DDD at L4-L5 and bulge L5-S1

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mykal

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Hi everyone. Thank god for this board! I was wondering if I could get some advice. I have degenerative disk disease at L4-L5 and a bulge at L5-S1 with very little spacing at the L4-L5 level and some space compromise at L5-S1. (I used to be 6'3" now am 6' 1 and 3/4"...) I have had this condition for years (tenpin bowled semi professionally). I first had problems at 26 (herniation at L4-L5) and am now 40. I had just gotten to the point after lots of pain that my back became managable (last 6 or so years before recent incidents). I had pains in the morning and stiff getting out of chairs but was mostly ok (Ibuprofen). I refused to think about surgery even after the first incidents left me bedridden for months. I had even gotten back to league bowling on Friday - stiff and sore on Saturday but accepted that.

So, about 1 and 1/2 years ago I was having an unusually bad back day and bent over to pick something up and my right knee bent backward and I felt something "go" in my knee. I tried to compensate too much for my back and somehow my right knee sort of gave out. I was thinking right after that happened "damn, thats going to come back and bite you". After that day my knee always had a somewhat unstable feeling like it was going to "give way" but never any swelling and never have I had any trauma or impact to my knees hip or back (besides the rigorous bowling). I went along like that for a year and a half.

Well, about one month ago on Christmas eve everything was fine (knee still feeling unstable but able to do things) went to the gym got on the elliptical and did 30 mins. (trying to loose weight I am 255 lbs.) Finished up got in the car to shop and when I got out at the mall 1 hour later I started limping. Pain in my right groin area causing me to limp on my right leg. It got really bad to the point that on Christmas day I was looking really bad barely able to walk without pain. Trying to put a sock on that right leg was really a struggle and painful for about a week. The pain was in the groin and my back was in play too, with my back spasaming when trying to lean forward to get the sock on. It has gotten somewhat better since then but as it did my knee came into play and now there is a pain from my hip/groin all the way down the thigh to the inside of my knee. I made an appointment with the Ortho who did the reflex tests with the triangle thingy (all good there) and took an xray of my back and hip. The hip looked fine but Doc scheduled me for an MRI on the hip this coming Saturday 1/22/11 and a follow up with him on the 25th. My back had obvious issues on xray but he said we would address that later and for now address the hip pain. He did not seem too concerned with the knee though. My knee situation is scary because again no trauma such as a car accident etc. but now knee feels like its burning even when resting. This post seems to be about knee/hip but really I think its my back perpetuating all of this hence posting here.

Can anyone suggest what I could have possibly done to my right knee when bending over that one time?

Can anyone suggest what might be going on re the elliptical incident and my hip/groin? I mean this came out of nowhere and at no point during the exersice did my body give any indications, I was feeling great actually.

What should I ask from my Ortho Doc on my next visit?

Thanks for reading and any advice anyone can give! (I know it was quite long)

Mykal
 
Welcome to the board. I'm not quite sure how to begin to try to answer some of your questions....but I would like to mention that since you already know that you have degenerative disc disease at L4-5, and you have lost that much height, and since "hip" pain often turns out to be an issue with either the L4-5 segment or the segment below, L5-S1, I would encourage you to get a lurabar MRI in addition to a MRI of the hip. I think chances are good that you have something going on with that level that is impinging on the L5 spinal nerve root. As you know, none of us has professional medical training, so at best, I am just giving you some thoughts based on my own experiences with L4-S1 problems.

It sounRAB to me like the problems you mention, like the elliptical trainer episode, may be coming from a nerve compression at the L5-S1 level. Those nerves run down through the buttocks, exiting the pelvis at the sciatic notch, and then run down the back and side of the thigh. Pain can continue down the calf and into the foot, but can stop at the knee, or hurt anywhere along this route. The top of the knee is usually L4 issues....so you can see why I would suspect your issues that you mention having at L4-5 and L5-S1.

If you enjoy reading on the internet, search for a "dermatome map." The dermatomes are like a map that indicates which spinal nerve innervates a particular area of skin, and provide a very basic clue as to where the doctor should begin looking for possible issues. For example if a patient complains that his big toe is nurab, the doctor will suspect an issue, like a herniated disc, at the L4-5 level, because it is the L4 spinal nerve that innervates that part of the foot. It gives the doctor a general idea where to start looking.

Regarding the hip....of course there is a possibility that you have an additional issue with your hip. But I would definitely check out the lower lurabar vertebrae too. A brief example: my MIL kept complaining of hip pain that made it very difficult to walk. She had several injections into the bursa, etc. Eventually she had a MRI of the lurabar area and discovered that she had an instability at L4-5 and spinal stenosis, and DDD at that level. She had a one level fusion, and after recovery, is walking without pain.

In your case it may be that you have mechanical hip and knee problems, but it won't hurt to have your lurabar area checked out. DDD is not something that improves with the aging process, so things may have changed since your last lurabar imaging.

Please keep us posted on how you are getting along. I hope you can find some solutions to your pain soon.
 
Hi, and welcome to the board. I agree with what tetonteri said totally. You mentioned seeing an 'ortho' but I am wondering if he is a spine specialist? If not, you would be best served by making an appt with either an ortho or neuro who specializes in the spine. Those doctors are best when dealing with back issues.....ordering the right tests, reading the results and prescribing the proper treatment.

I think for now you should avoid going to the gym until you have a firm diagnosis and then discuss whether you should continue working out.


Please let us know how you are doing, okay?

Carol
 
Thanks for the replies. I will keep everyone posted. I will try for the back MRI and try to find out what my Ortho's specialty is and report back to you. I have insurance that requires a referral so wish me luck with asking for the back MRI and the spine specialized Ortho but I will. Next open season I am going to up the plan so I can just walk in to who I want to see...

This really sucks and I sympathize/empathize with those who have spine problems...

Thanks again for the replies!

Mykal
 
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