prominent facets, L5-S1 prominent facets with a posterior osteocartilaginous bar. Mild bilateral foraminal narrowing c-spine c4-c7 RN
  • A Physiatrist is medical doctor who specializes in rehabilitation.
    A physical therapist is not a medical doctor. but specializes in the study of muscles and their funtion.

    Depending in the area that you live in, you may not have access to a physiatrist, but you could have access to a pain management. Often the pain management doc is a physiatrist or an anethesioligist that specializes in pain!

    Either way, you just want someone to manage your pain!

    wishing you the best!
  • My pain doctor is a physiatrist, if that helps with the confusion any :). You know, sometimes they just don't know. It's so hard- I've had a heck of a time too.

    Could you ask about a recumbent bicycle? They might have that at the PT. That's a way to move your legs without the weight bearing. Just a thought :)
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  • I also use a recumbent stationary bike now for 2 years. It's helped with mobility and decreased leg edema I had and helped with weight loss also. Charry
    DDD of lumbar spine with sciatica to left hip,leg and foot. L4-L5 posterior disc bulge with prominent facets, L5-S1 prominent facets with a posterior osteocartilaginous bar. Mild bilateral foraminal narrowing c-spine c4-c7 RN
  • tknow1978,
    It is thought that inactivity can create problems in itself and it is a balance between finding what you can do and what to some extent increases the pain for you, we sometimes set off doing exercise at great pace and the associated increase of pain we relate to activity itself, the key is to pace into it.

    Some days you will be able to do more than others and it is for you to determine what make the pain worse or better, it is hard not to take things literally and many here have that experienced over being hunched over to reduce the pain, is it down both legs. It is never easy when the nature of you job relates to the need to walk effectively.

    Trying to increase activity is a constant theme on this site and everyone finds it difficult, they have tried and keep trying to find any activity that helps, as the pain increases and the restriction of immobility takes effect. Try to do what you can, when you can and be kind to yourself, once pain impacts more on our outside existence trying to cope gets increasingly difficult.

    The first objective from my pain management team was to increase all our activity levels and function, in whatever aspect all achieved some improvement, we all worry that it will make things worse and many here are examples of just what activities can be achieved with the right and supportive environment, it does take time and skill.

    Look at the things you can do and set small achievable goals that will help you feel confident that in moving towards the next step will cause no addition harm; this is more of the thinking, than the doing.

    Take care and keep trying.

  • I think part of the problem is that it is just sinking in that this is probably something I will hve to deal with at some level for the rest of my life. I thought having to have a second surgery was just a fluke, just bad luck or risk of first surgery. When I saw my GP had written lifelong for duration on my STDisability papers, I started crying. I hate that. So even though I have had back problems for a couple years, I find myself now more frustrated, anxious etc. than ever like its something new to deal with. Sometimes I have unrealistic expectations, thinking that there is some particular way to do things that will make it all better or keep it from getting worse. Maybe there is, maybe there isn't. I just have to remind myself that I have to try to live and not worry so much about what might happen. I have enough to deal with in the present. you are so right about pacing myself - physicaly and emotionaly. Thanks for the words of encouragement. I,m gonna fight this, but I guess i just better pace the fight.
  • I think quite a few of us have been where you are with the dilemna that if we don't move too much the pain stops, but then if we don't move enough everything stiffens up and gets worse! Catch-22. I think it's so individual (i.e you could have the exact same injury as me, but experience the pain in different ways) that only you know what is right for you apart from overall advice doctors and experts can give. For me it's kind of 20 minutes of 1 thing then 20 minutes of another - standing too long hurts, but then sitting too long hurts and so on - so I've managed to keep working until the last couple of months for several years by learning (automaticaly now) to move every 20 minutes even if it's only down the corridor to the photocopier and back, instead of doing it all in one go, I'd copy a couple of sheets and go back a bit later and do others, which broke up sitting at my computer - that sort of thing. Some movements you *do* have to avoid altogether if they are simply too painful. I know various physiotherapists over the years have told me not to worry about making things worse, but then also say "within reason" - well, where does that leave you? And that's the difficulty I think, our conditions despite having the same name can be so individual that you have to come to a compromise between the advice you are given and what *you* can actually live with. The person giving you the advice, doesn't feel what you are feeling, so it's difficult for them really. You will come to a compromise that works for you, and things will be a lot better - we just have to learn acceptance about some things, and for some of us that really is hard. I still find my stupid male ego gets in the way for example when having to ask for a hand lifting something I'd have managed easily with in the past. But you'll get there. :)
  • A few thoughts on your post. First off you must have a surgeon somewhere in your list of doctors and probably a neurologist as well. Why would you be seeing your GP about your back problems? I barely trust my GP for a sinus infection!

    Physiatrist seems to be a regional term. For a long time I thought it was an English term but now I see they are in the US as well.

    If weight is stopping your surgery then you need to get active. Only safe way to do that is with PT guiding you.
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