Lower back still hurting, looking for advice

Injuries
#1

I know I’ve mentioned this in my log over the past couple months but thought I’d start a new thread:

I’m a 17 year old high school lefty pitcher. I’m taking baseball pretty seriously and trained very hard this offseason, as I’m looking to play collegiately. Made All-Conference for Varsity last year as a sophomore so this year is the one big year to stand out and impress colleges.

Anyway, 9 weeks ago I felt amazing. I had gained 5 mph on my fastball and was set to be the top pitcher in the league. Then, trying to make a slight change to my mechanics, I began to notice a little twinge in my lower back on the right side (I’m a lefty) after every pitch. I paid little attention to it - i was still throwing hard and my arm felt great…it wasn’t my arm so there wasn’t anything to worry about, right?

The change I made involved turning my back a little more to home plate as i lifted my leg, and a more violent snapping open of the hips into footplant. I had no pain prior to this change, and it hurt only after performing this motion for the first few times. 5 days later, I had thrown 4 more times. After the bullpen it felt so tight that i had trouble walking the next day (and week).

I iced for the first 3 days, and my trainer gave me heat for that first week. Moderate relief.

Then i saw the doctor who took an X-Ray which came back negative. He said everything was ok and that it was a simple muscle spasm. He gave me a muscle relaxant, told me to stretch and do heat + e-stim and that I would be fine in a week.

Fastforward 4 weeks or so. E-stim + heat every day with my trainer, + started very light core strengthening program for 2 of those weeks. No noticeable improvements after this time. He gave me stretches to do. Flexing forward is pain-free, but ARCHING (especially while also twisting to the right) my back produces pain. It’s kind of a tight aching pain and only occurs when I twist funny or arch my back.

So far rest has not diminished my symptoms. Some stretches (like the McKenzie arching exercises) made it worse, but nothing has really helped the problem too much.

Anyway to sum up:
Chronic low right back pain: 8 -9 weeks and counting
Hurts to go into extension
Pain is off to the side, there is no tenderness to touch

furthermore, I recently had a bone scan and the doctor’s assistant said that she couldn’t see anything from it. I will find out for sure what the bone scan showed in a few days, but I’m assuming that the bone scan came back negative.

Right now I’m researching and Prolotherapy looks like my best bet as it’s simple and used to treat a ton of different conditions.

Has anybody here had similar problems?

I would think if it was a stress fracture it would show up on the x-ray…

#2

Lanky,

I suggest checking out the forums on ASMI’s website. In particular, check out this thread
http://asmiforum.proboards21.com/index.cgi?board=other&action=display&thread=539
to gain some insights into low back injuries.

Hope things turn out to not be serious.

#3

First off, hopefully things turn out to be ok for you Lanky.

However, I will say several weeks should cure some muscle tightness. I would suggest seeing another doctor. For me personally, in college I had some elbow problems. First, I went to the team doctor and they took an xray, found nothing, claimed it as tendonitis. After complaining more about it, I went to another doctor, after some basic arm tests, there was nothing conclusive, and again is was diagnosed as the “t” word. With more rest and more ice and stem, etc. etc., I tried to pitch several weeks later (by now, it’s the end of my junior year), and still the pain was there! I pushed the team trainer to send me to another doctor, as reluctant as they were, I got my wish, and it turned out I need an operation! All in all, I’m not saying your doctor is wrong, however, pain doesn’t lie. Get it checked out again.

#4

Lanky,

Knowing the attention to detail that you give your pitching, I am sure that you are the same way with your health. So, I think you can’t go wrong seeking out a qualified orthopedic surgeon [orthopaedics being the branch of surgery broadly concerned with the skeletal system] near you. I believe if you post a request for a referral at the ASMI website, someone will make a few suggestions as to who you might see in your geographic area.

I and all of us I’m sure hope this thing resolves itself quickly so you can get back on track.

#5

wow. i have the exact same injury. it only hurts when i arch and when i first start to pitch after a while in the pen or on the mound it feels ok, but when i go back out after resting between innings it hurts like hell. mine is lower back and to the right (i’m a righty). i feel your pain…

#6

one of my teammates was experiencing lower back pain for a few weeks and went to the trainer. the trainer told him that it was because his legs were to tight. he stretched his legs really hard along with stim, heat, and ice everday for a month and he is back to new. so i guess maybe you could try strecthing your legs a good bit more and see how it helps

#7

I was diagnosed last week by the Physical Therapist. About time.

Facet Joint Sprain L2-L3 /L3-L4 also known as Facet Joint Syndrome.

http://www.cure-back-pain.org/facet-syndrome-treatment.html

Why do facet injuries occur?

Essentially, the spine is a long chain of joints which are protected by ligaments and muscles and if some of the links stiffen up through injuries or anatomical changes it makes other links move more to compensate and eventually the overuse of the flexible joints cause pain through sprain. Most injuries are caused by what is called recurrent micro-trauma, it means many small repetitive injuries, until the proverbial ‘last straw’. That is why people often hurt themselves doing very trivial things such as bending to pick up a pen, and they hurt themselves before they even get to lift the pen. This can happen through fairly trivial activities. It does not have to involve heavy lifting, it is more often caused by awkward movements. Maybe things that you have done a hundred times before.

There is another mechanism of injury that can cause facet joint pain called meniscoid entrapment. Research has shown that there is sometimes a fold present in the join capsule that project inwards between the joint surfaces. This fold in the lower back-joints can get trapped. In those cases chiropractic teatment can sometimes have a seemingly miraculous effect with almost instant pain relief after one session of chiropractic spinal manipulation.

My options are:

Physical Therapy (currently doing)

Acupuncture
Chiropractory (potential “miraculous” effect if it’s the meniscoid entrapment above)
Facet Joint Blocks (an injection normally given to confirm a facet joint syndrome diagnosis. It numbs the nerve endings of the facet joint and so if that’s where the pain originates there should be an immediate feeling of relief. I havent gotten this injection yet, but will likely get it if standard PT exercises and techniques are ineffective)

and Facet Rhizotomy: a minimally invasive surgical procedure in which the nerve roots/endings are not simply numbed as in the Facet Joint Block, but actually destroyed. This type of treatment is supposed to prevent pain from 6 months -2 years on average.

I’ve been doing PT for a little over one week so far. He’s had me:
Doing two stretches (Mecca stretch, and a hip-crossover type stretch lying on back) 5 times/day
See him 3x/week where he: Heats for 20 min, ultrasound for 5 min, then some kind of massage for 5 min, then he kind of presses all over on my spine with his hands for 5-10 min

This seems to have made a little progress with the ROM - after the PT sessions when he has me do McKenzie press-ups I can go a little bit further without as much pain, but when I do them at home (not directly after a massage/ultrasound) I havent made much progress there.

And it still hurts the same amount to twist/actively arch my back (like in a superman exercise on my stomach).

He only tests me directly after these massage/therapy sessions so he thinks I’m “90% of the way there” and he has told my coach this apparently. I’m scheduled to start throwing again from the mound tomorrow at 50%. I’m certain I can “cheat” and just use my arm, but that if I try to throw with good mechanics the hip rotation is going to give me the pain again.

Any thoughts?

#8

One thing you should be aware of is that while the upper spine is designed to allow rotation, the lower spine is not - it is designed for flexion/extension. So, trying to force the lower spine to rotate (possibly with inappropriate drills) is asking for trouble.

#9

I suspect this to be the original cause of the injury, but I have not done those drills or anything like them since the original trauma.

The incorrectly performed drill that led to the motion that led to the injury

#10

I am going to be specific as to what happened to Andy when he hurt his in very close the same location (On a swing while working on his hitting)…Go to an Orthopedic specialist, ours who is very renowned and now retired (Worked with Rick Wilkins and was the school physician for the Bolles School…think Chipper Jones, Rick and a few other pro’s I can’t think of off the top of my head)…applied a cortisone shot to the area to reduce the inflammation (Intermuscular…non-joint effecting). He said the first thing is to reduce that, it is very difficult to ascertain back issues while still inflammed. He also told us that due to the nature of soft tissue injury (Which a sprain is very definately), you will remain susceptable for some time to come for re-injury (We were then directed to a PT to strengthen the surrounding area…which was done with some very specific exercises on the big bouncy ball).
So Lanky it is critical to get rid of the inflammation and then rehabilitate, he has also perscribed Prendesone in a follow on re-injury situation, which is the momma of all anti-inflammatory drugs…way powerful and potent…not a drug to play around with…but highly effective for this sort of thing.

#11

[quote=“jdfromfla”]
So Lanky it is critical to get rid of the inflammation and then rehabilitate, he has also perscribed Prendesone in a follow on re-injury situation, which is the momma of all anti-inflammatory drugs…way powerful and potent…not a drug to play around with…but highly effective for this sort of thing.[/quote]

Ok this makes sense. What he told me today is that the goal is to

Increase motion - which he says is most of the way done
and then start throwing (without doing any kind of rehab exercises) to increase the strength in the area. He wants me below the pain threshold so <50%, and he thinks that it will heal itself slowly if I continue stretching and following this.

It still doesn’t make sense to me that I need to throw to stop it from hurting, but who knows.

I will ask him about the Facet Joint Block (cortisone shot I think) the next time I see him.

On top of all of this, my elbow begun hurting this weekend. I’ve been on an unregulated throwing program (told to just warm up with the team, play 1B and make snap throws so my back doesn’t both me, and I feel like this all-arm throwing is putting a lot more stress on my particularly weak arm(havent worked out in 3 months). So now I have to worry about a hurting elbow (outer elbow) on top of everything. Hopefully that has time to resolve itself while I figure out my back. Problem is I’m expected to do this throwing program 3x/week…

thanks for the advice JD it really does mean a lot all the help I’m receiving here. It’s threads like these that make me love LTP and realize how great of a resource it can be.

Lanky

#12

Lanky,

You most definitely need to watch out for cascade injuries. When you pitch/throw while trying to protect a sore or injured part of your body, you might recruit other parts out of sequence. Or you might recruit parts you don’t normally use. These can lead to further injury.

Be careful - listen to your body.

#13

!!! :wink:

#14

I do not know if this is helpful…

I had some lower back problems last year. Once cured make sure whenever you do any ab work, make sure you do even more back work. Or elese it will become unbalanced. In fact, whenever you do anything such as pushups, or bench press, make sure you follow it up with some back work.