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What Causes Radiating Pain In Lower Back To Sacrum Area And Difficulty Sitting?
Question: Hi Dr Mascarenhas,
You answered a question of mine last week after reviewing my MRIs - please let me know if you can't locate those details. After closing your question my doctor referred me to a Nuerosurgeon who has now said all the symptoms of my lower back pain ( of 10 months post-hysterectomy) and my MRIs indicate I have "disocogenic low back pain' and has indicated the chronic pain has resulted from me being a symptomatic prior to surgery but now 10 months on it is unlikely my symptoms will improve and I may require surgery to replace the disc in order to get me back to functioning normally again. I am unable to sit for longer than 5-10 minutes and stand longer than 40 minutes so he regards that as not functioning well. I think your option was that surgery wasn't needed and concentrating on abdominal and core strengthening exercises would be the answer ( which I have already started). I'd like to hear your thoughts/opinions on what this diagnosis of disocogenic pain?
Many thanks and you need the link to my MRIs again please let me know.
XXXX
You answered a question of mine last week after reviewing my MRIs - please let me know if you can't locate those details. After closing your question my doctor referred me to a Nuerosurgeon who has now said all the symptoms of my lower back pain ( of 10 months post-hysterectomy) and my MRIs indicate I have "disocogenic low back pain' and has indicated the chronic pain has resulted from me being a symptomatic prior to surgery but now 10 months on it is unlikely my symptoms will improve and I may require surgery to replace the disc in order to get me back to functioning normally again. I am unable to sit for longer than 5-10 minutes and stand longer than 40 minutes so he regards that as not functioning well. I think your option was that surgery wasn't needed and concentrating on abdominal and core strengthening exercises would be the answer ( which I have already started). I'd like to hear your thoughts/opinions on what this diagnosis of disocogenic pain?
Many thanks and you need the link to my MRIs again please let me know.
XXXX
Brief Answer:
Let us First Treat Muscle Spasm. Pain would disappear with that !
Detailed Answer:
Dear Madam,
Welcome Back !
You had earlier narrated the following 6 symptoms
1. lower back pain that feels at the bottom of my spine and sacrum area
2. Unable to sit for more than 5 minutes without pain
3. Previous muscle spasms in my gluteal muscles - primarily the minimus and medius muscles for over 4 months (has subsided recently)
4. Groin and hip aching - continued the whole time (10 months)
5. More recent (last 7-8 weeks) burning pain in lower back, now radiating slightly in the upper buttocks
6. Stiffness, and some aching in thoracic spine area
Of these six,
2 and 5 alone are Discogenic pains
1,2,3,4,5,6 are symptoms of Muscle Spasm
Discogenic Pain is rarely associated with Stiffness, Aching in Thoracic Spine Area, Spasm of Gluteus etc
So,
Muscle Spasm is definitely present.
Whether Discogenic Pain is present are not, Muscle Spams is Present
So, even if you get operated for Disc Prolapse, your pain won't go away.
Moreover the MRIs (Sep 2015 and May 2016) indicate the preservation of CSF Spaces round the roots in Axial Sections. Hence Surgery is not needed at present. (I had not deleted them and hence could review them once again)
If there is a doubt as to whether the pain is due to
(1) A Problem which does not require surgery e.g. : Muscle Spasm
(2) A Problem which requires surgery e.g. : Disc Prolapse
the time tested protocol is to first treat the problem which does not require surgery and look at the quantum of improvement
Surgery would be and should be the last resort. You have to think of surgery only if there is no improvement after treating Muscle Spasm with Abdominal and Pelvic Muscle Strengthening for 4 months
Hence I would advice you to continue Abdominal and Pelvic Muscle Strengthening Exercises. You would start improving by 4th week and will be back to normal by 12 to 16 weeks and that would clear all doubts
All the best :) :)
Let us First Treat Muscle Spasm. Pain would disappear with that !
Detailed Answer:
Dear Madam,
Welcome Back !
You had earlier narrated the following 6 symptoms
1. lower back pain that feels at the bottom of my spine and sacrum area
2. Unable to sit for more than 5 minutes without pain
3. Previous muscle spasms in my gluteal muscles - primarily the minimus and medius muscles for over 4 months (has subsided recently)
4. Groin and hip aching - continued the whole time (10 months)
5. More recent (last 7-8 weeks) burning pain in lower back, now radiating slightly in the upper buttocks
6. Stiffness, and some aching in thoracic spine area
Of these six,
2 and 5 alone are Discogenic pains
1,2,3,4,5,6 are symptoms of Muscle Spasm
Discogenic Pain is rarely associated with Stiffness, Aching in Thoracic Spine Area, Spasm of Gluteus etc
So,
Muscle Spasm is definitely present.
Whether Discogenic Pain is present are not, Muscle Spams is Present
So, even if you get operated for Disc Prolapse, your pain won't go away.
Moreover the MRIs (Sep 2015 and May 2016) indicate the preservation of CSF Spaces round the roots in Axial Sections. Hence Surgery is not needed at present. (I had not deleted them and hence could review them once again)
If there is a doubt as to whether the pain is due to
(1) A Problem which does not require surgery e.g. : Muscle Spasm
(2) A Problem which requires surgery e.g. : Disc Prolapse
the time tested protocol is to first treat the problem which does not require surgery and look at the quantum of improvement
Surgery would be and should be the last resort. You have to think of surgery only if there is no improvement after treating Muscle Spasm with Abdominal and Pelvic Muscle Strengthening for 4 months
Hence I would advice you to continue Abdominal and Pelvic Muscle Strengthening Exercises. You would start improving by 4th week and will be back to normal by 12 to 16 weeks and that would clear all doubts
All the best :) :)
Above answer was peer-reviewed by :
Dr. Naveen Kumar
Thank you Dr, and I was hoping you would say this. The nuerosurgeon i saw seem to think there was obvious degeneration and 'flattening' of my lower L5/S1 disc which he thought was pre-existing most likely before my surgery and occurred over time hence his diagnosis of discogenic lower back pain. Do you tgink there is degeneration and flattening of this disc? I think he thought the L4/L5 was flattening also.
I look forward to your response.
XXXX
I look forward to your response.
XXXX
Brief Answer:
There is degeneration of L4L5 and L5S1, but surgery not needed at present
Detailed Answer:
Dear Madam,
There is degeneration of L4L5 Disc along with 'flattening' , mild bulge and even endplate changes.
There is degeneration of L5S1 Disc along with 'flattening' , mild bulge and even endplate changes.
But,
In Axial Sections, these do not compress the Spinal Cord or Exiting Nerve Roots. The CSF Spaces are maintained.
Hence there is not much to worry regarding this
You can continue your abdominal and pelvic muscle strengthening exercises
Regards
Bruno Mascarenhas
There is degeneration of L4L5 and L5S1, but surgery not needed at present
Detailed Answer:
Dear Madam,
There is degeneration of L4L5 Disc along with 'flattening' , mild bulge and even endplate changes.
There is degeneration of L5S1 Disc along with 'flattening' , mild bulge and even endplate changes.
But,
In Axial Sections, these do not compress the Spinal Cord or Exiting Nerve Roots. The CSF Spaces are maintained.
Hence there is not much to worry regarding this
You can continue your abdominal and pelvic muscle strengthening exercises
Regards
Bruno Mascarenhas
Above answer was peer-reviewed by :
Dr. Raju A.T
Thank you Dr Mascarenhas, once again tou have been most helpful and i will continue with the 12-16 week abdominal strengthening plan.
Much appreciated
Juli
e
Much appreciated
Juli
e
Brief Answer:
Best Wishes for a Speedy Recovery
Detailed Answer:
Best Wishes for a Speedy Recovery
Best Wishes for a Speedy Recovery
Detailed Answer:
Best Wishes for a Speedy Recovery
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Above answer was peer-reviewed by :
Dr. Sonia Raina
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