We started a new case this week that involved a 39 year old man, Dennis, an avid golfer.
He has never had much of a problem with his lower back but last week he was doing the typical spring cleaning thing in his garage and he tried to push the snow blower out of the way and well -
he zigged when he should have zagged.
All of a sudden his back made a little popping sound and he felt immediate pain in his lower back.
As the day wore on the pain became more intense.
He decided to take some Advil but it didn’t do much for the pain.
So he did what many people would do - he tried soaking in the tub with Epsoms salts.
Not much help there either.
Three days after he hurt himself he decided to give us a call.
Examining him, I found that there was a thick tuft of hair growing in the mid-line and at the level of his belt line - exactly where he was feeling the pain.
Some might not see the significance of this but there was not another hair on his back - just at this one spot.
Most of the typical low back orthopedic and neurological tests I did were normal.
I decided to send him out for an x-ray of his lower back to see what else I might find ...
When the films came back it was immediately obvious why his back was giving him so much trouble. He had what we call a developmental anomaly or "variant".
His lowest vertebra (L5) appeared to be mis-shaped.
It was asymmetrical with the transverse process, (the small wing-like projections on each side), on the left being twice the size of the one on the right and the facet joint on the left was not the same shape as the one on the right.
Why is this a problem?
The asymmetry means the vertebra cannot move the same on one side as on the other. Because of that, joint anomalies are commonly weaker than surrounding joints. They break-down or fail before a more normal joint might have.
So when he tried to move the snow blower he bent and twisted in such a way that one side of that vertebra could move probably very well but the other side couldn’t...
The result was that he tore the ligament that restrained it / prevented it from moving in that one direction.
One can’t ever be 100% sure but, perhaps if everything was symmetrical, nothing would have torn.
Developmental anomalies occur in about 25% of the population and are a result of a failure of the bone development during the first trimester of the pregnancy.
Often, one can spot a spinal anomaly because they usually have an isolated tuft of hair growing over it.
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