I'm currently 38 years old and in good shape, exercise regularly and don't do any hard physical labor but the last couple of years I've had some lower back pain I can't seem to get rid of. It hits me when I stand up for 45 minutes or so is the main symptom I'm having.

Who would y'all recommend seeing for this? Should I see my general doc or should I skip them and try and see a specialist? Chiropractor? Is there anything else y'all would recommend I try?

Thanks,

If you find a good chiro- someone who isn't just doing pop/crack/come back and see me in 2 days type of doc...I would start there. you can also see PT's now without PCP referral, so that would be a tossup between the 2 I would see first.

Been dealing w/ low back pain off and on for a few years now. Unfortunately my experience is that you go to three different guys and you'll get five different opinions.

I'm finally proceeding with MRIs so that I know conclusively what's going on. Sucks getting old.

Where are you located? Maybe try to reach out to aggiederelict for some recs.

If you didn't injure yourself, you don't need to see a doctor or a specialist. You've probably got a mix of some poor posture and muscular imbalances that are causing it and it's something you can fix yourself. Google Foundation training and give that a try. There are some free videos on YouTube...

If you absolutely must see someone about this, go to an Airrosti.

Thank you!

i would go to a neurologist,
perhaps even one that specializes in neuromuscular issues

bigtruckguy3500 said:

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Geriatric Punk said:

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Having been down that road, I'd say skip the BS and go to an ortho for an MRI referral. Find a provider that is direct access.

On a side note, the key to relief is really stretching and strengthening. I started dedicated a few minutes a day to both disciplines since having a discectomy in 2016. My back has been strong like bull since.

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No, absolutely do not do this.

The vast majority of folks do not need an MRI. Your doc may give you a referral for one because he wants a happy customer that keeps coming back, but it is a waste of money and resources. Additionally, you're almost guaranteed to find something that's "wrong" on MRI. But that may or may not be the cause of your pain, and what ends up happening is you start to project what was seen on MRI to what you're feeling.

The only reason you need an MRI is if you're planning on having surgery. In other words, the symptoms have to be bad enough for you to consider a surgical option that may 1) not fix anything, and 2) make things worse. Many surgeons don't even operate for pain, they'll only operate for functional impairment, neurological symptoms.

Seriously, the problem with medicine in America is we always think more is better. It isn't. Sometimes, sure, but mostly no. Go to a physical therapist first, or even just start doing yoga on a regular basis. A good chiropractor that isn't all new age snake oil might also work well if they give you a treatment plan and home exercise program to help you get better without a permanent plan to come in for weekly/monthly adjustments.

Now if the physical therapist, who is more than capable of doing a good physical exam, determines you might need an MRI, then you probably need one.

I'll let Aggiederelict chime in if he agrees with me, and the statistics and stuff if he has them.

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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4464797/

Hits close to what he's saying. I know there might be even better articles, but I agree 100% with bigtruck.

I will respond later when I may more time. A lot to unpack here. Good questions being asked.

derelict will have the best response to this, but my main question would be, does this feel like muscular/soft tissue pain or is it in your spine? As much as I like airrosti, if it is the latter, airrosti won't do anything for you.

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If you didn't injure yourself, you don't need to see a doctor or a specialist.

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Having been down that road, I'd say skip the BS and go to an ortho for an MRI referral.

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No, absolutely do not do this.

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You go to three different guys and you'll get five different opinions

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Granted we're not all docs here, but I rest my case

I used to have a lot of lower back pain as well as straining muscles in my mid/lower back quite often. I got into hot yoga (vinyasa), along with my normal HIT and weight training and all the back issues have gone away over the past year. I honestly think it is the stretching and increased flexibility I am getting from yoga which is helping. Maybe worth a shot?

Airrosti helped mine a ton. Depends what the source is, really.

If standing for long periods of time I always have to pay attention to the kind of shoe I'm wearing. If they are dress shoes or cheap flip flops or anything other than a good supportive shoe my lower back starts to hurt almost immediately. Just something else to pay attention to.

Low back pain is one of the most common things people go to there doctor about and one of the least understood types of pain in the body. There are some things we do understand.

Most acute low back pain is self-limiting and will most likely resolve in 4-6 weeks whether you do something or nothing.

The fact that the OP isn't having radicular symptoms and just localized low back pain supports the argument that he most likely doesn't need imaging at this point in time. If he were complaining of persistent leg pain or numbness, weakness, or even difficulties with his or her bowel or bladder that would warrant more concern and possible imaging.

Imaging is expensive and not reliable. When I have more time, I will post some more in depth research on this topic. There has been a lot of evidence in the past 10-15 years that tries to move people away from imaging for those with just localized low back pain or even those with radicular symptoms without reg flags. Imaging correlates well to large disc bulges but there are plenty of people walking around that would have "bad" MRI's who have no symptoms at all.

I'm not saying that there isn't merit to imaging, but being selective about how we send people for imaging is very important. The likelihood that someone gets surgery goes up noticeably if they get an MRI. One could make the argument that these cases were more involved and thus warranted imaging to begin with.

The questions the OP asked is who to see first. I will lay out my bias but I think seeing a quality PT, now that you don't need a script right away, can be a great place to start. PT's are plenty good at giving a physical exam and I would argue better than your primary doc at doing so. Not to knock primary care doctors at all, but this what we do every day. My SIL in NYC is a pediatrician and frequently asks me for help with diagnosis and exams when she get an orthopedic case.

There are plenty of good chiropractors that are becoming more evidenced based and more focused on tissue work and good rehab exercises. They tend to be on the younger side but I don't want to pain with a broad brush. I would try to stay away from the old school your gallbladder isn't working well because your spine isn't in "alignment" type of chiro. And then suddenly they have supplements to sell you to help support the spinal adjustments they are doing.

I agree with the poster that mentioned shoe wear. I think wearing high quality shoes with good cushion can definitely help with supporting your spine and your body overall.

OP, where are you located? I'm located in Austin and would glad to help. And if you aren't located in Austin, I would be glad to help you find someone in your city that can help.

AD any thoughts on best treatment for chronic pain along one side of the iliac crest? I seem to have chronic pain along the upper gluteus medius edge on my right side. Currently it's working it's way through the upper edge of the iliacus as well. Current diagnosis from the doc is "Spondylolisthesis, lumbar region". I took a solid 4 weeks completely off, lots of stretching / ice / etc. Minimal improvement.

Guitarsoup said:

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Airrosti helped mine a ton. Depends what the source is, really.

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Me as well. Started doing HIIT and my back really tightened up, to the point to where I could barely sit. Tried looking up all kinds of lower back stretches and nothing seemed to help. Went to Airrosti (as a referral from my doc) and one of my legs were actually a half inch shorter than the other one from all the muscle tightness. Could tell a difference by the next day and about three days of the recomended stretches and I was pain free.

Stretching really should get more hype. I had to stop mountain biking this summer because of severe knee pain. I thought I was headed towards some intense surgery, but turns out I just wasn't stretching my quads and was getting tendinitis.

That's very fair point. Should have led with stretching, then go see a PT. At the end of the day, I defer the to the experts on here (of which I am not). I've just been down the road and had my own experience. I did 6 weeks of PT and then, out of the blue, a disc literally erupted into the central canal. I couldn't walk.

I do second yoga. It's hard to discipline yourself into going to classes, but it is worth it. I've found even the 20 minute progressions on YouTube help out a lot (both physically and mentally). Good luck.

Web,

How chronic is this pain? Any particular motions bring on the pain? I assume you had an X-ray if you got the spondy diagnosis. Did the report show it as significant?

Geriatric Punk said:

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Having been down that road, I'd say skip the BS and go to an ortho for an MRI referral. Find a provider that is direct access.

On a side note, the key to relief is really stretching and strengthening. I started dedicated a few minutes a day to both disciplines since having a discectomy in 2016. My back has been strong like bull since.

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Completely agree. Though I'd let the Dr make the decision on an MRI. My issue showed up on a simple x Ray.

aggiederelict said:

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Web,

How chronic is this pain? Any particular motions bring on the pain? I assume you had an X-ray if you got the spondy diagnosis. Did the report show it as significant?

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Comes and goes. Usually when I start trying to build power on the bike it shows up for a week or two and then goes away. I started a power build back in August and this time it came and never left.

Doc put it at level 1 based on xray. Had an mri done, seeing the doc to discuss on Tuesday. I'm ticked that he only ordered a lower spine mri, seeing how my come-and-go pain has been on the iliac crest for the past 5 years. I really think I have something in the muscle there going on. We'll see if he sends me back for a mri on the hip to confirm.

We discussed possibly doing an injection to get all of the inflammation gone if the lower back mri comes back clean. I'll post my results from my follow up Tuesday.

Wcb,

A level 1 spondy is not really significant and may not explain your symptoms. What level did it say it was at? Pain in the low back and hip area is not reliable meaning where you feel may not be where it is coming from. This why diagnostics in this area is challenging.

An MRI is needed to do an injection but if nothing is significant with your imaging, then that brings into the question to need for one. I guess once you get the results of the MRI you should hopefully be able to make a more informed decision.

Usually insurance requires an x-ray before they will approve a MRI to help manage cost. But you can sometimes pay cash for MRI's to avoid this progression.

Where are you located? Have you tried rehab for this issue either with physical therapy or chiropractic care?

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A lot of lower back pain is caused by muscle tightness throughout your backside...hamstrings, glutes, back, etc. Lengthening and loosening those muscles is key. Like someone else said, stretching can help. I've never been a big fan of static stretching, but found yoga to be hugely helpful....both from the stretching and strengthening standpoint.

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I've heard and found that because most of us sit all day long it's not muscle tightness but lengthening and weakness of the muscles that's the problem. So instead of stretching the posterior chain to strengthen it and stretch the hip flexors and quads. At least this is the problem my chiro has told me with similar issues.

lazuras_dc said:

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A lot of lower back pain is caused by muscle tightness throughout your backside...hamstrings, glutes, back, etc. Lengthening and loosening those muscles is key. Like someone else said, stretching can help. I've never been a big fan of static stretching, but found yoga to be hugely helpful....both from the stretching and strengthening standpoint.

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I've heard and found that because most of us sit all day long it's not muscle tightness but lengthening and weakness of the muscles that's the problem. So instead of stretching the posterior chain to strengthen it and stretch the hip flexors and quads. At least this is the problem my chiro has told me with similar issues.

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There is some truth to that. For me, though, glutes and hamstrings have been my biggest problem area. Glutes mainly from years of heavy squats. And the last time I screwed up my back a few years ago, it was due to straining a muscle in my left glute. But this is exactly what I like about yoga. It doesn't just focus on one area, but your entire body, stretching and strengthening. It's all intertwined. You find problem areas you did not even know you had. It's not going to fix anything overnight, but overtime things will slowly improve.

Spinal decompression from a forward-thinking chiro has helped me a lot. Also has me doing exercises to improve posture and improve flexibility. He's on the younger side so that probably helps his approach.

aggiederelict said:

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Wcb,

A level 1 spondy is not really significant and may not explain your symptoms. What level did it say it was at? Pain in the low back and hip area is not reliable meaning where you feel may not be where it is coming from. This why diagnostics in this area is challenging.

An MRI is needed to do an injection but if nothing is significant with your imaging, then that brings into the question to need for one. I guess once you get the results of the MRI you should hopefully be able to make a more informed decision.

Usually insurance requires an x-ray before they will approve a MRI to help manage cost. But you can sometimes pay cash for MRI's to avoid this progression.

Where are you located? Have you tried rehab for this issue either with physical therapy or chiropractic care?

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Thanks for your feedback. Had a MRI follow up this morning. One step back, I was really wanting an MRI of the hip to know if there are any tears / muscular injuries in the area. Doc only ordered lower back MRI. So I was frustrated going in.

Then doc proceeds to ignore the radiologist report as I don't believe it supported what he was looking for. His interpretation of the MRI imaging (not the radiologist report) was that it supports his previous findings (moderate to severe bilateral foraminal stenosis). Next step is an injection in L4 / L5 region to try and get some nerve relief.

I'm still not convinced that it's nerve or in my spine, though I'm open to the idea. I just don't see how ice and stretching (which seem to help some) would relate to nerve issues. Pain seems purely muscular. But I get that nerve / lower back troubleshooting is complex.

I'm seeing an Airrosti tomorrow. Curious to see what they say. Initial appointment w/ pain med / injection doc is 1/31.

Road goes on forever. Party never ends.

Wcb,

I totally get your frustration. This tends to be a critical junction where the medical system doesn't always know what to do. The doctors bias is not confirmed with the imaging report so this is where things can go sideways.

To unpack what you said, are you actually having an radicular symptoms which means burning, tingling, or numbness in your legs at all?

Epidural Injections are most helpful when someone presents with symptoms down the leg and not so much for isolated low back pain. I don't remember you saying you were having symptoms down both legs or even one of them. I don't want to minimize bilateral foraminal stenosis but you said they classified a low level spondy which is not really that concerning. How old are you by the way?

I think starting with some tissue work at Airrosti is a good place to start but I would put some caveat with it. Will the people at Airrosti have your imaging report before you go in? If not, don't give it to them right away to see what their exam reveals and if they ask about say you don't remember what it said.

We are all subject to bias, me included, when we see imaging results before we do our exam. I tend to want to see the imaging report not until after I do my physical exam.

It's unfortunate that you didn't get your hip looked at which will impair your trust of your physician going forward. You will always wonder why he/she didn't take a closer at the hip.

If you don't get improvement with Airrosti, there are other options that address soft tissue problems that don't include getting epidurals. But you cross that bridge if you get there. I think starting more conservative right now is a good place to start.

Txmoe said:

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Spinal decompression from a forward-thinking chiro has helped me a lot. Also has me doing exercises to improve posture and improve flexibility. He's on the younger side so that probably helps his approach.

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After working with chiros in MISTI cases, I never want to be the in presence of one again.

I've posted a few times already, but try yoga! I had sciatica and at times was very painful. I started yoga videos on Amazon Prime and the pain is gone. 3-4 times a week doing a 25 minute low back yoga routine has made a world of difference.

For your xrays, did they have you in multiple positions? I found that my spondy grade changed between standing, bending over, and laying down. My grade changed between 1-3 depending on when the image was taken.

Philip J Fry said:

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For your xrays, did they have you in multiple positions? I found that my spondy grade changed between standing, bending over, and laying down. My grade changed between 1-3 depending on when the image was taken.

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Yeah, they did multiple. What did you wind up doing to get relief?

So Tuesday saw the spine doc. He says it's a spine issue. Wednesday saw the Airrosti guy. He says it's muscular. Go figure.

For what it's worth, I tend to side with the Airrosti guy at the moment. He's convinced (based on symptoms and functional tests) my hip flexors are locked up, pulling the pelvis forward and causing the low back issues. Did some deep digging to try and release them, has me doing stretching / rolling / icing 2x daily with two scheduled follow ups. If no relief by then my injection is already scheduled, which he said would be the next step anyways.

Fingers crossed this does the trick. IMTX is roughly 3.5 months out.