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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Christopher Stepien
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?
Brandon Cohen DC, CSCS
Is the atrophy focal at 1 or 2 levels, or is it more widespread? I don’t have an answer, just interested….
Christopher Stepien
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.
William Brady, DC
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?
Christopher Stepien
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?
Seth Schultz, DC
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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