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20-yr old's (mysterious) lower back pain

I am the father of a 20-year old (formerly) athletic college student who first felt his lower back tighten about a year ago while he was using very light weight sitting and doing an overhead press. A few days later he was swinging a baseball bat and the lumbar pain began in full. He has seen orthopedists, chiropractors, and physical therapists. He has had shots (steroids/epidural) and acupuncture. He does core strengthening exercises and other (e.g., hamstring stretches) regularly. Bottom line, he hasn't been able to return to any even mildly strenuous activities for over a year without major pain. He has had a couple of major spasms, but he is able to walk to class and manage everyday life most days. 
Here is what stands out on his (comparable) MRIs (July and December 2018). Thankfully nothing outwardly ominous. Everything else is unremarkable: 
T12-L1: Disc desiccation with mild left foraminal protrusion
L1-L2: Disc desiccation with left foraminal zone protrusion
L5-S1: Bulge without central canal stenosis. There is mild bilateral foraminal narrowing.   

Most of the professionals believe that he has "facet syndrome" (facet joints causing pain in conjunction with degenerative disc disease (DDD)). They believed this would largely resolve itself after treatment. Happy that the orthopedic surgeons just recommended physical therapy, but one year later progress is minimal, so we're thinking there is something other/more than facet syndrome is going on.   

We're aware that anything DDD-related can be tough, but while he continues to work on further generally strengthening his core/stretching his hamstrings,  I'd be grateful for any advice. 


    edited 04/28/2019 - 10:16 AM

    Hi dogfather,

    If the doctors all say facet syndrome, have they mentioned the possibility of facet blocks?  This could at least confirm whether facets are the problem, and RFA ablation might be an option.  

    I had cervical facet syndrome and an RFA helped considerably. 


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  • Thanks for the replies.

    Kevin, my understanding is that pain relief from an RFA can last 6 months/1 year...possibly even longer. Last December, my son's physiatrist made an RFA sound like a last resort because of my son's age, but now that he has been in pain for over a year, although my son wanted to put the work in (e.g., stretching) to find a more permanent solution, an RFA might now be worth exploring. 

  • Dogfather,

    Yes, the RFA isn’t necessarily permanent, although some people say the pain never comes back for whatever reason.  By getting rid of the pain, it might eliminate muscle guarding etc. that gets in the way of the PT program.  

    Hope you find the right solution soon! 


  • I know a volunteer firefighter who was in a wreck on the way to a fire and hurt his back. After three RFA’s his pain went away for good. 

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  • Dear Sir,

    I feel for your son.  I am now 39 and have been dealing with similar issues, all be it lower in my lumbar spine, since I was about his age.  Don't give up on searching for the doctor who finally hits the bullseye.  It is a painful and frustrating road at times but relief is out there somewhere.  I know how hard it is at that age to feel as if you have the back of an 80 year old.  Still fighting the good fight today with hopes for a pain free future sometime soon.  The stretching and core exercises are necessary so that is good that he is putting in that work.  It will pay off.  Try to stay positive and keep pushing for answers to the pain.  Have a good one and I wish you luck.

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