Back Injury - herniated L5- Help advice plz

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Back Injury - herniated L5- Help advice plz

Postby Snagdog » Sun Jan 27, 2013 2:28 pm

Fellow Cyclists,

I just wanted to share my situation to you all in a hope to possibly gain some advice & tips. I'm a 35 yr old male 182cm and 77kg

Basically I happened to be playing some touch football with some kids and was going through a post match warm downs when I tweaked my upper glute / upper bum muscle. It was a touch embarrassing for me in front of the kids so I had to try and laugh it off.

I continued with life as normal, cycling 3 or 4 times a week and playing touch footy. I first started to notice something was a miss during touch football when I couldn't bounce around as i previously done. I was starting to thing I'm just getting old

By this stage my lower back was stiff and i had trouble putting shoes and socks on and this lasted for approx 5-6 weeks. I then went and sore a physio and she felt it was due to poor core strength. I followed the program but felt most of the things i had to do with me left side was uncomfortable due to my sore upper glute.

Moving forward i stopped going to physio and just got on with it.

I upgraded my bike to a carbon fibre model and my back pain seemed to disappear almost immediately. This then lead into some faint pain in my left hamstring. Initially i found some helpful YouTube clips that involved stretching to relieve sciatic pain and this seemed to work for about 2 weeks.

I also started to see a new chiropractor was took X-rays and said that I had bulging L5 disc and he was confident that he could help sort out the issue. Over the next 2 weeks it seemed to make some progress in the right direction.

This whole time i was holidays and riding around 30-50km day. Then on last Friday the pain in my leg got worse and by Saturday I couldn't stand up for more than 1 min at a time.

So I go to the doctor and he puts me on Celebrex 100mg, targin and Valium as I'm in a fair bit of pain and send me for a MRI. It turns out I have a 6mm bludge on L5 disc.

Doc wants to see if the meds will settle it down . They have been good for pain relief but hasn't seem to solve the sciatic pain. I'm looking at having a cortisone injection next week and if that's doesn't help then go and speak to a neurosurgeon.

Does anyone out there have any experience, ideas, tips, do' or don'ts or know of good surgeons that I can see to help out As I'm pretty concerned about it. I been pretty much stuck on the bed and couch, can't really play with my 5 month old daughter which is very depressing.

I'm on the Sunshine Coast qld

Thanks in advance........

Ps I'm dying to get back on my new bike
Last edited by Snagdog on Mon Jan 28, 2013 11:21 am, edited 5 times in total.
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by BNA » Sun Jan 27, 2013 2:37 pm

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Re: Back Injury - herniated L5

Postby warthog1 » Sun Jan 27, 2013 2:37 pm

Peter Oatey in Adelaide.
Did a microdiscectomy on my ruptured L5/S1 in 2001.
Gives me no grief unless I run. So I don't
Have an S5 cervelo and P2 tt bike. No problems on either. :)
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Re: Back Injury - herniated L5

Postby _mike_ » Mon Jan 28, 2013 12:01 am

Am 33 and same weight/height. Have had sciatic pain for 6yrs now. 2010 had a microdiscectomy to relieve a 5mm l 4/5 bulge. The procedure helped relieve the sciatic pain a little but I was still on the celebrex almost daily. 2011 I bent over to put my then 1yr old in a sleeping back and ended up with a 11mm re-occurrence. I've never wanted surgery so bad after that large bulge. I had the same procedure again and the result this time is very positive. The pain is there pretty much daily on a small scale but if I sit/stand for long periods or lift/twist excessively it's aggrevated. tri bars for me helped pre 2011 take weight of my lower back

Fortunately now the cycling doesn't aggravate any pain. I can highly recommend dr George Wong in perth who is a very well known and respected neurosurgeon. You have my sympathy in what your going through, especially being off the bike but there is light at the end of the tunnel. Let me know if you have any questions

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Re: Back Injury - herniated L5- Help advice plz

Postby Snagdog » Mon Jan 28, 2013 11:25 am

Thanks guys... Are you following core strength program's to this day to help manage it?
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Re: Back Injury - herniated L5- Help advice plz

Postby warthog1 » Mon Jan 28, 2013 1:52 pm

I was 32 when I had mine done, now 44. I currently do nothing specifically for the back. I have done core strength exercises in the past to help with tting not the back but currently do nothing specific for the back. :) I am very conscious of how lift, making sure i do so correctly but that is it. I am not carrying any extra weight due to cycling; 184 cm and 77kg, that and the careful lifting, helps more than anything.
When I woke up after my surgery it was instant relief from the cramping pain down the back of my leg and I've been fine since.
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Re: Back Injury - herniated L5- Help advice plz

Postby The Walrus » Mon Jan 28, 2013 3:54 pm

I had years of niggling back pain and then one day about 5 years ago I couldn't walk or stand up because of the pain. Ambulance to hospital and ended up having a spinal fusion at L5 S1. I haven't had a single problem since but I was very consistent with Pilates. I now do yoga and of course cycle, so I'm conscious of it in terms of lifting etc as warthog1 said, but it has never stopped me doing anything.

My surgeon was Doctor Robert Kuru in Newcastle. He was excellent and has a very good reputation...they call him 'Kuru the Guru'...

That pain is not a nice experience so I do sympathise. Plus the medication is so strong its important to take some kind of action soon.
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Re: Back Injury - herniated L5- Help advice plz

Postby UpDownUp » Mon Jan 28, 2013 4:01 pm

I've had a L4/L5 disc bulge. A couple of thoughts that may be of use to you:

-a lot of disc problems will develop slowly over time and then become symptomatic after a fairly trivial thing e.g. doing an exercise, sneezing. So, dont necessarily blame the last thing before the pain began as the 'cause' (unless of course it is an obvious acute trauma like a car accident or really bad heavy lifting)

-unless you are in intolerable pain then try conservative treatments first before trying surgery. With careful management and time some bulges will recede, the pressure is taken off the nerve, and the pain goes away.

-bulged disc / herniated disc are terms often used interchangeably. They are different. A bulged disc is still 'intact' whereas a herniated disc is torn and in soft nucleus leaking out. A herniated disc is a more severe problem as the outer ring of the disc needs to heal or be fixed. Bad management of a bulged disc can result in it developing into a herniated disc.

-dont get discouraged when other people say things like "oh, yeah, I had a disc bulge and I just HTFU and got through it" or "I just rested for a few weeks then everything was fine." Firstly they may not have actually had a disc bulge, but some other sort of back pain. Secondly, back pain is very individual. A small bulge in the "wrong" place in one individual can give excruciating pain, whereas a large bulge - even if it seems to be compressing a nerve on the MRI slides - can have no symptoms in another person.

-just because you are pain free does not mean the disc is fully healed. Once the pain starts to disappear still take things easy for a few months to avoid re-injury while the disc finishes healing.

-for longer term management keep a good check on your posture, lifting technique, core stability.

Good luck!
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Re: Back Injury - herniated L5- Help advice plz

Postby Snagdog » Mon Jan 28, 2013 4:09 pm

Apologies for the confusion I believe that I have a 6mm buldge.... That's what the doctor said after reviewing the MRI

And the sciatic pain has now travelled down into my calf/ Achilles as well as the original hamstring.


Should I be trying to do some Mckenzie stretches or just totally rest for now
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Re: Back Injury - herniated L5- Help advice plz

Postby _mike_ » Mon Jan 28, 2013 5:02 pm

^ Some good information there. Thanks for the correction, mine have both been herniated discs and originated from an accident.

My first surgeon who i saw (retired at the time from surgery) worked with me on core strength to avoid surgery. He insisted on swimming (freestyle) but to use a snorkel mask to prevent my spine twisting when trying to breathe. Unfortunately my pain became no better or worse. The herniated disc didnt reabsorb any material and it hardened over time. As time went past it was when i began to suffer a numb left left / pins and needles that i opted for surgery. That and the unbearable pain. Definitely see a neurosurgeon and book in asap to avoid delay once you have a referral from your GP. If the injection helps it'll no doubt still be there once it wears off.

As for exercise I cycle / run twice a week & do a few push ups / chin ups. Last words my surgeon told me is not to change my lifestyle / exercise, listen to your body and i never want to see you again. Its very depressing how much pain a pinched nerve can cause and disable you but you have to hang in there.

good luck
Mike
Last edited by _mike_ on Mon Jan 28, 2013 11:00 pm, edited 1 time in total.
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Re: Back Injury - herniated L5- Help advice plz

Postby Snagdog » Mon Jan 28, 2013 5:13 pm

Thanks Mike and the other posters.

I'm booked in for the injection Tom so ill let you know how I go. I'm also seeing the doc at about 10 am so ill get the referral then.

I'm thinking that surgery will def be on the cards as I haven't been able to stand for more than a minute for over a week now and that with all the meds on as well. TBH the pain is almost constant ranging from dull to tear jerking

I've already flipped the stem on my bike to hopefully make it more relaxed and back disc friendly for when I do get back on the bike.

Any more tips / experience from members I'd be happy to hear it .
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Re: Back Injury - herniated L5- Help advice plz

Postby Marty Moose » Mon Jan 28, 2013 5:20 pm

I had a herniated disc L5 S1 I didn't listen to my body I kept riding as it didn't hurt on the bike. To cut to the chase mine ruptured and I loss the use of my left leg and bladder for 8hrs. I had emergency an partial discetomy and lamenectomy L5 S1 that was in 97.In 98 it re occurred I had the excess disc trimmed again. It took years of rehab and hard work now its fine. I would suggest you take it easy and try to avoid the knife as much as you can. I found kayak paddling/racing the best for it. My surgeons name was Trinastic (spelling) here in Perth he is an absolute superstar and a true gentleman.

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Re: Back Injury - herniated L5- Help advice plz

Postby UpDownUp » Mon Jan 28, 2013 5:37 pm

Snagdog wrote:Apologies for the confusion I believe that I have a 6mm buldge.... That's what the doctor said after reviewing the MRI

And the sciatic pain has now travelled down into my calf/ Achilles as well as the original hamstring.

Should I be trying to do some Mckenzie stretches or just totally rest for now


If the stretches are helping with your symptoms then do them. If they are not helping or you have to struggle through pain to do them then do not do them. If your symptoms are really acute then I'd suggest leave off the stretches for now.

If you are able to move then make sure you move positions fairly often. I found my sciatic symptoms worse if I stayed in one position for a long time e.g. sitting at computer.

Snagdog wrote:Thanks Mike and the other posters.

I'm booked in for the injection Tom so ill let you know how I go. I'm also seeing the doc at about 10 am so ill get the referral then.

I'm thinking that surgery will def be on the cards as I haven't been able to stand for more than a minute for over a week now and that with all the meds on as well. TBH the pain is almost constant ranging from dull to tear jerking

I've already flipped the stem on my bike to hopefully make it more relaxed and back disc friendly for when I do get back on the bike.

Any more tips / experience from members I'd be happy to hear it .


Hopefully the injection will give you relief. Unless you are very, very lucky it will only block the pain but not 'cure' the underlying problem (i.e. the bulge of the disc onto a nerve). Generally the cortisone injections will wear off and the pain return.

On surgery, make sure you have a meaningful discussion with the surgeon about what they propose to do - how likely it is to succeed, other options, possible risks and the likelihood of problems occurring. It is hard to have such conversations when you are in pain and just want a fix but it's well worth having a proper conversation. I would be very, very suspicious of any surgeon saying that surgery is ever the only option and promising instant 100% risk free success.

I get that you just want to ride your bike but also at least have a think about working in some other options (such as swimming or walking) as you work towards your recovery.
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Re: Back Injury - herniated L5- Help advice plz

Postby Snagdog » Mon Jan 28, 2013 6:11 pm

It's funny you say that because I had been riding my bike pain free. Once the pain became to great to stand for too long I decided to park it up. While I missing my morning ride I'm not planning on getting back on it at the expense of my future health.

Laying on the couch seems to leave me only a dull pain and this is all I've been doing for the last 9 days. I can move around to the fridge and back but certainly couldn't take the dogs for a 10 min walk.

What are the surgeons likely to say?????
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Re: Back Injury - herniated L5- Help advice plz

Postby ft_critical » Mon Jan 28, 2013 6:51 pm

Did you guys with disc issues have any lower back swelling? If so where was it located on the back?
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Re: Back Injury - herniated L5- Help advice plz

Postby Snagdog » Mon Jan 28, 2013 6:58 pm

No swelling that I know of.
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Re: Back Injury - herniated L5- Help advice plz

Postby winstonw » Mon Jan 28, 2013 7:25 pm

I agree with everything UpDownUP has said (I'm a Brisbane physio).

Some more general info that may or may not apply to any one individual:

Up to a 3mm disc bulge in neutral posture is considered normal.
When you flex or extend your lumbar spine in standing, many bulges increase significantly, but rarely is kMRI imaging done (kinematic MRI in flexion and extension).

As UDU said, damage to discs is cumulative. They don't heal well after being mistreated because their blood supply is poor, it is hard to rest them adequately, and by far the majority of people do not respect their backs when sitting, lifting, etc. Slumpy posture from a young age ensures you are going to have compromised discs.

In my clinical experience, over 95% of lower back pain in people under 60yo is due to disc pathology.

There is no physio/osteopathic/chiropractic manipulation or short sharp thrust that can assist a problem disc. People who get some relief from such things often have a sharp pain originating from a facet joint or the sacroiliac jt, +/- disc issues.

The clinical rationale for decreasing pain and bulge is to
- reduce mechanical load and stress on the disc
- reduce inflammation. inflammatory products like interleukins, interferons, and TNF increase the pain associated with disc bulges profoundly by chemically irritating pain receptors. Therefore, anti-inflammatories are a mainstay moreso than pain relief like codeine and opiates. One of the new therapies for back pain is perispinal injection of etanercept, a drug that blocks TNF. Many patients have drastic reduction of back pain within 20 minutes. You should ask any neurosurgeon you speak to about this. However, AFAIK very few if any are doing this procedure in Australia. (This drug is used for rheumatoid arthritis here)
- As much of the pain associated with disc issues is often inflammatory, it is a very valid therapy to ice the lower back aggressively. However, most health professionals do not teach how to ice effectively - gel packs, ice contained with waterproofing (plastic), and packs of peas, are all useless imho. Icing disc inflammation effectively requires as much as 10x30 minute applications/day.
- often therapists recommend putting heat on low backs. This is to ease muscle spasm, which sometimes is a higher priority.
- The other significant pain reliever is to unload the discs when sitting and standing. Remember, you are trying to rest them. The principal of RICE (rest, ice, compression, elevation) is as applicable to acute back pain as to any acute joint injury. Discs can be unloaded by lying down more often, and wearing a lumbopelvic brace when sitting/standing/walking. Most disc sufferers get significant pain relief by lying on their back and having someone else pull on their straight legs, mildly at first, and then moderately. The relief is due to unloading the disc.
- as for McKenzies Extension in Lying exercises, when pain is very acute and intense, I don't recommend them. As the pain settles to <=7/10, I start cautiously introducing them to facilitate moving the inflammatory exudate away from the nerve roots and spinal cord, reducing the bulge, and aiding circulation for better healing.
- nerve slider exercises can be introduced to help stop inflammation causing adhesions between nerve roots and surrounding tissue.
- core strengthening exercises I don't introduce until pain is 3-4/10

- for many, once neurological symptoms have been experienced for several months, they are unlikely to go totally. Nevertheless, neural sliding exercises, deep tissue massage, hamstring and quadratus lumborum stretches, and back strengthening exercises should still be pursued seriously.

At the end of the day, the take home message is - compromised discs never "heal". They stay compromised, and they should be managed by taking good posture, correct lifting, healthy bodyfat %, a generally more active life, and core strength more seriously.
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Re: Back Injury - herniated L5- Help advice plz

Postby jimsheedy » Mon Jan 28, 2013 7:55 pm

5 years ago I developed a bulge in the disc L4/L5 I think. Similar symptoms to you. Although standing was ok sitting down was torture, lying flat on my back was the only comfortable position. I believe this developed over a long period of time possibly exacerbated by over training when I was boxing. 500+ sit ups a day are not good for you, I don't care what anyone says.

I used to get sciatic pain a couple of times a year which was treated well by massage but it always returned. Anyway this pain was a lot worse and physically debilitating. After one visit my Osteo told me to see my doctor and get x-ray or an MRI if needed. I did this and the doctor diagnosed a bulging disc. He told me the only course of treatment was cortizone and if that didn't help, surgery.

I went back to the Osteo with the results and she began treatment. 3 visits a week for about 8 weeks. There was hardly any improvement for the first few weeks then it gradually stated to feel better and eventually the pain totally subsided and my back was freed up. I haven't had any issues since. My work is quite physical at times I am on my feet for a minimum 10 hrs a day, I ride a carbon roadie ( with a slamed stem :wink: ) about 250 km a week, I surf a regularly as I have since I was a kid. I have had no recurrence of the pain or spasms.

I realise that back pain is a serious issue and one of the most common ailments. There are many and varied often conflicting tales of treatment and success or failure. Basically everyone's got a back story. I'm not judging the so called traditional treatments and i'm not trying to promote an alternative. I'm just sharing my story. This is what worked for me.
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Re: Back Injury - herniated L5- Help advice plz

Postby Riggsbie » Mon Jan 28, 2013 9:08 pm

You have my sympathy.....

I went through an L4/5 prolapsed disc.....microdisectomy after talking the conservative course for 14 months (lots of anti inflammatories, painkillers, nerve blockers, cortisone injections (worked fantastically for 10 days), core exercise, weight loss, deep tissue massage and a lot of numbness and pain)....

My experience was enhanced by the fact my injury occurred at work and my employer is self insured and employed an 87year old "independent medical examiner" and they terminated my work cover claim......based on the comments of a retired general surgeon.....

So I was forced to take action and went the private surgery route.....a fair chunk of disc was removed.......rehab from surgery took 10 weeks......then it took legal action and Magistrates Court to extract medical expenses from my employer (they still owe me a considerable amount of money)......

My surgery was 2 years ago and I get regular flair ups as my L5/S1 is badly bulged and pressing on nerves which affect my left side......currently going through my worst re-aggravation, 2 weeks of intense pain so far but it's subsiding now......

It's a long painful journey......but there is a Light at the end of the tunnel !!

Hang in there !!


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Re: Back Injury - herniated L5- Help advice plz

Postby The Walrus » Mon Jan 28, 2013 9:48 pm

Sitting is meant to be worse than standing due to where your body weight sits. I was told to sit in a simple garden recliner to get your feet up above your heart. It helped me.

You can get zero gravity chairs but I'm not sure how good they are.

No swelling that I knew of.
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Re: Back Injury - herniated L5- Help advice plz

Postby Snagdog » Mon Jan 28, 2013 10:07 pm

That's interesting because I can sit on a computer chair or on a couch relatively pain free but as soon as I stand up the pain starts up down my left leg.

Prior to getting on the meds during those initial couple of days where it really set off all I could do was lay on the floor overemthe weekend. When I got to see the doctor on monday for the first time for some pills I had to sit in this crappy chair for 40 mins waiting to get in. No word of a lie it was one of the most painful things I've had to do/ endure. I almost went postal

In all seriousness I really appreciate the advice you guys have shared with me, so thanks again :D
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Re: Back Injury - herniated L5- Help advice plz

Postby _mike_ » Mon Jan 28, 2013 11:30 pm

hear ya, been there waiting patiently. Sometimes adding some small pillows under the knees/lower thigh whilst lying on the back helped relieve a little pressure. Also try lying on a flat floor with a pillow under your chest and up on elbows too curve your lumbar spine a little
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Re: Back Injury - herniated L5- Help advice plz

Postby winstonw » Tue Jan 29, 2013 7:33 am

There was a study done decades ago that showed intradiscal pressure is higher when sitting than standing. Further, most people do not retain neutral spine alignment when they sit. Instead they let their back flatten against the back rest. This can increase a bulge. It's common for back pain to increase after sitting for long periods.

Positions of comfort to experiment with include lying flat on your back with several pillows under knees, or legs up on on a stool or large cushion so the hips are at 90 degrees flexion; lying on the side with knees bent up and a pillow in between them; lying on your tummy and pillow/s under pelvis.

It used to be common for acute back pain patients to have traction applied to their legs when resting in bed, though the force was negligible, around 5kg.
Physios use up to half body weight to do oscillating mechanical traction. I've got no issues someone wanting to rig up a traction pulley at the end of their bed with a 25-33% body weight of sustained traction for up to 30 minutes.

Regarding Jim Sheedy's good results with the osteopath, I'll say many episodes of low back pain are self limited in that eventually the inflammation settles and pain goes away. But as others have mentioned above, it doesn't mean the disc is as strong as it was before. Every chiropractor, osteopath, and physio has LBP patients that "get better", whether the three professions use the same techniques or not.

As others have mentioned, the current consensus is to give conservative measures (physio) adequate time, before considering surgery.
I can tell you there's a lot of back operations that do not resolve pain, though you are unlikely to hear about it from some surgeons.
And if you don't adopt healthier back habits after th op, you are ensured the op will eventually "fail".
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Re: Back Injury - herniated L5- Help advice plz

Postby The Walrus » Tue Jan 29, 2013 7:56 am

winstonw wrote:And if you don't adopt healthier back habits after the op, you are ensured the op will eventually "fail".


Very true. It's what helped me recover so well.

Regarding what a surgeon will say, that really depends on your individual situation or problem. But rest assured that surgeons love surgery and they'll cut you open if they believe they can help the situation.

To you it's a major decision, to them it's another cab off the rank! That's not to say they don't care or are flippant about it...that's their job.
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Re: Back Injury - herniated L5- Help advice plz

Postby Dr_Mutley » Tue Jan 29, 2013 10:18 am

All the appropriate exercises have been mentioned above, especially the extension in prone McKenzie stuff...

Try an epidural once or twice to see if it will settle, but given yr age, functional expectations, and pathology (?radicular pain + bulge) I would crack on to a microdiscectomy soon rather than later if it was my back. The procedure is reasonably small in terms of lower back surgery, well tolerated, and in competent hands, devoid of any significant risks
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Re: Back Injury - herniated L5- Help advice plz

Postby Snagdog » Tue Jan 29, 2013 12:54 pm

Here is a copy of the MRI report - I'm waiting to hear back from neurosurgeons for appointment

Findings:
There are fi-ve l-umbar vertebra.
There is normal bone marrow signal.
The vertebral body heights are maintained.
No spondylolysis identified.
The facet joints appear normal-.
The conus of the spinal cord terminates at L1.
There is normal- dlsc space height and contour to
L5lS1:
the L4l5 fevel-
There is dessication of the intervertebraf disc
There is a posterior disc bulge with focaf disc
Ieft paracentral aspect, measuring 6.5 x 5mm in
planes.
The sequestration displaces and impinges the feft S1 nerve root
within the subarticular recess.
There is no significant thecal- sac compression.
There is no compromise of the exiting L5 nerve roots within the
neural- foramina.
Comment:
There is a 6.5mm l-eft paracentral sequestration which is impinging
the left 51 nerve root.
If there is motor, or significant sensory symptoms, urgent
neurosurgical assessment is recommended.
Otherwise, CT guided left S1 nerve root sleeve steroid/LA injection
coul-d be trial-l-ed for symptomatic refief .
CT guided epidural injection may be more beneficj-al, but this would
need to be performed in a hospital setting.
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