LOWER/LOWER BACK PAIN - Spec. for Seashell

Enigmawrap:
That you have been completely off of steroids in the months preceding this injury do lend to thinking that factors other than steroids are at play in the mechanism of your injury.

However . . . it is often those who have been on long-term glucocorticosteroids or those that have been on high-dose corticosteroids that are most at risk for secondary effects due to steroids.

How long were you on corticosteroids (prednisone, methotrexate, others) for treatment of ulcerative colitis?
What doses were you typically taking to suppress the intestinal inflammation.

Effects of steroids are hidden and not evident to casual eye.

Typical effects of steroids: Tissue thinning - connective tissue, muscles, ligaments become thin, fragile, febrile. Profound muscle weakness, especially of the more proximal muscle groups (ex. gluteal muscles, quadriceps in the lower extremities). Added adipose tissue, especially to the face, upper back, and abdomen. Osteoporosis, profound bone loss.

Certainly, the case could be made that long-term steroid use caused proximal muscle weakness of your lumbar paravetrabral muscles, gluteal, quadriceps. The proximal weakness could then have served as the background leading to a severe muscle strain or nerve root irritation - simply due to postural weakness and instability.

Your SI joints, too, could have damage not seen by MRI. An MRI taken lying down does not show the weight bearing effects on the SI joints when you are up, standing, and weight bearing. You could have bone density not evident on MRI (MRIs are not very reliable for bone density measurements). Bones that look like swiss cheese, with lots of pocketing, are naturally going to be more uncomfortable than bone structure with a solid core.

You also mention that you are relatively inactive and sedentary. That can make for ripe conditions for muscular strain and strain.

Soft tissue injuries take time to heal. 6-8 weeks. It can be frustrating to heal a soft tissue injury because there is no verifiable proof on a CT scan or MRI to validate one's suffering. But make no mistake, soft tissue injuries are real and they are painful.

It's as though we, as a society, have become too dependent on CT scans and MRIs to either confirm or unconfirm possible ailments of the body. MRIs and CT scan show some/many structural abnormalities of the body and its organs. But not all injuries are amenable to discovery by CT scan and MRI. Soft tissue injuries - injuries of the connective tissue - one of them.

Next steps . . . see a physical therapist with interest/speciality in sports medicine rehabilitation. Participate in a pool therapy program or a basic yoga or Tai Chi movement class for gentle stretching and core strengthening.

Rest with warm heat and or ice . . . gentle stretching and strethening . . . walking to keep your body parts and joints moving.

It certainly does sound as though you have some irritation to the sciatic nerve. The sciatic nerve runs between the layers of the gluteal muscles and then down the posterior aspect of the thigh.

Always squat and bend from the hips/knees to pick up an object. Avoid rotating your torso when picking up an object.

I have worked with individuals who have herniated a disc picking up a paper clip. How? The individuals were pending from the waist, picking up the paperclip while rotating one direction or the other. Forward flexion at the waist + rotation = poor body mechanics and a recipe ripe for a disc herniation.

You may do better being on a prescription non-steroidal anti-inflammatory medication. Ex. Relafen.

Just trying to trouble shoot with you.
-Karen -

Karen,
thanks for responding....to summarize: I started prednisone in January of 1997...and it was the start at 40mg/day and taper down to 0 over three months..again, and again, and again..tried all the usual drugs: sulfasalazine, asacol, mesanine, etc. and to include methotrexate (hated that one)...finally, got to use Budesonide and got off of the pred...the Budesonide lasted about 18 months, then back on the prednisone permanently in summer of 2005 - after Remicade did nothing but make me eat lots of cheese and have nightmares about cats -....and, on 20mg/day pred until April of 2011 when I had the surgery....got off of Pred but had to go back on in Sep. of 2011 because was feeling terrible - my family physician stated that they took me off of it too fast...so, back on at 5mg/day until Jan. of 2012....the first back pain incident happened about 18 months later...just an fyi...in that interim period I had discovered world of warcraft - LOL! - and that is part of the reason I was sitting too darn long.

Thanks for all the advice about treatment....all the Dr.'s I've seen about the pain, up to this point, gave me the dose pack and a 3-day excuse for work - no mention of therapy until about 6 months ago, and now I'm on it again, but the 'gentleness' part is not there....so, I'm going to do it myself I guess.

Much thanks!!!