Question
QUESTION: Hello Dr Gold

I was wondering if you could help me make heads or tails of my current situation. I got my CT scan results from a scan I had done on th 17th of May and I am currently liasioning with a GP, Physiotherapist and trying to get an appointment. I was wondering if you could explain why physio seems to make my Right leg worse and if i do need to see a specialists and which field either orth or nureo. My scan showed

L3/4: mild to moderate broad buldge with mild compression to the anterior theca. Short pedicles and prominent facet joints. Minor canal stenosis.
L4/5: Moderate broad based disc buldge. Short pedicles and prominent facet joints. Moderate canal stenosis and moderate circumferential compression on the thecal sac and traversing nerve roots.
l5/S1: Moderate right paracentral and lateral angular disc protusion with posterior vertebral body osteophytes and minor calcification. Moderate compression of the right S1 nerve root and right anterolateral theca and narrowing on the right L5/S1 foramen and suspected entrapment of the exiting right l5 nerve root. Moderate to marked canal stenosis.
CONCLUSION: Multilevel disc degeneration. Moderate canal stenosis at L4/5 and at L5/S1 there is moderate central and right sided nerve root compression and suspected right sided foraminal stenosis.

Thank you.


Hanna Somatic Educatio   ANSWER: Hello, Jessica.

The distilled essence of this report is that you have tight back muscles, which cause disc compression and nerve entrapment.  Osteophytes are bone spurs that grow from bone along the lines of pull of tight muscles.

Neither orthopedics nor neurology are qualified to deal with this situation.  It's a brain-muscle conditioning situation, and neither drugs nor surgery can change brain-muscle conditioning.  The proper field is somatic education.  I offer articles that explain, below.

Physio, with its emphasis on strengthening and stretching, often causes "rebound" muscular contractions that make the problem worse. The more sophisticated physiotherapists use Feldenkrais functional integration or PNF, earlier forms of somatic education.

Here are articles that clarify your situation and best option (in my biased opinion):

http://somatics.com/chronic_back_pain.htm
http://somatics.com/back_pain_terms.htm

Somatic education is a fast-acting, long-term benefit approach.  However, I don't know if practitioners exist in Australia.  To find out, we would contact John Loupos, who manages referrals for The Association for Hanna somatic education (John Loupos <[email protected]>).

Lacking a referral, you may undertake a self-relief program.  Ask for more information.

---------- FOLLOW-UP ----------

QUESTION: Just another question that has me wondering Doctor. If it is just a muscular thing, why have the reflexs and sensations in my right leg gone. I get constant pins and needles and pain that runs all the way down my right leg with general numbness all the time. And if Physio is the answer, why had Physio caused the injury and the damage to my right leg to worsen.

Answer
Hello, Jessica,

The reason reflexes have gone and you have pins and needles is that reflexes and sensation require nerve conduction -- the ability of nerves to conduct the electrical impulses that communicate between the brain and muscles.  Tight muscles that press upon nerves block that nerve conduction the way a kink in a water hose blocks the water.  The result:  tingling/numbness in nerves of sensation and loss of control of muscles (i.e., reflexes) in nerves that control muscular activity.  Note that the muscles doing the compression are other muscles than the ones the nerve(s) control.

So, it's not "just a muscular thing", but a neuromuscular thing.

regard,
Lawrence Gold