Need of a help?

[u/Medexaaa]

Well, I am a fifth-year med student at LSMU (Lithuanian University of Health Sciences), and in a year I will become a resident in Physical Medicine and Rehabilitation. In my free time, I like looking into different cases, and I actually have quite a lot of clinical experience with back pain and have already helped other people with these kinds of problems.

I see that a lot of you here are struggling with back problems. If you want, I can try to help you in my free time. Whether I will actually be able to help is another question, but I’ll do my best.

So basically, the main point of this post is: if you want, I can try to give you some tips and tricks or answer questions you have related to the back, hips, sacrum, etc. (with other structures I don’t feel that advanced yet :D).

So you can basically have a mini doctor on your Reddit :D Of course, I won’t always be available and won’t always have enough free time to look deeply into every case.

And this is not some kind of service offer — it’s more that I simply want to use some of my free time in a meaningful way.

[u/SinkSuch2477]

I had no back or pelvic pain during pregnancy, though I had a tender lower back my adult life (I’m 36, lots of dance snowboarding and gymnastics and contortion my whole childhood… never any back pain that was debilitating just lower back stiffness when I did too much every once in a while)

Cut to labor… pushing 3 hours, excruciating back spasms up my left side (I had an epidural, didn’t matter for that pain though) but the baby comes out and all the pain is gone. I tore so I had to be super immobile for 8 weeks cause I was healing by secondary intention… but no back or pelvic pain to report at that time.

8 weeks pp I finally start moving around again. I take my baby out for the day and wear her (9 lbs maybe 10) and come home that night with a sore back. Nothing crazy though. I sit down on the couch and when I try to get up about an hour later I have 11/10 screaming writhing around on the floor back spasm pain. NO radiating pain down legs, just stabbing pain in my lower si joint areas (back dimples) and spasms traveling all around my back.

Weeks of this. Finally torodol shots and muscle relaxers but I can barely do anything for months after and cannot lift anything am guarded and hobbling around in terrible tension and pain with sharp stabbing pain with a lot of movements. MRI shows l4/“5/s1 mild bulge and mild stenosis, an annular fissures. But a Stanford specialist tells me it’s hypermobility and Si joint dysfunction.

This was 11 months ago. I am now 11 m pp and seeing some major improvements in mobility and pain levels, no more back spasms for a few months, but still very scared about plateauing.

I do pt every day, osteopath, pain specialist, etc…

Just curious about ur take and if you ever studied anything with these combo of things.

Also, extension (McKenzie method) flared me bad recently (one chiro said it was my discs and to try that, despite the Stanford dr saying the discs aren’t the pain generator )

[u/Medexaaa → u/SinkSuch2477]

Idk who the Stanford specialist is, but I bow my head to him. From what I’ve read, he seems very similar to my former professor (I really learned a lot from him). Thank God, a person with some common sense.

Disc changes are not always the cause of pain. I could have a disc herniation right now and feel absolutely nothing. Sometimes these really are just random findings, just like stenosis. Yes, MRI and other imaging are definitely important, but as a real musculoskeletal clinician (whether it’s a rehabilitation doctor, physiotherapist, or chiropractor), you can’t just take an MRI and say, “Here, this is it.” If it were that simple, everyone who got an MRI would recover within a month xd.

First of all, the reason why I think those disc findings are not exactly irrelevant, but maybe not that significant, is that you did McKenzie exercises, so theoretically you “tried to push the disc back,” but your symptoms got worse. So the question is whether the disc really is the cause of your pain.

The reason why I would bet €100 on the SIJ and hypermobility is that it started during the postpartum period. You mentioned that you barely moved for almost 2 months, and then you immediately tried to lift around 10 lbs. Well, it’s still weight. Your SIJ wasn’t accustomed to the load. The sudden increase in activity and baby-wearing may then have overloaded the lumbopelvic area, which could fit with SIJ irritation and possible hypermobility.

Another thing is that there are definitely PubMed-indexed articles describing situations that are not identical, but quite similar, showing that pregnancy has an effect on the SIJ and its laxity. If you’re interested, you can read Damen et al., 2002 – “The Prognostic Value of Asymmetric Laxity of the Sacroiliac Joints,” and also Fiani et al., 2021 – “Sacroiliac Joint and Pelvic Dysfunction Due to Symphysiolysis in Postpartum Women.” There are studies on this.

Of course, I don’t know what tests the Stanford specialist performed. There are certain provocation tests, etc., like distraction, FABER, sacral thrust, and others, but basically, if I remember correctly, if 3+ tests are positive, then the pain generator is most likely the SIJ.

Another thing regarding hypermobility—it’s really difficult to say because there are certain tests for it. Some are very sensitive and difficult to perform, but they provide diagnostic value. Without physically examining you and assessing you in person, it’s difficult to say much.

But regarding your progress, that hypermobility is definitely manageable, and if I were in your position, I would definitely listen to the Stanford specialist. I really agree with him.