What next when physio's not getting anywhere?

Bones, joints and muscles
1

My wife is 53. Following a diagnosis of breast cancer, she had a mastectomy and LD flap reconstruction in February 2011. She is currently taking arimidex, also alendronic acid for the borderline osteopenia which is primarily a consequence of long-term use of arimidex. Her BMI is 25 and she is in good health apart from back pain.

She injured her back almost 9 months ago when pulling something off a shelf whilst twisting her shoulders about 45 degrees when squatting down in a confined space (as you do!). GP prescribed Ibuprofen, rest and time

In due course the specific pain in her left lumbar region eased off, but she developed debilitating spasms in the muscles running up the left side of her back. She had a bone scan which revealed nothing of any note apart from very mild arthritis of the right hip. GP referred her to physiotherapy.

One physio who my wife saw identified a spot about 4 to 5cm to the left of the centreline of her spine, level with L4, which she could manipulate in order to relieve the spasming. She prescribed various exercises to strengthen my wife's back and buttock muscles.

That was nearly four months ago, since which time my wife has seen the physios at 4-weekly intervals, conscientiously done the exercises she has been shown, and also been going to modified Pilates classes.

The only real improvement since February is that the muscle spasms in her back are not quite as frequent, and do not last for quite so long at a time as they originally did. They are however still debilitating and still preventing her from getting into the weight-bearing exercise which she urgently needs to start in order to help prevent her osteopoenia turning into osteoporosis.

We're short on clues as to what's going on. All we know is that ...

1 The spasms in her back can occur spontaneously or they can be triggered by impact such as from jumping up and down

2 It is obvious even to me that the muscles in her left buttock are nowhere near as developed as those in her right buttock

3 There appears to be some sort of connection between her hamstrings and her back pain, in that doing a specific Pilates exercise to stretch the hamstrings in a particular way could be almost guaranteed to trigger the back pain and spasming.

4 Matters are complicated by the re-arrangement of her left side LD muscle during the reconstruction of her left breast.

5 And they're further complicated by another side-effect of arimidex being what can only be described as a "disconnect" between mind and body where feedback from muscles etc is concerned.

6 Her GP is no real help and she's getting nowhere with physiotherapy.

We're keen that her treatment for this problem remains within the realms of conventional medicine, but we have no idea where to go from here. Her GP can be relied upon to refer her to any consultant who might be able to help, but we're not even sure what speciality might be appropiate!

Any suggestions for a way forward, please?

 

2

Hi Serendipitous Sid, sorry to hear about your wife's problems and hope that her breast cancer treatment has been wholly successful. As for the back, it sounds as though the spasms are Sciatic and this would also be consistant with the L4 that Physio has identified. With regard to the hamstrings, this would suggest Spondylolisthesis and this is normally due to a vertebrae being out of position. I have prolapsed L4 and L5 both to S1 and also have Spondylolisthesis with my vertebrae having moved forward, unfortunately quite significantly. Normally, it would be advised to have an MRI but with your wife having breast cancer, it may be not be such a great idea. Instead, you could ask your GP for a referral to a Consultant whose speciality is Spines. This could be either Orthopaedic or Neurological depending on the area in which you live. Spondylolisthesis didn't show up on my MRI which was taken last October but did show in standing 'flex' x-rays where you have to bend backwards for one and forwards for another - not very comfortable, but regrettably necessary. The bending forwards where you lean on something is far more comfortable but this is yet another sign of the Spondylolisthesis smile

I hope this is of some help to you both and send my very best wishes to you both.

3

The gluteal maximus is not used in either sitting or standing but in running, climbing and similar and I'd guess (and it's only a guess) that from your description that there could be damage associated with connective tissue?

I'm afraid I'm on a bit of a mission with connective tissue at the moment with some 20 years of "don't know what it is" syndrome but, from a lay persons point of view, the muscle wastage must be significant and jumping is one occasion where maximus is used.

Hamstrings originate from just underneath maximus as well.

 

4

The painkillers your wife is on are weak and useless don't know why your GP gave them she needs to be on stronger painkillers . 

I found the physio a waste of time I'm still doing my exercise from last year and I'm still in pain if you can afford go private. 

Hope your wife breast cancer treatment has worked 

As for the gps I'm in the same boat as your wife no X-rays or scans and that's from nov 2013 

5

Gosh, there's a few things for us to ponder on.  Thank you!  My Lady Wife is now off to hit the internets yet again, starting with spondylolisthesis ...

Thank you also for your kind enquiries as to her cancer, which we're now over 3 years down the road from and all is looking good.  She still has another two years to go with the arimidex, which means two more years of depletion in bone density and progression towards full-blown osteoporosis, and it's this which is driving us to find a solution before much longer.  We can't afford to have her prevented from doing any significant load-bearing exercise for much longer!

My wife has another physio appointment tomorrow morning at which she intends to say that we need to adopt a different approach because the present one is patently not doing any good, so I'll probably be back here tomorrow with an update ...

6

Right, we seem to be getting somewhere now ... sort of.

Current thinking is that the problem is 100% muscular.  The theory is that the lower back pain is a general tightness of muscles in that area, and the spasming higher up my wife's back is primarily down to the re-arrangement of her latissimus dorsi during her breast reconstrcution.

One complication is that a spasm in one area seems to trigger a spasm in the other, and another is that the left side of her back is generally weak as a consequence of the surgery and her protracted recovery from it.  Matters have also not been helped by her initial enforced inactivity after she injured her back in January and her subsequent reduced activity because of the spasming!

The proposed way forward now is for her to see the surgeon who did the reconstruction with a view to him being able to suggest how she may ameliorate the upper back spasms, and to continue with specific exercises to stretch and strengthen the muslces in her lower back.

Unless anybody has any other suggestions, that's the current plan ...

7

So pleased that you seem to have found the root cause of the problem.I really do feel for your good lady as she does seem to have been dragged through the mill.

I'm not sure whether these would help, but I use a 'Swiss' ball (a gym ball) to sit on when using laptop or watching TV as it is good for strengthening your core muscles without strain smile Another investment I made fairly recently was a 'Perching Stool' which is great for taking the weight off while cooking, ironing, etc. Both available from a well known internet site, the ball from about £7.50 and the stool, which is a German make for just under £40. Whatever the future holds, I wish you both well and hope that you will give us updates as to her progress from time-to-time. Here's to some well deserved good news for your wife for a change!

Best wishes,

Kim

8

Cheers Kim smile

9

Hello Sid

I think we are all fishing around in the dark here but have you looked at thoracolumbar fascia issues? Once again I am not a medical person but am now approaching my undiagnosed back pain from a mechanical point of view and it makes interesting reading. Also https://www.youtube.com/watch?v=vIFDwDdGnhQ

is an extremely interest documentary on the topic. It certainly increased my grasp of the complexities of back pain diagnosis.

All the best.

10

Crikey, that's a video and a half!  Thanks spinworm!

11

spasms are triggered by nerves so it may be a nerve trying to repair itself following damage that is causing this.  Surgery may not be the answer.

Richard

12

Indeed it could be a nerve issue, but at this stage we don't have firm diagnosis, so we're certainly not considering surgery!

13

Hi, Would you please explain further on the benefits of going private? I have Spondylolisthesis L4-S1. I got tremendous relief from Turmeric for 3 months but read that because of the immune system, it only works for inflammation for about 3 months.

Thank you!