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Warring Diagnoses: What To Do Next? Discretized Pain "Energy Levels"

Hi all,

Thanks in advance for your time. I really appreciate the community here and all the support I've seen on other threads.

I'm new to the forums. Feel free to direct me to a thread if you think my case is especially similar, but I've done some browsing and haven't come up with anything.

The decision I'm trying to make for myself is: should I go ahead and get an MRI (~$300 out of pocket) to see where it leads, or should I continue conservative treatment?

What I want to know from this forum is: does my history lend itself to any diagnosis that you know of besides slipped/herniated disk and stress fracture?


Intro:

I'm a 23-year-old male physics grad student. I'm 6'2", 186 lbs (lost 4 lbs since the accident, for what it's worth). I'm athletic, as physicists run.

About 6 months ago I think I injured my back deadlifting (300lbs, which at the time didn't seem like very much). I didn't notice it until doing yoga the next morning--not so much a shooting pain as a "firey" ache. At the time, I think the pain would've been a 6. It lasted about a week, gradually dying down to a 3 in certain positions and 0 otherwise. 

Over time the pain has oscillated, but it's always dependent on my position. In particular, bending while turning to the right is a no-no.

Rest seems to help temporarily, and ice helps dull the pain. Major aggravators include pulling my shoelaces up while bent over and sitting forward to solve pen-and-paper problems.  In fact, my main complaint is that the distracting pain is making it difficult to do my studies.

What's seemingly unique about my case is that if unaggravated, I experience no pain whatsoever while standing up straight, bending over, etc. However, after achieving aggravation (sitting forward for an extended period, sitting on the ground for a few minutes, road-biking 10 minutes to class), standing straight up or bending over (especially with axial turning) can be pretty painful (5-6 on the pain scale). There seem to be two "states:" unaggravated and aggravated.

So far, nobody's sure exactly what's going on. Lumbar x-ray came back normal.

The conflicting guesses/diagnoses:

PCP: Originally contending for muscle strain, now unsure

Chiro: minor disk issue, could be tiny tears in the annulus if I twisted during the deadlift

PT: potentially chronic pain having to do with some sort of nerve compression

Sports Science doc: facet joint issue or stress fracture

My next step, it seems, is to get an MRI, but since I'm a lowly grad student with a teeny-weeny income, I want to be sure it's the right move.


Description of symptoms:

When unaggravated, glimmers of pain emanate primarily from my low right side; when highly aggravated, both the low right side and the mid left side produce pain when bending and engaging my back. In highly aggravated states, standing fully erect also causes a deep central pain.

No sciatic or radiating pain; it's all restricted to the low back.

Pain is greatest the day after doing high-impact or strenuous activity.

I have very tight hamstrings; back sensitivity worsens when my hamstrings are sore.

Pain tends to be lowest at the beginning of the day, but this is also the portion of the day where aggravation is most likely to occur.
If in the aggravated state, transitioning from slouched-sitting to standing produces a grinding/"shifting into gear" sound/sensation just above the pelvis. I can reproduce this by laying on my back, angling my outstretched right leg at about 80 degrees against a wall, and moving my bent left leg up and down relative to the floor.
If I do a super-intense static core workout, with planks to exhaustion, many sets of bird-dogs, etc, the pain disappears for a period of about an hour. Like 100%, all grinding sensations gone. I was gleeful the first time I found out.

The story so far:

For the first five days the pain made it difficult to walk completely upright at times. I assumed I had a light strain and took it easy in the gym.

After the first month I made an on-campus appointment with my PCP. After bending me over, moving my legs around, etc, he found no neurological issues. He recommended I keep taking ibuprofen and generally avoid flexion.

I kept lifting for the next few months, occasionally revisiting squats and deadlifts, always at low weights. These exercises would relieve pain, believe it or not, until the next morning, when I would wake up in the "aggravated" state. 

After the fourth month I experienced a pretty painful three days after playing rec touch football with some friends. I decided it was time to make another appointment.

I made another visit with my PCP, who prescribed me muscle relaxants and referred me to a PT and a chiropractor at my request. I didn't take the muscle relaxants, as they interfered significantly with my studies.

I had two visits with the chiro; he first believed my pain was chronic, and noticed that "bowel movement muscle"-induced pain indicated a disk issue. He was happy that I was going to PT. The second visit, he was happy with my mostly-recovery. He guessed it was a disc issue and hoped it would resolve itself with icing and careful hamstring stretching.

At the fifth month I experienced a pretty gnarly day of pain the day after lifting shoulders, no more than 90 lbs in top of my bodyweight. I scheduled another appointment with my PCP and resolved to stop lifting weights entirely to see if I improve. PCP set me up with an xray and an MRI referral, along with a referral to a sports science doc. The xray came back normal.

I stopped lifting weights and bike-riding entirely and have transitioned to a "static abs and low-impact cardio" regimen. My hope is that this issue will resolve itself over the next few months of reduced activity, as laying off was something of a last resort. Weights were one of my primary sources of stress-relief, and a Physics PhD is pretty demanding in terms of mental health.

Three weeks in, this reduction in activity has been very effective in terms of pain management, but I can definitely still "feel" the rumblings of pain. Aggravation spells are far less common and less intense, but I'd like to have them resolve entirely before gradually resuming strength-based activities.

Today, I met with the sports science doc, who noted that one of my hips is more flexible than the other and recommended I go ahead with the MRI. She thinks maybe I have some small bone or joint issue which hasn't been fully resolved yet with reduced activity.


Question time!

1) Any other places I should look to consider what this might be/more conservative treatment options to try before dropping the cash for an MRI?

2) Have you heard of/experienced these "energy levels" of pain? Excited vs. unexcited? What was the diagnosis?

3) What advice do you have for keeping up morale? I'm starting to lose hope that I'll ever return to full function.


Thanks for your time, and please don't hesitate to ask questions. I understand if you haven't read all of the above, and am happy to say anything again or rephrase as needed. This injury is the #1 visible threat to my PhD, and I hope to attack it with your help, so I'm receptive to all advice, forum-related criticisms, and words of warning.


-Adam

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