This is a story about what happened to a mate of mine who showed me the radiologist’s report from the X-Ray of his back. Here’s what the report said:
‘There is a central disc protrusion with a focul annular tear… facet joint arthropathy and ligamentum flavum hypertrophy… there is a disc bulge which is paracentral to the left side and extended in to the foramen and far laterally… there is mild crowing of the cauda equine… there is no evidence of spinal canal stenosis… blah, blah, blah.’
So what is an ordinary person to make of this gobbledegook?
Well, it’s extremely difficult to make anything of it. You can Google ‘ligamentum flavum’ and discover that it is ‘a strong ligament that connects the laminae of the vertebrae.’
Then you need to Google ‘laminae of the vertebrae’ where you’ll find that the laminae are ‘two flattened plates of bone extending medially from the pedicles to form the posterior wall of the vertebral foramen. The Pars Interarticularis is a special region of the lamina between the superior and inferior articular processes. A fracture or congenital anomaly of the pars may result in a spondylolisthesis.’
Then you’d need to Google ‘pedicles’, ‘vertebral foramen’, ‘Pars Interarticularis’, ‘lamina’ and ‘spondololisthesis’… and on and on it goes. You need a PhD in Latin, surgery and probably rocket science to work all this out. Certainly it will take you a long time to get full bottle on it.
Is all this asking too much of an ordinary bloke with a crook back? You betcha.
Anyway, as part of my research I went looking for images and found a diagram on which the Ligamentum Flavum was highlighted.
At least I now know where the Ligamentum Flavum is, though I can’t tell from the radiologist’s letter what has caused the hypertrophy – which for those who don’t know what ‘hypertrophy’ means, it means ‘it’s got bigger’.
Why has the Ligamentum Flavum got bigger? That is the burning question.
It is a pity that the radiologist does not address this issue. Radiologists must see these things all the time. You’d think that sooner or later they’d want to know what the cause of the hypertrophy was, just out of interest.
But what is the cause of it getting bigger and inflamed? I’ve searched high and low and can’t find the answer to that.
But what all this points to is that the radiologist’s report is certainly beyond the limits of an ordinary explanation for an ordinary bloke to understand. It’s pretentious. It’s medical grandstanding. It’s useless to the consumer who wants to know in straight forward terms
1. What’s wrong?
2. What caused what’s wrong to go wrong?
3. What he or she can do to restore poor function to good?
The radiologist has not answered any of these questions, just looked at an X-ray and stated a few facts.
The information to the consumer is useless.
But, and I beg the question again, what does the average bloke do with this information.
Well, of course the information is not for him is it? It’s for his doctor.
Now I understand that the doctor is meant to read the report from the radiologist and ascertain the cause.
Most can’t do that.
In the case of my mate, the doctor certainly didn’t do that. All that happened was that he was told that it was probably not necessary to have an operation to cut off the disc protrusions, and to go home, lie on his bed and bring his knees up to his chest. He was also sent over to the chemist for a packet of anti-inflammatory pills and some Panadeine Forte.
End of story. Case closed; at least until it gets worse and it is time for the scalpel.
SEARCH FOR THE CAUSE So what is the cause of the problem?
Well somewhere along the line there’s a good chance that muscles attached to the pelvis have become weak and/or tight causing the pelvis to tilt and twist. (Coupled with this, the muscles of the front, back and core of the trunk have become weak and can’t support the vertebrae in their correct alignment.)
You can work out which muscles are tilting and twisting the pelvis by taking note of your ability to sit up straight against a wall.
If you can’t sit up straight in this position, with your bottom close to the wall, your hamstring and calf muscles are too tight – usually hamstrings. Try it and see. If your bottom is well away from the wall, as in the second diagram, it means your tight hamstring and calf muscles have tilted your pelvis backwards. If that has happened the ‘S’ shaped curve of the spine will have become a ‘C’ shape. The bones are out of alignment. You feel the pain. The pain is telling you to get back into alignment by loosening off calves and hamstrings.
If you can’t sit up straight in this position your buttock muscles are too tight. One buttock will usually be tighter than the other. Not only is your pelvis tilted backwards, but it is probably twisted around as well. The bones above it move out of alignment to compensate. Ligaments, tendons and muscles are stretched beyond their pain threshold. Discs start to bulge. You feel pain. The pain is telling you to get your body back into alignment by loosening off your buttock muscles.
You can also work out the likely cause of the problem if you have someone poke you in the buttock muscles while you are in the hip crossover and reverse frog positions
In hip crossover and reverse frog positions, people with back and neck pain will usually have tight buttock muscles. When poked in the buttock muscles (with some vigour), people with low back pain may find the pain quite intense. One side will usually be tighter than the other, symptomatic of a pelvis that’s twisted. The pain is usually a symptom of muscles that have been stretched beyond the pain threshold by bones that have been pulled out of alignment by muscles somewhere that are too tight.
Sounds a bit convoluted doesn’t it? Well it is, but the search for the ultimate cause of back pain may indeed be a convoluted process that ends up with the cause of the pain being well away from the place in the back where it’s painful. In fact you can count on that.
Of course, like most things, it’s probably a bit more complicated than that.
THE MUSCULO-SKELETAL ECOSYSTEM
On a global level the body is an ecosystem, in this case a musculo-skeletal ecosystem and it stands to reason that a weakness or tightness in one part of the system may well lead to a problem in another part or the system; which is all the more reason to keep the musculo-skeletal ecosystem, strong and flexible.
WHERE DO YOU GO TO FROM HERE? Well, you need a set of set of strength and flexibility exercises designed to treat the cause of the problem – get the pelvis square and strengthen the muscles of your trunk, front, back and core. In the mean time stay tuned, highly tuned and remember, the cause of the pain is rarely at the site of the pain.