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Powerlifter With Significant Atrophy L4-S1

Exit forum ID Forum Discussion Powerlifter With Significant Atrophy L4-S1

This topic contains 5 replies, has 2 voices, and was last updated by   Seth Schultz, DC August 14, 2018 at 11:16 am.

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  • #3640

    Christopher Stepien
    Participant

      Again, skipping data points …

      I have a 35 year old male with chronic, mild low back pain when he runs 1/2 mile or once every few months during deadlifting for a few days.  It’s relieved by rest.

      He has significant atrophy from L4-S1. I had him take his own thumb and push into erectors and he could even feel it.

      I understand that this type of atrophy occurs when we have disc pathologies.

      What I don’t understand is why, with significant atrophy, he only has mild symptoms with all of his low back loading. My reasoning is that he’s strong enough (right now) to handle the load with inefficient levers, but that this problem will get worse with continued loading.

      Has anyone had cases where this atrophy goes away as the adhesion deloads the discs?

      #3653

      Brandon Cohen DC, CSCS
      Participant

        Is the atrophy focal at 1 or 2 levels, or is it more widespread? I don’t have an answer, just interested….

        #3654

        Christopher Stepien
        Participant

          It’s localized to L4-S1. It’s like someone went in his low back and took out a 4″ by 6″ x 1″ piece of steak and grilled it up.

          It was a sharp drop off in mass from L3-L4. That’s the only way that I noticed it when palpating.

          #3655

          William Brady, DC
          Participant

            May not be a disc injury (we would need the full history)? That is a large area- may even be congenital. Do you have a MRI?

            #3656

            Christopher Stepien
            Participant

              Not yet. I’m on it though.

              While this does look like disc pain, it’s not episodic.

              I don’t know anything about congenital atrophy. Does this happen often? Could something like sacralization of L5 cause this?

              #3657

              Seth Schultz, DC
              Participant

                With that large of an area of atrophy I don’t think sacralization would be the cause. If it was the culprit I would expect the atrophy to only be around L5/SI where the fusion occurs. Again, I am not sure sacralization alone would cause widespread atrophy.

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