Back/nerve issues and getting back riding

I have battled a wrecked back primarily at L4/5 - L5/S1 for 25 years, half of my life. I wish I had a short simple answer for you but it took me years to figure out the right combination of physical therapy modalities, strengthening, stretching, when and how to apply heat/cold, scripts and other treatments. Now that I've figured out what works and what doesn't work for me I can handle pretty much any activity and exertion level without pain or subsequent flare ups. The shots did not work for me, and an inversion table almost wrecked my hip. I know others that had success with both, though.

On a macro level: keep your core strong, keep your legs, hips and piriformis loose, and keep your weight down. I substituted cycling for running and that helped me immensely. Once I got things under control I went back to light running with no problems.

So to answer your question, once you feel 100% you can get back on the bike but if you're not strong, light and limber the pain will likely return. Welcome to the battle!

My back is rubbish.  I have found a plan that works for me, stretching and core stuff along with meds.  I have my bad days and good days.  I'm just happy I can still get on a bike.  I know the day is coming when it will end.

My last MRI.

FINDINGS: Scoliosis and advanced multilevel degenerative disc
disease. Conus medullaris and cauda equina are normal. Moderate
central and left lateral recess at L1-L2 stenosis. Moderately severe
central stenosis at L3-L4 and right foraminal narrowing here also
moderately severe.
Severe central L4-L5 stenosis and right foraminal disc herniation.
Also severe L5-S1 central canal and bilateral foraminal stenosis.

Same, L4/L5/S1. Did the injection once, which is only a bandaid. 

Like GrapeApe, the best way to keep the pain away, is being flexible, and strong. I stretch my lower half(hips/groin, lower back, legs) for 10 minutes or less before every workout, and lift weights a few times a week. 

Grapeape nailed it! I have the exact same thing. I herniated my L3 L4 and L5/S1 in Sx 2023 which led me to find out I have spinal stenosis/degenerative disc disease.. I’ve done 2 rounds of injections which did nothing for me. I tried multiple inversion tables and a traction machine which probably made it all worse if anything. For me what helps the most is diet, hydrating like a mf and trying to keep inflammation down as much as possible and foundation training has helped a lot getting my core/lower back and glutes stronger. I know how frustrating this is because it’s ultimately stopped me from racing at the top level. I’m here for any answers I can get as well haha.

Wish you the best!

Proper posture is key as well!

Had an L5-S1 disc herniation that eventually expelled a chunk of the squishy part in October 2020.  Before the chunk, I had sciatic nerve pain (4-5 out of 10) when lifting my right leg or when flexing my spine.  Impacted my running, lifting weights, sitting in a chair, riding, and more.  When the chunk was finally expelled (went from bulging disc to herniation with fragmentation) it was around the clock pain between 6-10 out of 10.  Truly miserable.

Ultimately had surgery to remove the expelled chunk of disc from the nerve root and I felt 90% back to normal after surgery.  I still have some lingering nerve sensitivity, though.  Mostly normal now.  I ride MX almost every week and race offroad/MX many times per year.  I also run and lift weights but am particularly careful in allowing my spine to flex (I don't let it).  I do not stretch or work on flexibility at all.  

That said, when I first started having this issue in December 2019 I could have interrupted the degradation if I had made a few small changes to my fitness training.  Namely, degradation of discs and the associated pain comes from specific positions, movements, and loads.  If you get these wrong, damage accumulates and you develop an injury.  If you stop damaging yourself your symptoms while likely diminish pretty rapidly.  Figuring out specifically what you're doing is key.  I was doing full depth squats (ass to grass) with heavy loads and allowing my spine to flex at the bottom position.  The combination of heavy load on a badly supported disc (weak and unengaged core muscles) resulted in the bulge and later the herniation.

Long story short, you can likely fix your problem with some very specific core strengthening exercises.

This book is a great place to start:

https://www.amazon.com/Back-Mechanic-Stuart-McGill-2015-09-30/dp/B01FKSGJYC

Here's a lecture by the author (Stu McGill):

https://www.youtube.com/watch?v=IyGaKuSzD_M

Here's a summary and shortened version of the book:

https://squatuniversity.com/2018/06/21/the-mcgill-big-3-for-core-stability/

Edit to add: I'm 43.  Also, I don't think injections are going to do a damn thing and would skip it personally.

These threads seem to be popping up regularly.  I’ve been dealing with my spine issues for many years as well. I fractured my L5/S1 in a car accident along with my pelvis back in ‘84, which caused permanent nerve damage down the backside of my left leg and arthritis has taken a toll over the years. Although that seems pretty serious, it’s the least of my issues. 
I had a bad MTB crash in ‘15 that compression fractured my T2/3/4/5&7 vertebrae along with some ribs and my tibia. Lucky for me the discs weren’t destroyed, but I do get sciatica down my right leg and around my waist area that can really be very painful. 
But more than anything my neck is the worst of it all and has become the nail in the coffin for me. My discs between C4/5/6/7 are all compromised and have all the symptoms of Alphado’s back (Severe central stenosis and right foraminal disc herniation and degenerative disc disease) there is 3-4 and 5-6mm bulging in them and they aggravate the nerves. The nerve pain I’ve been dealing with over the years is downright debilitating and has ultimately put a stop to my riding. 
Ironically my neck issues haven’t been from anything involving accidents, but rather wear and tear from my job. I’m 58 years old and have a very labor intensive job, which continues to aggravate my back as well as my neck. 
I’ve had a dozen epidurals in my neck and back over the years, but as mentioned they are usually temporary, but can help with the excruciating pain and I’m happy to have them when I need them. But don’t expect them to do much in the long run… pain pills and muscle relaxers help, but they can definitely be a big problem if you aren’t careful. 
Stretching, watching my weight, hydration and lots of PT is the only thing I can do, besides surgery, which I don’t even want to consider, unless it’s my last resort. 
I wish I could offer a solution for you, since I understand what you’re going through, but to be honest we are all different and some deal with pain better than others. I hope you are able to overcome it and continue to enjoy riding. I will miss it, there really is no substitute. 

Can you guys explain where and how you are feeling pain?

For a couple weeks I have been experiencing extreme pain in my lower back right side. I thought it was a 3rd kidney stone and went to the emergency room Sunday and they didn’t find any obvious reasons in internal organs or bones. Even on Oxy pain killer, muscle relaxer and inflammation meds I am still feeling extreme pain. Oxy is reducing pain a little but not 100% and I am running out today and seeing a DR tomorrow afternoon.

Same , Herniated disc l4/l5 , two injections so far and they have quieted the nerve pain and numbness in my leg but the best thing I've found so far is exercise . Cycling is tough so I started hiking and now run a few days a week . Riding its annoying but not unbearable and Dr says its not going to make it worse . I worked on my feet up until a few years ago and sitting aggravates it worse than anything so I have a standing desk which also has helped a little 

You’re going about it right. Pain meds help mask the pain, which can then cause you to push it too far and causes damage. 
Being in great shape is a huge advantage in healing as well. 
The epidural will eventually wear off, but I do find that I’m able to commit to physical therapy without having nerve flair up. I had an epidural on Tuesday and went to PT on Wednesday and made some significant progress. 

I wish you luck, it’s no fun being injured. 

I'm 52, I had an episode around 15 years ago. Took me around a year to go from crawling to sprinting. I had 3 months basic therapy, then a Physical Trainer, Chiroprator and a Massage Therapist that were all SPORT specific for around a year. I still use them today, play soccer, 2 hour off-road rides and ride MX weekly. Cleaned my diet up & lost 30 lbs, cut back on stress and try to sleep 8 hrs. Stress, excessive physical stress & inflammation seem to contribute to flair ups now and again.

I had a ton of injections back, neck, knees, shoulders, elbow.  After a epidural injection at the hospital. Your leg  and foot will b numb. Be careful walking it’s like your leg and foot r 100% asleep.  I went back to work 1 day after a epidural. The 1099 Chicago trk is a million times more physical than Mx.  I did get a little woozy after 1 . I left the hospital asap & started driving. Take a few minutes b4 you drive .  1 injection site is getting tough to get a needle in   Its so narrow . So there jamming nerves, 2 nurses had to hold my legs down from popping off the bed while he did the injection. 

That’s not how it works bud, you gotta put down the crack pipe and stay off the internet. 

I’m 33, but had a bulging L4-L5 disc at 23. Missed a year and a half of my life from it. Tried the injection, but like Camp said, it’s a bandaid that actually did nothing for me. I was in more pain than I was in originally for the 4 days that followed the injection. After that the pain went right back to where it was before the injection. I asked my doctor to push for surgery so I could get back to normal life. They pushed and insurance approve. Had a laminectomy and micro-discectomy and age 24. Biggest thing they stressed in PT was core strength. Now 9 years later I’m basically normal, but I do notice when my core strength starts to diminish a bit as my back will start to annoy me a bit. 

Core strength, core strength, core strength! And get yourself a really good kidney belt. I wear a Kevco Stubbs and it helps a lot. If I forget to put it on, I feel square edges through my back for a quick second and it hurts! 

**All processed foods… You are what you eat and unfortunately by 30s- 40s your body can’t handle the load of preservatives, processed sugars, pesticides and toxic seed oils disguised as food anymore hence all the inflammatory conditions that arise needing medical intervention. Eating organic produce, grass fed hormone free meats and raw dairy where possible while avoiding sugars, seed oils and gmo glyphosate grains is the only real way to heal but it’s not a quick fix that everyone thinks exist. I broke my L1-L2 requiring plating at 17 and crushed my t9-t10 at 27 with 3 knee reconstructions inbetween so I know all about aches and pains and the truth of the matter is your body can’t heal if your processing centre (your gut) isn’t functioning on real food. Undo the damage to your gut and you will slowly heal the inflammation. I’m 5 years into my journey and while I get frustrated at times that the process isn’t quicker my health and vitality is 80% better at 37 than it was at 27 and I spent 32 years poisoning my body so it is not an overnight fix.

Paul Chek has a great podcast to learn what real health and fitness is plus the Weston Price literature lays it all out and is worth looking up.

Food is medicine 

Been through everything with that area as posted above except surgery. Will add to try an inversion table. They work and feel fantastic especially after riding. You can feel your discs decompressing. These days I have to consciously think before I move and focus on proper body mechanics. 

I didn't dive too much into how I keep my sciatica at bay. But a lot of the above have said it. Diet- I consistently eat the same real/whole foods at my 1st breakfast, 2nd breakfast, and post workout meal every day. Dinner is still healthy, but that is where we put variety to keep dinner exciting. Supplements are a personal adventure but most of what you all said above in that department are in my regiment as well. 

The stretching and working out are the fun part. Yoga style stretches, deadlifts, squats, and bench press all with proper technique and more reps than heavy ass weight work best for me.

Core strength helps when I get time off I do speed sit-ups but if everything is deteriorated in your back it really doesn’t do anything.  My belly button can b pointed at my rt hip for weeks & there is nothing you can do. It band blows up more painful than a broken femur & the whole knee is extremely painful the bones even in the knee. Waited here since 11.30 am Thursday to get lded. Trying to get home to do my taxes. F I g blown seat,shocks, steer tire like a square block full body beating. All the disk in my neck r blown a few in my back the other problems r much worse in my back than the blown disk.  The hrp bio foam kidney belt is by far the best made.  

39 years old here, had a small-ish disc herniation at L4/L5 in 2020 was misdiagnosed by a pain mgmt Dr., which ended up getting worse with multiple herniations at the same spot, requiring a microdiscectomy and then a fusion.  I also basically drove for a living as a traveling sales rep and in 2020 got into probably the best shape of my life, went to physical therapy for a troublesome knee and I herniated a disc IN physical therapy.  Likely a result of doing a one legged deadlift incorrectly bc I'm an idiot and didn't know how to lift properly, but ultimately because I did NOT ever move/lift anything my whole life with correct form and then all the miles of sitting in a car with terrible posture... 

I'm still dealing with substantial nerve damage in my left leg, likely permanent due to the time lapse caused by the misdiagnosis and COVID delays at the hospitals to get surgeries done, so here's the advice I wish I could have told myself and that I'll give to you:

My single biggest piece of advice is to get involved in your healthcare.  Get radiology reports, google all the terminology, research it.  Just like a carpenter's instinct is to build something out of wood, a surgeon's instinct is to do surgery and a pain managment doctor wants to give injections.  Not their fault necessarily; it's just in their nature.  I initially trusted doctors too much, let a pain mgmt doctor do 8 different injections over the course of 6 months but still say I was ok to go on a DH mtb trip.  I was not ok and ended up causing two more additional herniations at L4/L5 and have never been the same.  Ultimately, the first MRI I got within 60 days of the initial injury literally said "mild disc herniation at L4/5, contacting the L5 nerve root", but the pain mgmt dr. insisted on SI joint injections, piriformis injections, etc.

Don't wait too long to find a solution.  Don't accept significant limitations because there likely is a treatment modality that will work for you, or even a surgery (more on that below).

Also, realize that the more you aggravate a nerve, the more sensitive (painful) it gets.  It's a vicious cycle and can end up turning into a runaway train if you let it go too long.  If a movement hurts or causes nerve pain, STOP IMMEDIATELY.  A lot of times the disc herniation will retract or at least lessen, then you need to give it time to sort of heal or harden up.  If you keep hammering on your back either with improper movement or impact or whatever the cause is for you, it'll either never heal, causing constant flare ups, or it will get worse, like mine did. 

Get an MRI if you haven't already.  Then get a copy of the radiology report and understand what you have going on.

Don't fuck around with basic orthopedic doctors and pain management for too long.  Go see at least one spine surgeon and a neurologist.

Do NOT go to a large Physical Therapy clinic like Athletico. 

This was the most impactful for me:  Get professional help to correct your movements and posture.  I got connected with a wonderful PT and in the first visit, she was able to help me identify the major movements that were causing me to "trigger" the nerve.  She taught me how to work around those movements and my symptoms started improving pretty quickly because the nerve was able to start calming down a bit.  I think that had I met her within a few months of the initial injury, I'd have been able to avoid any surgery or permanent issues.

Lastly, if it comes down to it, don't be afraid of surgery.  It's a bit of a catch 22 in that the healthier, more fit you are, the better your outcome will be after surgery, so I preach to people that ask to just get the surgery if it's needed.  I had a microdiscectomy and it was no big deal, recovery-wise but I had what turned out to be much more extensive nerve damage than anticipated.  The fusion was truly a quick recovery as well.  I was back to doing light MTB rides and 75+ road bike rides in 60 days.

As you can see, everyone has a treatment modality that works for them.  Maybe a foam roller fixes you, or an inversion table, but everyone is different.  There's probably a 99% chance that you can nearly eliminate your issues and go back to doing literally everything you want to do; you just have to find the right course of treatment.  Do not settle.  I've had two different friends get microdiscectomy's after struggling with sciatic issues and both are literally 100%, like it never happened.  They are both relatively fit, active and are at least mindful of how they move and don't do stupid things like lifting shit that they know is a bad idea, but otherwise are completely good, so it can definitely happen for you too.

Happy to help if you have any questions on any of this.

So that you know, when I found my PT to help with my movement, I only visited her once every couple of weeks.  She's a cash-only clinic and it was a deal where she would evaluate me, teach some new movements/exercises and then send me home to actually do them and told me not to come back unless I actually completed them and made progress.

The big PT clinics always want you to come in 5 days a week to watch you do exercises as a way to maximize how much they get from your insurance company.  

Jrunge612 is giving you the secret sauce.  Your injury is caused by bad posture/movements/loads.  You don't need a chiropractor or chain physical therapist.  The stuff I linked above shows you how to diagnose your own issue and how to treat it.  More specifically, the book (Back Mechanic) shows you how to identify what makes your pain worse and what makes it stop.  When you stop the repeated damaging position/movement/load, and start stabilizing things, your body will mostly take care of itself.

At the beginning of my saga, I saw a general orthopedic surgeon and was diagnosed as piriformis syndrome (not actually a thing).  Did months of physical therapy and things got way worse.  Then tried specialist massage therapy. Saw a chirpractor/Airrosti guy.  Tried an inversion table.  Foam rolling. Stretching.  Tried lots of other shit.  Nothing helped.  Some made it consistently worse.  Finally had the disc rupture and expel the chunk while lifting weights - due to not having a stabilized core during a squat.  

Some of these posts probably sound pushy, but I personally had a year of bullshit along with a month of around the clock pain and sleeping on the floor.  If I'd made some tiny changes to how I moved/lifted/etc, I could have avoided the whole shitshow.  Your description sounds like you're about 2 months into my year of bullshit.