Compression fracture

[alex38]

Hi,

Just got back from an Orthopedic Doctor who X-rayed my back to diagnose lower back pain. He said I may possibly have a small compression fracture in a disk. He is scheduling an MRI and said I may possibly need to talk to a Neuro-Surgeon, depending on what appears on the MRI.

I was hoping to go to Fla. and ski from Feb 10th to the 16th, but Doctor said I should at least wait for the MRI if not take the whole winter off from skiing. 

That was pretty much all he could tell me, if anyone whom frequents this invaluble resource for slalom skiers has any input on this it would be greatly appreciated.

[MrJones]

Alex,

You haven't given much history regarding your problem, but I have a few thoughts for you. 

 

An x-ray shows bone and not disc. It could show if you have decreased disc space between the vertabrae, but that is about it. A compression fracture normally is used to describe a fracture of the vertebrae caused by osteoporosis or a fall onto the buttocks from a height. Unless you are in M8 or above this is not likely your problem. 

 

I am not encouraged by your ortho's idea of sending you to a neurosurgeon and get an MRI if you have not already attempted a course of conservative care. This would be rest, Physical Therapy, Chiropractic. I am a PT and biased, but I would recommend finding a good PT who does a lot of manual "hands on" work and does sports/back rehab. If you get hot pack, e-stim, and ultrasound only find someone else. 

 

Surgery can be a viable option if you have a certain pain history/presentation that correlates with your radiological findings, but this should be a last ditch option that few people need. If this is a new presentation of back pain (which is my impression from your post) you should be able to get over it and go back to skiing. I would strongly recommend getting Stuart McGill's book "Low back disorders". He is a biomechanics PhD who has done tons of research into back pain. He does an excellent job of explaining the causes of back pain, how your activities correlate with this, and an excellent researched based progression of rehab exercise. You can find it at OPTP.com. 

 

Good luck and be smart about when to start skiing again. It is mid January you know.

sj

[RichardDoane]

Beware of Surgeons, they'll always want to operate. Definitely find a Sports Medicine PT, and a good massage therapist.

[alex38]

Thank you. Should I even bother with an MRI? I think I will skip the Fla. trip and "ski another day" as they say, thank you again guys.

-Alex

[alex38]

I did go to a PT place for a foot strain, and it helped immensely, i just checked and they do have sports PT, and they did work with my foot manually too.

[35 in the bag]

Scot,Thank you for once again weighing in with your expertise. You are one of the best resources we have when it comes to an informed medical perspective. Your contributions allow us to examine our problems more thoroughly and work toward what is hopefully a better answer for us. We are often limited by our ignorance in this area and further stalled by what some "expert"/Dr tells us in the 3 to 9 minutes with us. FYI, my spondylylothesis (sp?) is basically (99.9% of the time) resolved with core training and eliminating low back stretching or beyond moderate twisting. Every now and then the floating pars (I'm guessing this terminology) move into the wrong place.....I feel it happen and experience immediate moderate limitation and pain. I can resolve the acute issue myself by lying on my back and manipulating the L5 process with my fingers until it seems better. Usually I am back to 90% upon completion (which can take some time....it’s all trial & error) of the manipulation and 100% within days. Not really looking for you to comment here, I just thought you might like to know.One year later....I am still reading McGill’s "Ultimate Back".....I can only endure about 1.5 hrs at a time!! Thanks,John Miller

 

[ktm300]

Thanks to Scot Jones, I got the McGill books and became my own quack Dr.  Seriously, I did know more than most of the Drs. I met with after having studied the McGill books like I was going to be tested on the material.  80% plus of low back issues resolve within six weeks doing absolutely nothing.  This is why most Docs and many insurance companies suggest that you wait 6 weeks to get MRI.  However, this wait time is for regular people not skiers.  I suggest that you get the MRI now and rule out any obvious disc problems.  Knowing what you are dealing with will really help you decide what to do in rehabing your back.  Reading x rays is as much an art as science.  The MRI will most likely be performed with you lying down which gives a misleading view.  See if you can get your Dr. to refer you for MRI standing up with your spine loaded.  Some facilities can do this.

 

This is not advice but, to me, funny.  I went an entire winter with little sleep because I had to get up and walk around 2-3 times a night as a result of sciatica.  Tried everything to help it.  When spring came my sciatica was still there but, I skied.  By the second time I skied, the sciatica went away.  90% improvement.  Go figure.

[alex38]

Thanks for the help guys, just got back from MRI, will bring the pics to the Doc on Tuesday.

[MrJones]

Glad I could be of help. If someone out there is looking at the McGill books I would suggest getting "Low back disorders" and reading it first. I think it is a better thought out presentation that is easier to understand. I believe he had an editor for it and then self published the "Ultimate back fitness" book. The second does have a great deal more strength/stabilization work in it, but knowledge comes first and the strengthening comes second.

 

You can certainly get an MRI. I typically tell patients that if they are not having strength loss, bowel/bladder signs, or are strongly considering surgery at the time due to pain then they might as well wait. I have seen horrible looking MRI reports from patients with minimal to moderate pain, and brief reports saying no abnormal findings from people who can't straighten up to walk. Backs are the most compliacated injuries. It is art and science with some psycology mixed in. 

 

KTM. I have had the same thing happen regarding skiing and feeling better. I was very stiff and just not feeling good (or skiing much) due to the back all last spring. Went to Ski Dawg's house for 3 days of blow out skiing over Memorial day. Stiff friday night, better on saturday, by sunday I felt great! I actualy noticed this trend a lot last summer. If I was off 4-5 days my back would feel "not right" on the first set back, but fine after 2-3. Kind of nice after a couple of years of 1 round and out.

sj 

[alex38]

Hi, MRI report did not display any fractures, orthopedic stated I had a couple slightly bulging discs and prescribed some PT. I will buy these books, and I will thank you all again for your advice and support. I am not going to Fla. in Feb., gonna try for April, obviously will focus on getting myself into good shape with a nice strong back.

Oh yeah, MRI did show one thing that was wierd.....I only have one Kidney!!! (this is true)

[Thomas Wayne]

Well now you have an answer if your best friend ever needs a kidney donor.

 TW

[scoke]

 

Scot Jones is the man! He has "been there done that" on most of these things....

I talked to two different Orthopedic guys and one physical therapist about a hip issue I was having. Everyone was scratching their heads and couldnt come up with something solid.

 Jones semi-diagnosed me in Chilis parking lot one afternoon. Then he put me on a PT table, did some strecthes and "diagnosed" me 20 mins later. Ever since then I can stretch the problem out and consistently have resolve when it starts getting tight or having issues.