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PL
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2490th
Edited Date/Time
10/16/2021 10:16pm
I know this has been discussed before but I'd like to hear some fresh opinions. Last weekend on the face of a jump I felt my back go out, was already committed, landed and felt like someone put a sword in my back. This is the 3rd time in about 4 years that I had my disc slip out. This time is the wost.
I took MRI and X-Ray 1,5y ago, and the outcome was basically that there is too much distance between my lower back vertebrae so the disc slips out easily. Did a lot of PT and strengthening the core but stopped about 6 months ago. I know, bad move.
Now I have unbearable pain, can barely move and have my legs that go numb if I stand too long. Going for new scans next week, my physio says likely dislocated vertebrae as well.
I'd just like to hear some advice of how others dealt with it, and if it might be better to stop riding for good. I am too afraid of surgery, as I hear mostly horror stories. With 2 kids it's a though decision, it feels now like the more important is that I will be able to play with them instead of ridding and destroying my back for good. How'd you guys deal with it?
I took MRI and X-Ray 1,5y ago, and the outcome was basically that there is too much distance between my lower back vertebrae so the disc slips out easily. Did a lot of PT and strengthening the core but stopped about 6 months ago. I know, bad move.
Now I have unbearable pain, can barely move and have my legs that go numb if I stand too long. Going for new scans next week, my physio says likely dislocated vertebrae as well.
I'd just like to hear some advice of how others dealt with it, and if it might be better to stop riding for good. I am too afraid of surgery, as I hear mostly horror stories. With 2 kids it's a though decision, it feels now like the more important is that I will be able to play with them instead of ridding and destroying my back for good. How'd you guys deal with it?
My case was “easy” in that removing the offending chunk eliminated the pain by about 95%. I just had to wait almost a month from injury to surgery.
If you really have a ruptured disk and and or a displaced vertebrae then it probably can be fixed. If they can’t pinpoint actual causes and line them up with your symptoms then I wouldn’t be a sure if diagnosis and treatment plan.
The Shop
I went from not being able to walk 10m - to pain free.
When I feel it starting to slip (back feels lop sided, right lower leg goes numb) - I go on the inversion table straight away.
I understand most of you still ride, just learnt that this is lifetime thing and adjusted to it, that's great to hear. I'll hold the surgery, depending on what comes out of the scan. I know there are doctors here that say to do surgery as first thing, so always getting second opinions. I'll update on the outcomes and look into orthotics.
Hydration is key.
I'll share what I know (not playing doctor) and if any of it helps you- great! Ask any questions if you want. So my 2014 injury was bulging and burst discs in L3-L4 and L4-L5 as shown by MRI. I was told I didn't need surgery yet and sometimes the discs sorta heal over time and I could do core and other exercises at home to strengthen mid section and protect spine. I'm also real careful about twisting, lifting and wear a stretchy waist support belt for any activities like shoveling, lifting heavy objects (moving furniture!), pulling/pushing bikes up ramp, moving in shop, etc. I was regularly racing VMX for about 12 years before injury and have done some since and mostly woods and trail riding when I get a chance. Never did any SX type stuff- too old for that!
I still tighten up daily and have to work it some every morning to start my day. So a couple things to note: my Drs and Chiro talk about not rushing into a surgery unless the injury affects your everyday normal life stuff-OR if you have nerve involvement like pain or numbness down your legs. You said you have that- and it's a huge Red flag to seriously follow up on. My wife had that and has had 3 big surgeries where they had to fuse vertebrae and put a cage around the spine, which left her better off then she was before surgery- no nerve issues or daily routine pain like before- but less bending motion. I've been avoiding that with good maintenance, but latest findings of severe degenerative disc disease means I'm eventually headed for surgery.
The good news on surgery now is they can replace damaged discs with artificial discs and no metal cage or fusing and you are up and walking same day and normally only 1 night in hospital and no long term PT or limitations. They go in through your abdomen instead of slicing open your back and no connecting vertebrae with metal at all. Recovery is a couple weeks and back to work less than that. I'll know to follow up on that at 1st sign of nerve issues down my legs.
1 last thing: you mentioned too much space between vertebrae allowing discs to pop out? That inversion table may be contributing to that as it is meant to loosen compression of your back by expanding the spine. Yours is already TOO loose, so continuing to loosen it more may not be helping, but the opposite?
Don't give up hope, it can be managed and the surgery options isn't as scary as before. Research that some...
To give an update, the pain is gone, I just feel some very mild itch in my lower back, but no pain and got back all movement. I did the MRI, see results below. I have 2 herniated discs. Funny enough the upper herniated disc looks better then it did on the MRI 4 years ago and the lower one doesn't look worse since then.
The advice from my therapist is that no surgery is needed at this point if I do the following:
- everyday routine of core exercises (starting light to let all parts of muscles be stimulated)
- drink a lot of water (having to piss every hour)
- healthy food diet
- warming up and stretching (yoga, preferably pilates)
- if pain resides biweekly physical therapy
He says it's fine to do sports also MX, it's what you do around it. Any action can cause this, it's just about taking the right precautions and not do anything without prep. The physio did scare me by saying worst case scenario the disc can break off and permanently damage the spinal cord. Which can lead to paralysis. But that it is very rare.
I am visiting a neurosurgeon next week for an opinion as well.
Currently, I have two major diffuse disc bulges at L4-L5, which are putting pressure on nerves (particularly the L5 nerve root) causing lower back pain, sciatica type symptoms going down my entire left leg, substantial stabbing pain in my left calf, ankle and bottom of foot. My foot is almost entirely engulfed in a burning/stabbing/numb sensation, I feel like I have something stuck to the bottom of my foot at all times and I've lost a lot of strength in my leg due to not being able to activate different muscles because of the nerve impingement. Normally, this would have a straight-forward treatment plan of a pain management doctor giving an epidural at L4-L5, which can help "push" the protruding disc back into place, as well as calm the surrounding area via cortisone. If that doesn't work, then most people are candidates for a surgery called a microdiscectomy, which can be best described as a minimally invasive (not quite orthoscopic) surgery where they just go in and cut out the protruding disc material (they do have to remove a bit of bone from the vertebrae to access the nerve canal where the disc protrusion is) and the patient wakes up with their symptoms already gone.
However, I have a condition called spondylothesis (which it sounds like you may have?) which is when the two vertebrae have shifted and no longer align. In my case, my L4 is shifted in, towards my abdomen and my L5 is pushing out. This can be a genetic thing, but is most likely caused by my L4-L5 disc being so worn or degenerated that it's lost it's thickness and resulted in the vertebra no longer aligning. Also, I have severe facet arthropathy, which is basically when the sides or "wings" of the vertebrae have deformities and/or are not aligned, so they bones rub on each other, causing pain and long terms stability issues of the spine. (Think of it as like overlapping shingles or a suit of armor and once something causes a misalignment, they get all wonky and contact each other too much and where they shouldn't, so they wear much faster.) The facet arthropathy in my back is caused by both the loss of disc height and breaking the left side facet (wing) off of L5 years ago in a crash, so the bone growth when the vertebrae healed itself caused excess bone in spots and un-uniform thickness, as well as arthritis and bone spurs. For me, most surgeons have recommended a fusion-type surgery instead of the microdiscectomy due to the possible instability caused by the spondyllisthesis (mis-alignment of the two vertebrae) and the facet arthropathy (worn and deformed wings of the vertebrae). I decided I wanted to try to the microdiscectomy, so I found a good spine specialist surgeon that agreed with me that I am at much less risk of instability issues due to me being healthy, pretty fit (5'10" and 160lbs) and having the motivation to stay on top of physical therapy/strength/correct movements. He's confident that I can go back to MX, DH mountain biking and anything else, so long as I give myself plenty of time to heal after the surgery and stay physically strong.
Originally, I had just sciatic type pain but only when standing. I got an MRI via my orthopedic surgeon who then referred me to a pain management specialist (apparently neither of these dickheads actually read the radiologist's report from the MRI, which I finally got a copy of later and pinpointed the cause of my issue). I spent about 8 months with the pain management doctor, doing a variety of injections in my SI joint, piriformis muscle and finally an epidural, but it was at L5-S1, so it did nothing but cause me extreme pain, due to my L5-S1 being naturally fused together, which is a genetic thing. Eventually I realized this guy was sort of jacking me around, so I pushed him to refer me to a surgeon. The weird thing for me was that I ONLY had sciatic type pain when standing, which went away as soon as I sat or laid down, up until late June, when I went on a DH mountain bike trip, where at some point, I caused second disc protrusion that was just above the original, minor-ish protrusion and caused me extreme pain and the numbness/weakness in my leg and foot. Once I found a good surgeon that was open to a microdiscectomy, we tried a second epidural (this time at L4-L5), which did not help, so I am scheduled for surgery within 45 days of initially seeing him. I wish I had pursued seeing a surgeon back in March...
Here are the main lessons I learned, or at least advice I would give someone dealing with something similar:
1. A bulged/slipped/herniated/protruding disc, are all basically the same thing. There are obviously different grades of severity of these issues, but no real scale. For example, I have a "diffuse" disc bulge at L4-L5, which is the site of my pain (the disc is contacting the L5 nerve root, which can cause the "sciatica" symptoms), but I also have a "mild disc bulge" at L3-L4, for which I show no symptoms and subsequently is not worth treating.
2. Bulged/slipped/herniated/protruding discs do "heal" themselves over time. If you can eliminate the motion that aggravates or triggers the pain, which is usually done by physical therapy, the disc will almost always go back into place. Granted, this may take anywhere from 2 weeks to 2 years, but theoretically, in most cases they will heal.
3. Pay close attention to your symptoms. This sounds stupid, but figure out exactly when you have pain, where it's at and also make sure that any muscle weakness is noted and your doctor is aware. I lost about 40% of the strength in my left leg, being unable to activate my glute max and a few muscles in my lower leg, due to the disc putting pressure on the nerve. If this happens, you need to get it fixed ASAP, like within a few months because the longer the nerve is impinged, the longer it takes for it to heal (if it even does at all) once the nerve is freed from the protruding disc. I have been getting jacked around by a pain management doctor, costing me about two months and it's going to make getting my leg strength back (and getting rid of the numbness in my foot) even tougher and a full recovery likely going to take upwards of a year.
4. Find a good "physical therapist" that is specializes in functional movement/biomechanics. NOT just a physical therapist at your local bullshit PT chain company. Those assholes allowed me to do knee exercises wrong, right in front of their face, which caused my original disc issue. I found a person that has a doctorate in PT and is a "board certified orthopedic clinical specialist" and she sort of changed my life. She was able to help me identify what movements were REALLY causing me to trigger the nerve, taught me to how avoid them and prescribed exercises to not only build strength, but build good movement habits. Within two months, I went from taking prescription pain pills, muscle relaxers, THC gummies and alcohol, just to get through a day of minimal movement from my bed, upstairs to my office and to the couch, to being able to drive, sit at a desk for 12 hours, ride my bicycle on the trainer and generally get the majority of my life back. This is all the result of moving in a way that didn't trigger the nerve, which allowed it to become less aggravated and lessen the symptoms, day by day. It's like a snowball effect, when the nerve is being aggravated; it just becomes worse and worse. Also, stretching is not always the answer. I used to love to stretch and it always seemed to help, but doing so the last 11 months has actually aggravated the nerve and made my condition worse. Every case is different, depending on where your nerve issue is and which nerves are affected, but don't just blindly do stretches and see your chiropractor for sciatica; you may not actually be helping yourself. 99% of regular PT's can go fuck themselves, or at least the PT companies can fuck themselves because they operate to serve old and lazy people that don't really want to help themselves... My PT specialist or whatever she is, runs a cash only operation and I only saw her once a week, where she evaluated me and then prescribed exercises for me to do the next week. Her motto is that her clients WANT to get better; they're not just there because their insurance is paying for it or making them do it. I was absolutely astounded by how "wrong" I was moving. I had been using my back to lift things my whole life and I did not use my abs or glutes to support my lower back, which was one of the causes of my issues. She also identified some other genetic issues and problem areas, like my hamstrings being tight, which was causing my pelvis to basically rotate down and aggravated my nerve issues. Simple, but amazing stuff. I'm confident that if it weren't for the weakness in my leg, she could have me healed relatively quickly.
5. There are two types of surgeries when talking about disc issues in backs. There's a microdiscectomy, as I mentioned above, which is pretty minimally invasive and takes about 4-6 weeks to fully recover from (and can be again if needed, with even less recovery required) and then there's a fusion. Spinal fusions are a mother fucker and are generally super painful, have huge recovery times and are the ones that you hear horror stories about. Surgeons either go in from the front, install a wedge/bone graft and a plate with screws OR they go in from the back to install two rods on either side of the spine, which are anchored by two screws in each vertebrae, to go along with a bone graft in between the vertebrae, which they get from your hip and is generally pretty painful. Basically, the hardware is just there to support the vertebrae in the correct spot while the bone graft takes hold. Obviously, you then lose movement at that level, but the gap between the vertebrae is locked in and since the disc material is completely removed, there's no way for it to herniate again. However, immobilizing that spot in your back then puts more pressure on the other levels/joints in your spine and accelerates wear of the discs. The issue for me having this particular surgery is that my L5-S1 is already fused naturally, so fusing L4-L5 then puts a ton of pressure on L3-L4, where I already have a degenerating and bulging disc. So, the solution is either to only fuse L4-L5 and likely have to go back in to fuse L3-L4 in 10 years or less, or fuse all the way from L3 through L5, but there again, it just puts more pressure on the next joint and the further you go up the spine, the more leverage is on those smaller vertebrae and the likelihood of future issues is almost certain. I want to put off doing a fusion for as long as possible, but I WILL eventually have to have it done... I just want to enjoy my 30's first, if I can. Recovery for a fusion surgery is generally about 12 months. From all the research I've done and talked to people, I've come to the conclusion that most people that have ongoing pain and complications from this surgery, you know the ones that say they are in more pain now, than before the surgery, generally don't do all the work to recover. I've been told that it's possible to get back to 100% within a year, but it's a ton of work and a lot of pain and most people don't have the stomach for it.
6. Doctors are like glorified car mechanics in a lot of ways... Think about it. So, don't put your doctor on a pedestal and think they are impervious to mistakes or can look at a situation/condition completely objectively. A surgeon will always want to fix things via surgery. A conservative care physician (a good PT) will always say that things will naturally heal by doing the right exercises, a chiropractor will say that something needs re-aligned. A guy with only a hammer as a tool will always see everything as being a nail, right? My advice is to ask questions, second guess them and get a second opinion. Health care in general and doctors specifically just provide a service, much like a mechanic. There needs to be some sort of customer service and satisfaction; if there's not, fire them and go elsewhere.
7. Request copies of your MRI's, X-ray's, CT scans and the radiologists' report for each and spend some time to go through them yourself. It's honestly not that difficult. Use the Google machine to educate yourself and learn what the terms mean. I mean shit, you can look at your MRI and see that there's a fucking problem at L4-L5, right? Don't assume your doctors spend much time looking at this stuff. Most will only look at them for 5 minutes before they walk into your exam room and then maybe another couple of minutes reviewing it with you. Understand the terminology a bit, so that you can have a conversation with your doctors.
8. I see arguments for going to see a neuro surgeon versus an orthopedic surgeon. This is not as big of a deal as it seems. My take is that there are good surgeons from both specialties; just MAKE SURE they are spine specialists and fellowship trained. Don't trust your normal orthopedic surgeon that fixed your knee to do your back surgery; while he may be capable, it's like having your motorcycle dealer mechanic work on your diesel semi truck... He can maybe do it, but it likely won't be super smooth and easy...
In closing: Try getting an epidural. Find a GOOD physical therapist-type person to evaluate how you move, so that you can correct it and build resistance to future disc issues. Explore having a microdiscectomy because even if it doesn't work 100% for you, you can still get a fusion and it only cost you a few weeks of time.
Sorry - long post disclaimer, but I’m desperate for advice/hope.
Background: (31 years old) I live in Asia - Borneo, so health care is, I would say mediocre at best.
I have been having nerve issues with my legs, off and on over the last year and a half. Live in a very hot climate, do lots of mountain biking so put it down to that, fatigue, dehydration etc..
Eventually had an MRI of my hips, and said I had thickening of the nerves (femoral), got a referral to see orthopaedics but a year later still no appointments. By this point it has got so bad have so much weakness, burning, numbness, aching - all the seasons in one day.
Nothing seems to trigger it or aggravate it, just constantly there. Had another MRI (year after the first) with a different doctor, they only noticed slightly bulging discs in lower back. Sent to Physio for a month, given some exercises and have had no relief. It’s so difficult to even do the exercises. After a couple I’m exhausted and the symptoms are really bad. At this point it’s worse than ever, then put into lockdown so can’t see Physio doctors or anything (3 months). Still really bad pain and symptoms. Had bloods done, most things were as they should be. Put on meds for pain, but that’s a whole other story… off meds now!
Finally just the last two weeks, Have been able to get to Physio. Have been getting needling done on the muscles in my lower back, piriformis muscles, glutes, also getting mayofascial release massages. This has given me some relief, finally… after feeling like I’m going to end up in a wheelchair or I have a neurological disorder. Have been able to do my Physio exercises most days atleast.
Crazy depressing and stressful times. Have gone from really fit and active, competitive mountain biker, to struggling to get out of bed.
Still feel like I have a long way to go, and no matter how much I ask I don’t really know what is going on, what the status is and how much of a full recovery I’m going to make. Language barrier makes things with my physio hard.
So basically, has anyone else dealt with this kind of thing? As I said, I’m living in Asia, covid has screwed us and it’s going to be a while until I can get back home to some decent healthcare and answers.
Sorry for the ramble!
Some good points in here, thanks! And noted!
Pit Row
http://www.biogenix.com/
From what I hear they are seeing incredible results and for about 10k you can get specific treatment for your injury. I think they also have a more general treatment for 6k.
For sleeping I am using my wife's pregnancy pillow, you know pillow between the legs and in embryo pose. Feels like this has helped lower the pain.
At least this made me finally buy a scissor lift to work on my bike!
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