Darth Stenosis, an MRI Report, and a Clarification

Bad Genes

“My father has it. I have it. My sister has it.”

Yesterday I was talked with my sister who is 2 1/2 years younger than me. She said she’s having back pain. She does not read my blog. I asked her to describe it.

Pain in the outside of her lower left leg. Pain when walking that is reduced when she leans forward or leans against something like a grocery cart. Pain that kicks in after about 50 yards. She can’t trust her left leg; it feels like it’s going to give out.

Gregor Mendel, phone home.

MRI Report

My MRI report confirms that my spine is FUBAR. Most of the pathology doesn’t seem to be causing me pain. I have moderate disc bulging and thinning here and there. And there is some stenosis in various places in my mid to upper spine. Mostly this seems to be the cause of mild discomfort as well as numbness in my feet and hands from time to time. My lower back gets achy when I stand or walk for long periods but muscle spasms are rare.

Near my 4th and 5th lumbar vertebrae, however, the report said:

There is severe left foraminal stenosis with indentation of exiting left L4 nerve root. The right foramen is moderately to severely stenotic with indentation of exiting right L4 nerve root.

This is consistent with my recent left leg problems. My guess is that’s where the epidural will go.

The same MRI center had a record of my 2014 scan. The report noted that a disc extrusion (i.e., bulge) found back then no longer exists. This is one reason why back patients are told to give it time. Many of these abnormalities resolve on their own, as did my 2014 problem.

A Clarification

In yesterday’s post, I described a conversation with my friend Julie who is a Rolfer. I may have given the impression that she is reckless or aggressive in her methods. If I did, I apologize to her and want to clarify.

Recapping: a Thai massage therapist skipped past my thighs when I indicated that the therapist had hit a sensitive nerve. What Julie meant when she said she’d “dig right in” to nerve pain was that ignoring the problem as the massage therapist did is unhelpful. The objective of massage is to grant short term relief and reduce tension. Oversimplifying, the objective of Rolfing (and for that matter Feldenkrais) is to reduce pain and stress in the long term by improving how body parts interact. Rolfing focuses on connective tissue called fascia that wraps around muscles and nerves. The end result should be pain and stress reduction on an on-going basis.

For now, I am focused on getting the offending nerve to calm down. Once I get the pain under control, I can consider how to deal with the situation longer term. My guess is that I’ll be doing some combination of yoga, PT, massage, Feldenkrais, and Rolfing.

 

 

Advice from Alaska

For the last several days I’ve been staying off my feet and taking over-the-counter pain medication. When I walk, I generally use a cane (if I haven’t left it somewhere). As a result, my pain level has been greatly reduced. I have no intention of sitting around for the rest of my days, however.

I am still riding but the arrival of winter has nudged me into dialing back the mileage and intensity. On Saturday, I rode Big Nellie in the basement for 80 minutes. It’s a nice change of pace and infinitely preferable to riding while anxiously looking for icy patches on the pavement. Yesterday, I rode the CrossCheck outside. Temperatures declined into the 30s and winds picked up with each passing mile so I cut the ride short at 17 miles.

As I may have said earlier, I quit PT and Feldenkrais, at least until I give the pain doctor a shot (so to speak) at my problem. My friend Julie (a Rolfer, jewelry maker, proud momma, and Alaska backcountry bad ass hiker) said that I should give Structural Integration a try. (This should not be confused with Functional Intergration which is the basis of Feldenkrais.) In my current physical state, I will have to take a pass on her advice; Rolfing (one method of Structural Integration) can involve rather aggressive manipulation of body parts (in contrast to Feldenkrais which more closely resembles Reiki).

Julie’s Rolfing suggestion follows up on part of the conversation we had in Astoria, Oregon at the end of my cross country tour. I mentioned to her that a few years ago I had a problem with sharp pain in my right leg. While having a Thai massage, the therapist hit the problematic nerve in my inner right thigh and I flinched in pain. The therapist decided to skip over that part of my body. Julie said that if it had been her she would have dug right in.

It’s interesting that massage, Feldenkrais, Rolfing, and, for that matter, chiropractic, all profess to address the same body problems. Whether one method works probably depends on the pathology involved. At the moment, I know from x-rays that my back is showing numerous signs of age-related deterioration, complicated by my genetic make up, a previous back surgery, and a whole lot of wear and tear. Hopefully, tonight’s MRI will give an better view of what is causing the specific pain that I’ve been dealing with.

In a few weeks, I may be able to ramp up my activity level without pain.

I met Julie the day after I reached the Pacific coast on my 2018 bucket list cross country bike tour. I was feeling what I called afterglow. I want to feel that way again.

Thanks, Julie, for your suggestion. One of these days I hope to meet again. Come to think of it, I haven’t ridden a bike in Alaska yet.

 

 

 

Climbing aboard the PT Boat

Today was my second physical therapy appointment for my numb right foot. Of course, this meant that when I woke up my foot felt fine for a few hours. I drove to the appointment because the temperature was dropping almost as fast as the wind was howling. Along the way, my foot became number than it has been in weeks.

At the PT place, the therapist I saw last week, put my right foot, now back to its usual numbness, through various gentle twists and turns. The working theory is that a big nerve in my foot has been damaged or is entrapped. The gentle twists and turns of my foot, ankle, calf, and entire leg are attempts to address this.The technique is actually called nerve flossing. I didn’t notice much difference. I was handed off to another therapist who gave me a number of exercises to do that seemed simple but actually were not all that easy, if done correctly.

Most of the exercises were designed to address my lower back and core strength to deal with the possiblity that my problem was related to my back. The doctor had alread ruled this out but the first PT person said that it’s possible that the EMG test was done when the nerve was not fully misbehaving, and thereby led to a false assesment.

I was doing fine, partly because many of the exercises were variations on the PT I routinely do for my back and core and on the yoga poses I do. Two exercises were particularly notable. First, I was doing something called the pointing dog. It involves kneeling on all fours and extending your right arm and left leg while squeezing your stomach and butt. Nearly all the exercises involved squeezing core and butt so by the time I got to the pointing dog my stomach and butt were pretty much all squeezed out. When I did the exercise my numbness in my right foot untensified and spread from below my ankle to pretty much my entire foot. Instead of numbing it was now tingling. We modified the exercise and made a note.

The second exercise that seemed to be fruitful was using a lacrosse ball to knead the muscles in my calves, my quadriceps and my hanstrings. This had no discernable effect on my hams or quads, but it hurt like hell on my calves. Each calf was all knots of tight muscles. Ah ha!

Of course, I have no idea if this has anything to do with my numb foot but it was interesting none the less. I go back next week for two more PT sessions. In the meantime, I am reconsidering rolfing, because it seems as if it might involve the kind of deep muscle massage that the lacrosse ball is getting at. A friend of mine highly recommends a rolfer in DC. Once I close the loop with the neurologist at the end of the month, I may give the rolfer a call.