TMBRA - Rider Board

[Guest]

Doc,

6 years ago I was put in an ambulance and sent to the hospital for a 5 day retreat. They had determined via cat scan that I had a Myofacial tear between my spine and muscle. After the cat scan I got the impression, from the doctor, that the tear was so small that the cat scan didn't even pick it up in the image. So, ever since I haven't had piece of mind with the diagnosis, but everything I've read about the injury seems to be accurate with the doctor's diagnosis. I couldn't get scheduled for an MRI at the time and never got around to getting one.

Yesterday - I went for an extremely easy spin on the mountain bike and was feeling very strong, but never unleashed. I kept a very high spin through-out the ride and never used a bigger gear or experienced any strain. About 10 miles in to the ride came a creek crossing, which I do all the time, it's not technical but is a little slippery. I begin my move over the water and get to the other side, still going very easy. I stand up to shift my weight forward a bit for some balance and low and behold my lower back feels like it slipped a little and the EXACT same pain occurs like the injury I describe above. I mean exact, but without the extreme muscle spasm and lock down position. I can still move and walk a bit but turning, bending and straightening different ways hurts like a mutha.

Day 2 and I am still indoors taking 800mgs of Advil with lots of rest. I am planning to see an orthopedic doc (recommendations are welcome) tomorrow and hope he will send me straight to an MRI. I don't want the age old advice of a first visit of; take anti-inflammatory, pop a few muscle relaxers and rest... How can I get a prescription from the doctor for an immediate move to an MRI? I have great insurance. Everything I've read about the injury seems to point to the general classification of a strain or sprain in the lower back. This broad category includes the myofacial injury and many others, but in my case the myofacial seems accurate. Also, if in fact I had a myofacial injury is there a possibility of scar tissue at the spine where it occured and is it an injury that can potentially become chronic / recurring. Last, I want to begin rehab asap. Any thoughts about this?

Thanks
Mike

[The Bike Doc]

Mike:

Discuss your history and discomfort with your orthopedic doctor much as you have done here. By the time you will have seen him or her, you will have had 2 days of rest and anti-inflammatory medication. If the pain has not eased up or it is worsening, or if there is any associated numbness or weakness, your orthopedic doctor likely will move earlier in pursuing an MRI. If the injury is a myofacial tear, therapy likely will be conservative much like you are doing now. Local ultrasonic therapy, physical therapy and CAREFULLY implemented manipulations if you have pulled your spinal body out of allignment from the injury may be in order.

In regards your questioin regarding scar tissue and chronic reinjury, yes both of this can be an issue. One of the keys in therapy to help reduce this possiblity is to do focused exercises and stretches that can help build up supportive muscles and keep the muscles, tendons and ligaments limber and less prone to reinjury. A Physical Therapy consultation can be invaluable here.

Thanks,
_________________
Paul K. Nolan, MD
AKA: The Bike Doc