Hi Lankylefty.

I'm so sorry you are dealing with this low back pain issue and are so young as well.

I'm not a doctor, but rather both a patient that has spinal issues and also a mother of 2 kids; a son almost 31 now and a daughter almost 26.

Both of my kids where athletes from the time they where 5 years old, through HS and college and both played and where varsity athletes in HS and college.

Be that as it may, they also had their share of various sports injuries, both minor and my son a very serious sports injury that required some serious big time ankle surgery and the ankle totally reconstructed before he could return to the sports field.

So, being the experienced Mom with the sports injuries in kids and a spine patient myself, I am going to talk to you from both angles.

The first thing I will say is that the trainers, regardless of how good, bad or indifferent they are, and my kids had excellent ones, would be the last place I would have turned or allowed my children to turn to for any kind of treatment with a problem that continues to go on and not improve.

You've had x-rays that will show very little of what may or may not be going on with your spine, you've done treatment with your trainer, again as a Mom's opinion, not a good idea.

You've had a bone scan, though I'm not sure why that was chosen to be done for you.

What you haven't done, and your parents should be taking for this, is to see a spine specialist for a full evaluation of what is going on with your spine.

Low back pain is not normal, it is a signal, a symptom of something not right, and your bodies way of telling you that something is wrong and you need to find out what it is.

Only a spine specialist is going to be able to properly diagnose what is going on with your spine, what tests you need to have done to help the doctor determine what is going on and what the best course of treatment will be for you.

You no doubt need an MRI done of your spine to help with a diagnosis.

Once you have a proper spine evaluation done with a spine specialist, then you will know what is going on and how to treat your problem.

Now, as a Mom of those athletes, and your age, I would suggest that you and your parents find a sports medicine orthopedic surgeon that specializes in spines and sports injuries of the spine.

That kind of spine specialist will be familiar with patients that are your age and the type of injury you are suffering from.

Any other kind of doctor that a spine specialist is not qualified to diagnose you.

Please get to a spine specialist ASAP. Times a wasting on finding out what is going on, what is wrong and getting the proper treatment. AND, that baseball season is just around the corner. You don't want to waste time and find that you will miss a whole season because you have not seen a spine specialist soon enough.

Good luck and keep us posted on what you find out with a spine specialist.

Fran

the orthopedist examined my bone scan and has ruled out any sort of stress fracture. He thinks it's muscular but had no way of confirming that and doesn't know what the problem is

Was the orthopedist a spine specialist? Why wasn't an MRI done to see further and provide more information than a bone scan would provide?

Fran

I believe he was a spine specialist, yes. I'm not sure but based on my symptoms he didn't think an MRI would show us anything new.

If you where my son, lanky, I would take your for a second opinion with a sports medicine orthopedic surgeon who specializes in not only spines but teenage spine problems.

Growing teens, and at 17 and a male, you are still probably growing, many times present differently than full grown adult males.

Being that you are an athlete, and from experience with my own kids, you keep yourself in good physical shape and eat well.

What ever is going on with you and your spine, may or may not be sports related. Sports may have aggravated a pre existing condition that you and your parents, your coach and trainers are totally unaware of.

A well trained sports medicine ortho spine doc that specializes in teens and pre-teens will be well experienced in various sports related problems, whether they where caused by the sports or indirectly caused a flare up from something that you already had and didn't know about.

The odds are that an ortho doc like this has seen something very similar or the same as you are experiencing.

I know from personal experience, having seen that kind of result with my brother when we where kids. It was an ortho doctor that specialized in teenagers that was able to diagnose the problem with my brother, and he played baseball.

No one could find the problem. Why did he have pain in his hip if he tried to catch a ball in a certain way, but never in another.
All kinds of x-rays and tests where done, including bone scans and nothing was found.

Back in the 60's we didn't have MRI and CT scans to give far more detail like we have now.

Finally my parents turned to an orthopedic doctor at a Children's Hospital in Boston. They had been reluctant to take him there because he wasn't a "kid", he was 16 1/2.

All the test results where brought along with the films and he examined my brother and couldn't find anything wrong. He believed my brother and my brother tried to describe what would happen and when, but it was hard to explain.

So this doctor took my brother, my parents and one of the doctor's associates out to a baseball field. Along came a baseball, baseball bat and my brothers baseball glove.

The orthopedic surgeon stood right beside my brother and the ortho's associate started hitting balls to my brother with the bat.

Every move my brother made was carefully watched by the ortho surgeon. Finally after about 25 hits towards my brother, he finally moved to catch the ball the way it hurt and went down on the ground.

Doc told him not to move, "don't breath if you can help it", and the doc was down on the ground.

His exam, right there on the field found what he thought was wrong, but we had no way to check it then, with visual tests.

My brother had a partial tear to a tendon and sometimes his hip would rotate wrong, if he moved in the right position and presto, pain and down on the ground.

No other ortho ever tried to find the problem except with test after test and it didn't work. The ortho that worked with kids and teens knew he had to see the kid in action and recreate the situation to diagnose him.

My brother tried various non surgical treatments, including physical therapy, but in the end he had to have surgery to stitch the tendon back in place properly.

He finished his senior year playing baseball, went on to play in college and at age 54, the problem is a very distant memory to him. He has never had a problem since.

By the way, that doctor that treated my brother is the doctor that started to create a whole new ortho specialty in the late 60's early 70's and is now known as orthopedic sports medicine.
He and his associate are still in practice and are some of the best in the field.

Get yourself to a sports medicine orthopedic spine specialist that treat teens as a specialty.

As for the prolotherapy, I was unfamiliar with it, until I checked it out. I would be reluctant to try something like that without knowing what the specific cause of my spine problem is.

It may be safe, it may not be safe, but to try it without knowing what is wrong, IMHO is too risky.

Get some other opinions first. I'm betting that you will be very glad that you did.

Fran

I'm 16, and have been suffering with chronic back pain for 2 years, which is now spreading and not improving. With all the many scans, we finally found out what was wrong, yet the treatment (in the form of lumbar epidural injections) doesn't appear to be helping, and i find it very difficult to walk unaided.

On the subject of bone scans and MRIs, in young patients bone scans are done first as in the age group it is a lot more likely to be a bone disease/ bone problem that an mri scan wouldn't pick up.

An MRI is almost always the next step if a bone scan comes back negative.

When they found 2 slipped discs on mine, that can't be fixed with surgery, they suggested these injections. If these don't work, then i will be reffered to a pain clinic and an exercise clinic.

hope this answers one of your queries

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

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

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?

Lankylefty,

I have lots of thoughts about your post in new info.

First of all, in most states if not all, physical therapists can not make any kind of medical diagnosis, so finding one that has diagnosed you, really has my red flags up.

Spine specialists are the ones that diagnose patients and then refer them for physical therapy, if they deem that appropriate.

Though the diagnosis may be correct, facet pain can come from more than just sprains and it is a doctor, a doctor with an MD after his/her name that is the qualified person to make the diagnosis, not a physical therapist.

I have met and used some of the best physical therapists in the world, but they would not be one that I would trust a medical diagnosis to in any way shape or form, nor would they even attempt to diagnose a spinal problem.
They have had years and years of experience and all 4 of them have doctorate in physical therapy.

The fact that you are getting heat for part of your treatment and heat is not a usual treatment for facet join syndrome makes me wonder if your diagnosis is correct.

Your physical therapist thinks you are 90% rehabed and has told your coach this and yet you say you are still having the same pain, says to me, that your physical therapist is not doing the job that he should be doing in evaluating your progress.

Have you told the therapist about your pain at home? If you have been and the therapist still says you are 90%, then the therapist doesn't know what he is doing or talking about.

It will take 2-3 weeks minimum for the area to basically heal and that's without doing anything to aggrivate the problem.
Then it takes at least 6 weeks at least for full healing of which you really shouldn't be attempting to throw your ball.
Then you should slowly start to throw a ball and build back up to pitching.

If you do what you call "cheat" you can and will cause further injury to your spine and or other parts of your body.

Chiropracter's have a history of making spine problems worse than they where to start with, get you trapped into repeated visits for treatments that don't work and I wouldn't suggest it.

Acupuncture can be a good thing to try, but only after a proper diagnosis by a spine specialist, not a physical therapist.

As for the facet injections, they can be an aid in diagnosis, but they come with some serious risks that you need to read up on as well.

Depending on what is given in the injection, you may only have pain relief for a few hours.

Usually lidocaine is what is injected as a diagnostic tool to see if the pain is coming from the facet joints.

This is done in an OR setting under floroscopy, a type of running x-ray so that the doctor can be sure he/she is injecting the solution into the correct location. There can be serious consequences and very serious complications if the injection is done in the wrong area.

If floroscopy is not used during the procedure, never, ever let a doctor administer anything into the facet joints or any area in or around your spine.

If lidocaine is used only, then the pain relief will only be a few hours and you will be instructed to keep very detailed information about the pain relief that you obtain. If the lidocaine is going to work, you will no it right away.

It may be that not only will lidocaine be used but also a long acting steroid as well.
In that case, the lidocaine would either work right away or not and it can take up to 2 weeks for the steroid to kick in and start to provide any pain relief.
It is also possible that the steroid will not provide any pain relief.

Facet injections can result in quite a bit of muscle spasms and pain that can last a week or 2. This can happen to many, many people.
muscle relaxers and narcotic pain meds are prescribed to limit this pain.

If you have a rhizotomy done, also known as radio frequency nerve ablation, you do have to have the facet injections done first, but only with lidocaine and keep those records to see how your pain relief is with the lidocaine.
If it is enough and it is determined that rhizotomy could help you, then it can be scheduled to be done.

Rhizotomy is can be very painful to be done. As with the facet injections a small amount of lidocaine will be given to numb the skin area to insert the needle, but instead of lidocaine and or steroid being injected into the facets, a needle type tube is inserted into the area of the facet and the nerves.
The patient can not have any sedation given for the rhizotomy, but it can be give for the facet injections.

In the rhizotomy, the patient must be fully awake and alert to help guide the doctor to finding the right nerve or nerves that need to be severed. This can be quite painful as when the correct nerve is touched the pain will be felt.
Once the nerve is found, the probe used to sever the nerve with the radio frequency is inserted into the tube and the nerve is "zapped".
That can hurt quite a bit as well.

This procedure is repeated for each nerve that needs to be done.

After this is done, many, many people find that there is a mass increase in pain for a couple of weeks as well as some very severe muscle spasms until the both the muscles and the nerves calm down from the procedure.

Again muscle relaxers and narcotics are provided for pain to get the patient through this period of time.

Rhizotomy can be very successful in treating facet pain, if it is used for the correct type of pain and cause.

But it is not always successful and you may go through this and still be in pain and have no relief.

Neither facet injections or rhizotomy are a cure for the problem, the are just a treatment that may or may not need to be repeated.

The severed nerves will grow back within 6 -18 months at most and then you may be back to square 1 again with pain. Some people find that the pain returns worse than it originally was and others find that it is no where near as bad as it originally was.

What you really need to do is get a proper diagnosis and treatment plan from a spine specialist, not from a physical therapist.
Least of all from a physical therapist that says you are 90% healed when you are still in pain and it takes a lot longer to heal from facet syndrome than a week of physical therapy.

Please get a proper diagnosis from a spine specialist before you do any further damage to your spine or your body.

so, just to add on to the previous post:

the PT says:

1. My motion is 90% of the way there - (this isn't the only issue because even directly after his massage sessions when I have more motion, it still hurts to actively arch my lower back (i.e. do a superman, or anything where I need to support any weight with my back in the arched position))

2. If my goal is to return to pitching as soon as possible, I need to start pitching, but below the threshold of pain. The pain now, he argues, is a result of me not having used my back in so long and that I need to start using it as much as I can provided there is no pain whatsoever. (The problem here is that I cannot go through an actual pitching motion even at 10% intensity without some remote soreness/pain, so I don't know how I can possible follow this program or how it would help).


3. Facet Joint Blocks are never used on 17 year olds and only in the most severe cases (he doesn't think a 13 week injury with no relief is serious and that I'm still developing skeletally)


I personally do not see how pitching at 10% (basically moving in slow motion) is going to get my back to begin to feel better. I asked him why I'm not doing other rehab exercises, and he said "we don't want to do too much too soon."


Am I right that this is not standard treatment for facet joint pain?


The guy I saw before this who couldn't tell me anything was an orthopedic surgeon who works with professional athletes. I guess I'll have to find a different spine specialist

Lanky,

I've posted to you several times and am doing so again.

This post has you sounding quite mature this time and quesitoning all that this physical therapist has said and done.

YOUR GUT IS TELLING YOU SOMETHING ISN'T RIGHT WITH WHAT HE IS SAYING. NOTHING IS MAKING ANY SENSE.

YOUR ARE ABSOLUTELY CORRECT.

So let me try and analyze what is being said by your PT for you and help you see that you need a new physical therapist.

PT says your motion is 90% there but you are still in pain and it hurts you to arch your back.

PT says that your back hurts because you aren't using it and you need to start using it but not to the point of pain.

BUT when you do use your back in a pitching motion you are in pain.

I think I summed that up correctly from what you posted.

So, let's look at it this way.

If you have 90% motion, then you should have very little, if any pain, and most likely only some mild discomfort at most.

So how is it that you are at 90% motion?

Doesn't add up, does it?

You asked the PT why you aren't doing any other rehab exercises and he told you "we don't want to do too much too soon."

Maybe I'm missing something and it sounds like you might be missing something in what is said, because that response makes absolutely no sense what so ever.

If the PT doesn't want to do to much, to soon, why in the world does he want you to go out and start using your back to pitch?

Pitching is far more strenuous then any rehab exercise he could give you to do. The twisting, turning, arching of your back is far more strain on the facets then rehab exercises and those movements hurt you.

Again, not making any sense.

And you are 100% correct that this is not the standard treatment for facet joint pain.

Nor is it correct for a physical therapist to be diagnosing you either, as I said in my prior post.

I don't know about facet joint blocks normally not being used on 17 year olds, but I do know teens that have had them done.

Another point, 13 weeks of an injury with no relief is serious and any physical therapist that tells you it isn't doesn't know what he is talking about.

Nor is it the place of a physical therapist to tell you what doctors do and do not do and how they treat patients.

That comment about facet injections not being done sounds more like the physical therapist is afraid that if you have them done, he will lose you as a patient and not have the money he is getting paid for his services.

There are many types of orthopedic surgeons, They specialize in various parts of the body and even if they work with professional athletes, that doesn't mean that they are specialists in spine problems.

You really do need to see a spine specialist to diagnose you. I will keep telling you this.

If you are not satisfied with one that you see, then see another and another and another if you have to, until you find a spine specialist that you like, trust and have faith in and can diagnose you and get you the treatment plan that you need.

I know how desperate you are to get back out on the pitchers mound, but your priority needs to be and you need to focus on getting a diagnosis of what is wrong with your spine before you worry about pitching again.

Without knowing what is wrong, and getting the proper treatment for what is wrong, you can do very serious harm to yourself by trying to pitch.

You gut was talking to you and telling you what to post in your last post, and that gut of yours was telling you that your physical therapist is wrong and doesn't know what he is talking about.

Now follow that gut and get a spine specialist to help you and do it as fast as you can.

A spine specialist is either an orthopedic surgeon that specializes in spines only or a neurosurgeon that specializes in spines only.

You do not want to just see an orthopedic surgeon that works with athletes and various parts of their body, you want one that does spines and spines only.

Good luck and keep us posted.

Fran

but my parents say I need to at least try this for a week or two to see if I feel any improvement.

Luckily I pressed him a bit more and got some new responses.

I told him I could not perform the pitching motion at any intensity without at least some remote pain, so he says we need to back off from that.

Now he wants me to start with some different exercises instead. He's not giving me more than 1 or 2 new ones because "the joint can only handle so much"

Apparently he has treated more athletes with facet joint pain than he can count and all of them have recovered by following this type of plan. Facet Joint Sprain is never a permanent injury, he says. This is, of course, assuming that is the correct diagnosis.

If I dont begin to see improvement in a week or two, my parents say they will take me to a spine specialist.

thanks so much for the help

not ignoring what you have been saying, it has been extremely informative and helpful.