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comixguy74 11-19-2014 05:17 PM

Lower Back/Hip Pain - When walking
Hello All,

My first post!

I have had severe back and hip pain after walking a short distance for several months now. The pain is a deep ache that worsens as I walk. Sitting or crouching relieves the pain, although if I decide to push through the day, my lower back feels like it has been through a major workout for a day or two.

I was sent to a department called Occupational Therapy, where the doctor decided to do an MRI of my full spine, minus my neck. The results showed no spinal stenosis so I was sent to a Vascular Surgeon to look for claudication. I did some tests, and no claudication was found.

I am wondering if anyone has any ideas of what could be wrong and possibly knows how to read this report from my lumbar MRI (where the pain is).



** HISTORY **:
Complains of low-back pain with radiation of the pain into the
upper legs for 9 months worsening. Worsening that responded to

Technique: Multiplanar multisequence MR images were obtained
through the lumbar spine without gadolinium.

There is scoliosis of the thoracolumbar spine with convexity to
the LEFT side. 5 lumbar vertebrae are present. No compression
fractures are seen. There are old Schmorl's node deformity is
present at the superior and inferior endplate of L3 and L4. This
is also identified T12. No spondylolisthesis is seen. Mild
posterior subluxations are present at the levels of L3-4, L4-5,
and L5-S1. There is moderate narrowing of the disc at L3-4 and
L5-S1. Spinal cord ends at the level of L2. Paravertebral soft
tissues are unremarkable

L1-L2: 2-3 millimeter disc bulge is present posteriorly to the
RIGHT of midline.

L2-L3: 2 mm disc bulge posteriorly to the LEFT. There is mild
narrowing of the LEFT neural foramen.

L3-L4: 2 mm broad-based disc bulge posteriorly.

L4-L5: 4-5 mm disc protrusion posteriorly to the RIGHT of midline.
There is indentation of the anterior thecal sac. The LEFT neural
foramen is mildly narrowed

L5-S1: Spondylotic spurring posteriorly to the left-sided facet
degenerative changes present on the LEFT as well. The LEFT neural
foramen is mildly narrowed

Disc bulges at L1-2 through L3-4

L4-5 disc protrusion posteriorly to the RIGHT of midline

L5-S1 with spondylotic spurring to the LEFT resulting in LEFT
neural foramina narrowing

No significant canal stenosis seen

teteri66 11-20-2014 07:06 AM

Re: Lower Back / Hip Pain - When walking
Welcome to the board. The lower two lumbar discs ( L4-5 and L5-S1) are the ones that cause us the most problems. They take the brunt of movement in the spine...and thus, are most subject to the usual wear-and-tear type degenerative issues most of us tend to develop as we go through life.

Your MRI report looks pretty good. Nothing sets off a red flag as an obvious explanation for your symptoms. However there are a few issues in these two levels that could ne contributing to your symptoms.

Do you have pain on one side or the other? While you have very small disc bulges from L1 to L3, the disc at L4-L5 is protruding and pushing out on the right side toward the back side...and it is pushing into the thecal sac (the membrane that covers and contains the nerves of the cauda equina located in the central spinal canal). This can cause some compression of the nerves which would result in pain or symptoms like tingling, etc. Also, at this level, this protrusion is pushing into the foramina to a very small extent, on the left side.

One level down, at L5-S1, there are some degenerative, arthritic type changes that have caused some bony growths on the facet joint which is taking up a little space in the foraminal opening on the left side.

Any time there is "something" that pushes into a canal where the spinal nerves pass, the result can be nerve pain. This can be felt right at the level of compression or it can be any place along the path of the nerve. The L5 and S1 nerves run down the back of the buttocks, back of leg and into the foot, and L4 runs down the lateral side of the leg and into the big toe. You can check a dermatome map to see specifics....

Stenosis just means a narrowing. The report does not specifically show stenosis in the central canal other than the indentation of the thecal sac at L4-L5 but there is that as well as a bit of stenosis in the foramen at both these levels.

You might want to find a physical therapist with an expertise in orthopedics who can show you the proper way to do strengthening exercises for the back and core. If the pain gets worse, you may want to make an appointment with a spine specialist. This could be either a fellowship-trained orthopedic spine surgeon or a neurosurgeon who limit their practice to issues of the back and neck.

Your issues are very slight at this point. Now would be a good time to focus on the health and welfare of your back...focusing on using good posture and structural alignment, strengthening exercises and stretching, maintaining normal weight, not smoking, etc., in an attempt to keep things from getting worse!

comixguy74 11-20-2014 10:37 AM

Re: Lower Back/Hip Pain - When walking
Thanks so much for the reply, much appreciated.

The pain seems to start in the lowest part of my spine near the buttocks, and then starts to spread to both hip areas and then into the hamstring on both legs. Both left and rights sides seem to be equally effected.

It's a deep ache type of pain, no sharp pains. It's pretty dehabilitating, after walking for about 10-15 minutes or so, I need to sit. The pain gets better after a few minutes of sitting and then I can go again for another round of walking until I need to sit again.

Do you think that it might be possible that the nerve is getting irritated when walking? Can nerve compression worsen upon walking movement?

Thanks again for your help.

teteri66 11-22-2014 08:12 AM

Re: Lower Back/Hip Pain - When walking
I had that issue too. You need to find out if you have spinal stenosis, and you need a flexion/extension x-ray to check for a spondylolisthesis. This is a common problem that occurs mostly often at L5-S1, followed by L4-5. It is a situation that can cause instability. One vertebra slips over the top of the adjacent vertebra, which often results in a spinal nerve at t hat level getting caught or pinched.

In my case, I had terrible pain when standing or walking, but it was relieved by sitting or lying down. If I sat too long, the pain would continue. This is a situation that usually continues to get worse and worse. I postponed surgery until I got so bad that I couldn't stand long enough to chop and onion and I was driving down my driveway to the mailbox to get my mail as I could not walk even that far.

My spine was structured in a way that created a sharp curve at the beginning of the sacral vertebra when I was upright; the force of gravity pushing down created almost a > sharp and caught the spinal nerve right at that angle. When I lay down, the space opened up and there was just enough room to provide relief to the nerve...and the pain would stop.

This is just one example of a problem that is not caused by a common problem like a herniated disc. There are many other situations as well.

teteri66 11-22-2014 08:19 AM

Re: Lower Back/Hip Pain - When walking
Another possibility is that the sciatic nerve is being irritated when you walk. The piriformis muscle located in the buttocks lies on top of the sciatic nerve and it attaches over by the hip. If this muscle becomes inflamed or is taut, it can tug on the sciatic nerve, causing pain running down the leg and radiating over to the hip.

I know a number of people who thought they had a hip problem when it turned out to be an issue at L4-5.

comixguy74 11-22-2014 02:15 PM

Re: Lower Back/Hip Pain - When walking
[QUOTE=teteri66;5329736]Another possibility is that the sciatic nerve is being irritated when you walk. The piriformis muscle located in the buttocks lies on top of the sciatic nerve and it attaches over by the hip. If this muscle becomes inflamed or is taut, it can tug on the sciatic nerve, causing pain running down the leg and radiating over to the hip.

I know a number of people who thought they had a hip problem when it turned out to be an issue at L4-5.[/QUOTE]
Thanks so much for the replies...super helpful.

If the piriformis muscle were irritating the sciatic nerve, could this effect both hips/legs?

teteri66 11-22-2014 05:09 PM

Re: Lower Back/Hip Pain - When walking
Probably not. When there is a disc bulge, if the issue happens to be in central region, the pain can go into both hips and legs. Pain from the sacroiliac joints tends to be on one side. Pain from sciatic nerve can be either, depending on where there is compression. If it is compressed beyond the sciatic notch, it is just on one side. A spondylolisthesis can cause pain in both legs or it can switch from side to side. If there is movement, it can cause pain to move around.

Piriformis dysfunction is usually one sided.

Everything I write is "generally speaking...." Since we do not all come from one mold, there is always an exception to the rule! Doctors tend to pick out the most common cause that would explain a person's pain symptoms. If one has something more unusual, it can be difficult to get an accurate diagnosis.

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