David's story: A Badly thrown box, back pain, and a return to basketball
As a delivery man for an international freight company, twenty-seven year-old David had logged a few years and a lot of experience throwing packages around. But when one of his co-workers threw him a box, something was immediately wrong. "As soon as I caught the box, I knew something happened. I felt a sharp tearing sensation in my low back, and the pain literally dropped me to my knees".
A series of visits to his primary care doctor resulted in an MRI of the low back (lumbar spine), and a referral to Riverside Spine for pain which had not responded to mild pain medications and a short course of physical therapy. "There was nothing obvious on my MRI that explained the constant, aching low back pain that I was experiencing. There was not a herniated disc, and I didn't have pain shooting down my legs. But yet, I couldn't run, and I couldn't play basketball because of the pain."
"Sometimes, a lifting and twisting injury can cause a tear of the ring around the lumbar disc, which causes chronic low back pain like David had", says Dr. Kornick. "Often, a tear of the disk is not even seen on a traditional MRI, but requires a specialized test and CAT scan". Riverside Spine recommended that test, which would only be considered by a physician who routinely treats spine problems and can recognize pain coming from the disk directly. This pain is called discogenic low back pain.
"At first, we treated the problem with medications and physical therapy for core strengthening," reported David, "but I was frustrated at not being able to play basketball". Dr. Kornick then recommended a discogram, which is a test that involves injecting a contrast dye substance directly into the disk under low-dose X-Ray, and then sending the patient to the CAT scanner for further detailed diagnosis of a suspected disk tear. "The information from a discogram lets me know if a disk is torn, where and how badly. This may require a surgical consult for lumbar spinal fusion in severe cases of disc tears with pain" Dr. Kornick explains.
In David's case, there was a minor tear at the lowest lumbar disk, and although it was enough to explain his pain, it wasn't severe enough to warrant surgical evaluation. "Dr. Kornick recommended that we try epidural injections first", David says, "and after two simple shots, I could tell that I was improving". His medications were working better, and he needed fewer of them. Pain flare-ups were not as severe and less often. Another important part of his therapy has been core strengthening, like yoga and pilates. He learned some of these techniques through a referral to physical therapy.
Now, with occasional injections, medications and physical therapy techniques, David is back at work and feeling more like his old young self. "The doctors at Riverside Spine definitely helped me with their diagnosis and therapy, and relieved my pain. I'm back on the basketball court, maybe not as crazy on the offense, but at least I'm doing the things I like to do again."