Hello, I’m a new member to the Forum and only recently exposed to the Barbell Medical oeuvre and I must say I’m soaking it up like a sponge. More about me at a later time. This post is in regard to my mother.
She was recently diagnosed with Spinal Stenosis and Arthritis. Her doctor basically told her not to walk for more than 20 minutes at a time without stopping to rest for five minutes. He said she can’t bend over to pick something up off the floor and has her using a grasping arm device to pick stuff up. He gave her a permanent handicapped placard for daily use and essentially has her on very limited movement as possible. She seems to be having back pain but reports it as being rather severe as of late (Something I owe possibly to the “seriousness” of the recent diagnosis?). My mom is also very overweight. She’s 62 years old. And until somewhat recently was on track to improve her health. She had two total-knee replacements and has been fairly active since. I live in Japan so admittedly I don’t see her as frequent and thus can’t fully account as to how recent or frequent her bouts with pain have been. But, she visited me just this past year in October and though labored to get about due to being generally out of shape she didn’t really complain about back pain at that time.
I have watched as much as I could find of Dr. Baraki’s talks about pain and injury and have visited the painscience.com website and read through quite a bit. That being said, I am not a doctor (though may be a future possibility). I am a skeptic, hard-rooted in science and reason and I am an avid picker-up of heavy things. Thus, this diagnosis has me very worried both because I think the doctor may be making her pain worse, nocebo-ing her into what could lead her into immobility, and because prior to this she was losing weight and getting more active.
She has since had a set of shots into her back which she claimed to help but has worn off and is set to see the doctor again on April 8th. I will be talking with her frequently until then and was wondering what I should do? What questions should I have her ask the doctor, since I am not able to be there? What should I be telling her? I realize this isn’t much information and I hope to get more from her when I speak to her tomorrow so I can provide more info if needed. Any specific information needed let me know and I can report back as soon as I can get it.
I received the information from my mother regarding the MRI:
The patient states low back pain and bilateral leg pain off and on for one months. She has had bilateral knee replacements in the past.
Technique:
Magnetic Resonance images of the lumbar spine without intravenous contrast in multiple planes.
Comparison:
No relevant prior studies available.
Findings:
Vertebrae: Unremarkable. No acute fracture.
Interspaces: See Below.
Spinal Cord: Unremarkable. Normal Signal
Soft Tissues: There is mild edema in the facet joints of L4-L5 and L5-S1 with periarticular soft tissue edema.
Discs/Spinal Canal/Neural Foramina:
L1-L2: At L1-L2 there is a road based 3mm disc protrusion with mild canal stenosis. There is no significant foraminal stenosis.
L2-L3: At L2-L3 There is a mild disc bulging without significant canal or foraminal stenosis.
L3-L4: At L3-L4 There is a mild disc bulging without significant canal or foraminal stenosis.
L4-L5: At L4-L5 there is moderate facet arthropathy with ligamentum flavum hypertrophy. There is broad-based disc protrusion. There is moderate spinal stenosis with mild left and moderate right foraminal stenosis.
L5-S1: At L4-L5 There is marked disc desiccation and endplate degenerative signal change.
I also spoke with my mother at length and she reports pain is basically located lower-lumbar area with radiating pain down both legs with a bit of numbness in the toes, moreso on onse side than the other. The onset of pain was somewhat sudden but did coincide with a large number of key life stressors, but was not precipitated by any physical shock or injury. Also pain is considerably worse in the morning than in the evening, interestingly before going to a job that has very recently become much more stressful.
The doctor gave her a book on back pain that he wrote and seems to have donated to her free of charge…
Printed right on the cover “Introducing Straight Spine Safe Spine therapy and exercise program”…I think we may know what model of pain this guy subscribes to. A cursory look at what I could read on Amazon seems to say that all pain originates in the spine. Even what I researched when I was an undergrad seems to go against this particular take on pain. That being said, I am not a pain expert nor am I a doctor. Nor am I the doctor to the Houston Astros…oh boy.
I introduced my mom to painscience.com and I got her permission to go further into detail here. She is actually rather eagerly awaiting what you have to say.
Hey Thanks for getting back to me. I too apologize for a delay in response as I was away in Kyoto with family for several days and didn’t have a chance to talk with my mother. I spoke with her today and she told me…
The symptoms of pain started rather suddenly one day in Early December of last year, 2018. It started with a fairly strong pain in her lower back radiating down both her legs ending at the knees. Her pain worsened over time which lead her to seeing the aforementioned spine doctor. Recently, I have had her reading as much as she could from painscience.com and information about the biopsychosocial model of pain. She has reported to me that her pain is considerably better and isn’t needing to take the opiates she was prescribed but instead is only taking NSAIDs and topical treatments for the pain. She still feels numbness in the big toe on her right foot which sometimes spreads to the ball of her foot with increased walking. Unfortunately because of her doctors recent diagnosis and behavior toward her MRI she ceased any exercise she was doing and tried to do as little walking and movement as possible as to relieve the edema and to prevent pain. She’s been trying to move more recently though which seems to be helping.
The doctor did not really lay out a plan for moving forward but she is returning to the doctor in early April for a series of steroid shots and to speak with the doctor about her prognosis, what the plan will be for improving her mobility and, per my insistence, asking what he thinks in regards to resistance training. At the moment she and I both remain slightly skeptical of his response.
That being said, thoughts from you are very much welcome and if time allows should you have any specific questions she should be asking the doctor please let us know.
Also I sent her the link to the BBM website consult page and hopefully in the next day or so she will fill it out and a consult can be scheduled.
Thanks for the information. Yeah, I definitely think she’d benefit from a consult with us. I’m skeptical the physician will go along with introducing resistance training but perhaps there is a chance. Keep us posted how things progress.
Given her symptoms have a fairly recent onset (December) and are improving overall, this is a good sign. Radicular symptoms like she’s describing take time to resolve and often this timeline doesn’t align with our expectations.