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Q. I have a continous left lower back pain after an injury. Please help.

Answered by
Dr. Sumit Chawla
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Mar 18, 2017 and last reviewed on: Jul 26, 2021

Hello doctor,

I have had a lower back injury for three years, and that has not been improved with rehabilitation or anything. There is a constant pain in the left side of my lower back, which becomes worse on twisting motions, exercise and bending to the point where I can barely walk. My physiotherapist believes it is an injury to my left iliolumbar ligament between my spine and my left hip bone. I have attached my files, and I was wondering if you could take a look at my MRI and let me know what you think it is?

#

Hello,

Welcome to icliniq.com.

  • Your iliolumbar ligament is completely visualized and is free from any pathology in the MRI (attachment removed to protect patient identity). Your vertebra, intervertebral disc, spinal column, and spinal cord are also grossly normal.
  • However, there is early facet arthropathy at multiple levels, prominent at L5 with mild ligamentum flavum hypertrophy, which is the cause of your lower back pain.
  • I suggest you consult with your specialist doctor and try taking a muscle relaxant and short wave diathermy along with physiotherapy for pain relief. In the case of no assistance with this conservative treatment, local Cortisone injections can be applied to individual facet joints.

For further queries consult an orthopaedician and traumatologist online --> https://www.icliniq.com/ask-a-doctor-online/orthopaedician-and-traumatologist

Hello doctor,

Thank you for your answer. Unfortunately, that is not what they told me in the MRI report. But I do not understand if it is the facet arthropathy or ligamentum flavum hypertrophy that is causing the pain And why my pain has gotten worse now?

#

Hello,

Welcome back to icliniq.com.

  • I have discussed your case with a radiologist, according to both of us facet arthropathy can be the cause of your back pain. You should consult an orthopedic surgeon for clinical evaluation if the pain is not resolving from the past three years.
  • Besides your MRI reports are taken a long time back, so we do not know for sure if your condition is the same or worsening now. You should get both clinical and radiological evaluation done again.
  • To help you out with your condition, please let me know a few things. Since how many days has your problem worsened? Do you have any tingling, numbness or radiating pain in the lower limbs?
  • Does the pain aggravate on bending backward, coughing, sneezing or bending sideways? Was there a period of increased activity or unaccustomed lifting heavy weights before worsening of pain? Are you involved in any sports? Have you taken any supplements, steroids or recreational drugs of abuse?

Revert with more information to an orthopeadician and traumatologist online --> https://www.icliniq.com/ask-a-doctor-online/orthopaedician-and-traumatologist

Hello doctor,

Thank you for the reply. Are you suggesting to get MRI done again because my injury has become worse? The pain has worsened since the injury happened. So, throughout the three years, it has become worse every week. I have no tingling or numbness in the lower limbs. The injury occurred during a kickboxing training session where I felt a pain in my left lower back that got worse every time I kicked sideways with my left leg to the right. I slowed down my workout intensity, but the pain just got worse. The pain went from not being able to maximize my training sessions to barely completing my warm up. That was 2 to 3 years ago, and I have since then fully dedicated myself to rehab and strengthening of the core, but the pain just keeps getting worse. I take walks every day but even when doing that I feel the pain. I have tried NSAID, and it felt little better, but the pain got back when I stopped with that treatment. The pain becomes worse when I bend backward and forward, as well when I am sneezing. I have not taken any steroids or injections yet.

#

Hello,

Welcome back to iclinq.com.

  • Any spinal pain that is refractory to 6 to 8 weeks of conservative treatment requires clinical and radiological evaluation.
  • The first investigation is always x-ray spine to rule out the gross bony pathology even if we suspect nerve root irritation or disc prolapse, which will be evident only on an x-ray.
  • The second investigation is usually MRI if we suspect disc prolapse or nerve related symptoms and CT scan if there is a bony pathology. Clinical examination has a vital role as at times MRI gives false positive results which are ruled out by the clinician.
  • You have been suffering from lower back pain for past three years, and my recommendation is to visit your local orthopedic surgeon for clinical evaluation before going for any investigation.
  • Sometimes pathology in the sacroiliac joint (SI) or hip may also give rise to lower back ache, which is also determined by clinical examination before ordering x-rays.
  • At times young males with early morning stiffness of back or lower back pain, on clinical examination, pathology is detected at the SI joint level as sacroiliitis or ankylosing spondylitis which is entirely different from the lower spinal pathology.
  • You do not have any specific symptoms to point towards a provisional diagnosis apart from an aggravation of pain on sneezing, which is present in patients with posterior intervertebral disc prolapse and ankylosing spondylitis.
  • But, if you are reluctant to go to an orthopedic doctor, but can get an x-ray done, then you can follow-up with following reports.
  1. X-ray of the lumbosacral spine - anteroposterior and lateral view.
  2. X-ray of the pelvis with sacroiliac joint - anteroposterior view and oblique view.
  3. HLA B27 testing.
  4. MRI might be required later.

Revert with more information to an orthopaedician and traumatologist online --> https://www.icliniq.com/ask-a-doctor-online/orthopaedician-and-traumatologist



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