Just be careful whatever you do. If you want to PM me I can tell you what happens when you don't. I was the first non-clinical PAD(Percutaneous Automated Discectomy) in the state of Indiana back in the mid 80's.....86 actually if memory serves. L4 and L5 bulging, had myelogram, dye made me ill and threw up for 24 hours straight which ruptured the aforementioned discs. PAD is like arthroscopy for the back basically. They aspirate disc and it encourages the swelling to go down. Worked like a charm except for the permanent nerve damage in my right leg.....will have 'foot drop' the rest of my life. Lesson: take it easy grasshopper!

My understanding is that discs don't 'slip' and can't be moved back in to realignment (you would then be describing scoliosis).

Discs also are not vascular tissue and don't regenerate or heal. That said, you can often get relief from symptoms over time with treatment, physical therapy, and just time passing...

However, you have been 7 months on....And frankly in my experience my symptoms do not correlate to my level of physical activity. That's why you are more likely to be told now by your Dr. to keep up the activity.

If you have the surgery, in all likelihood when you walk out of the hospital that day you will feel better than you have in 7 months. And except for a relatively small amount of pain for the next few days you will be glad you did. I don't know for sure what type of procedure this calls for.....but if it's the rather simple procedure of shaving down the bulge...prognosis is great.

The disc cannot "realign". It will always be like that, and most likely will get worse with age. You just have to find symptomatic relief / increased core strength / increased flexibility.

check your PM.

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Brian Stover USAT LII
Accelerate3 Coaching
Insta

I'm one of the lucky. Ruptured disk confirmed by MRI on Jan 1st of this year. 10 out of 10 on pain meter. Did nothing but let the nerve recover and after two months good to go. However, I did stay active, walking early on, some bike on the trainer, swimming but no flip turns or big pushes off the wall, resumed running one month post. 100% recovered after two months. The key is you have to find what works for you but try and stay active.

What I did notice, the tri bike seemed to place more pressure on my lower back and I have stayed on my road bike with good results.

Stretching and doing things like core work, that I have never done in my life, seemed only to make the problems worse. However, this has worked for some. Like I said, find what works for you and take all the recommendations on ST with a grain of salt, mine included.

Good luck

I have/had the same thing starting a few months ago. I continued to train and race but it got so bad, I died tried to sit or roll over in bed.
Looks like the running is what really got me. After the MRI showed the bulging disc, I was able to get the shot in the spine. Boy did that improve things!!
But, I basically have not run for 2 months, and do NOT plan to try again until Jan. Have not had a long bike ride in 3 months either.
So, as hard as it was/is, RESTING from hard training is what has gotten me back on the right path. Doing your level of training, and an IM in July,
well, you know the answer to that!!!

So, I would stop everything, other than core exercises for a month. Then, go back to some swimming and short biking. Hang up the running for
3 to 6 months. These options are much better than surgery which may not fix the issue, and could make is worse.

Rest sometimes is a wonderful thing.

Dave

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Dave Campbell | Facebook | @DaveECampbell | h2ofun@h2ofun.net

Boom Nutrition code 19F4Y3 $5 off 24 pack box | Bionic Runner | PowerCranks | Velotron | Spruzzamist

Lions don't lose sleep worrying about the sheep

I had the same thing, same location last year, I couldn't roll over, I couldn't sit up, flipping sides in bed impossible. It happened in conjunction with a huge life stress, though I didn't think of that much at the time. I've also had this before in my life, though not within the last 5 years of triathloning. I have a shitty spine setup with some scoliosis & another bad disc.

I stopped training after 2 weeks of trying to do so, and laid on my back mostly on ice. Got up after a few weeks, went to Kona (painfully) and laid on my back for 2 weeks (planning to acclimate). Got up, did the race, in very bad form, some drug was given to me before the race (tapered though so I wasn't "on it" during the race of course). Went back to lying on my back on ice.

Could not see getting the shot - doc said it would never be the same once you do - though he was eager to do it, and repeatedly (I forget exactly but it was something like try 1x, recover, 2nd time, recover, and then see if it's gone, otherwise, repeat).

Rested for another 6 week (so 2 weeks limping through, then 4 weeks of almost nothing, then one very slow and excruciating Ironman, then 6 more weeks of nothing). It cured. I went on to race ok this season, back to Kona and all.

100% rest, is my thought! Make sure your stress level is under control. The docs later said that the life stress undoubtedly had something to do with it (central nervous system - who knows but sounds feasible) and while my disc is for sure compromised and always will be, it may only flare but from time to time (years).
Interestingly, I sort of blamed it on aggressive core work last year, especially during block I was doing before it happened. This year I did no core work, "just" training.

In hindsight it seems worth it compared to getting the shots. It was a really long time though, of being in pain and of doing nothing. But I think I'd do the same thing if I had to, again.

I hope the best for you whichever way you go.

Stress, interesting, I wonder if losing my job after 30 years was a little stressful.

I have not heard much negative about the shot. All I can say is it gave me a life back. Now, some said get more than 1, but
I said nope, will just do the rest and I no longer have glute pain or anything else.

I do my back exercises daily now and it helps to keep the back under control since I have more than one issue in the back I am dealing with.

I know at Worlds I limped around the course when the doc said do not run. Have not run since though.

I did everything during the getting worse expect rest. For many weeks I could swim, bike and run with no pain. It was the after as you described.
So, sure made sense to finally try rest when I was getting to the point I could not even walk it was so painful. If racing makes it act up again,
I am done!!

Dave

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Dave Campbell | Facebook | @DaveECampbell | h2ofun@h2ofun.net

Boom Nutrition code 19F4Y3 $5 off 24 pack box | Bionic Runner | PowerCranks | Velotron | Spruzzamist

Lions don't lose sleep worrying about the sheep

PM sent.

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Formerly DrD

My bulging S1/S5 was a nagging problem until herniation occurred, the pain was so bad I couldn't walk, actually I couldn't move. Two things I would suggest you look into. I had treatment on a machine called "Spine Med", basically traction on a computerized table to stretch your spine out. The treatment was M-F for a month, no problems since then. I also read a book "Healing Back Pain, The Mind Body Connection" by John Serno. The book was a recommendation by a good friend who went through a similar situation 15 years ago and has been pain free since. Consider these options, they helped me.

Something you want to try that has very little risk is a course of oral steriods (Medrol Dose Pack). I have had symptoms similiar to yours, and twice (once back in 1995 and once a couple of years ago), and it worked like a charm for me. Last round, the Orther surgon I saw suggested the injections as a first course of action. I suggested the Medtol, and he agreed to it but said he avoids perscribing it because some studies have links Medrol to some kind of organ damage (pancreatitis I think) - he's probably practicing defensive medician.

Just out of curiosity when you tried the McKenzie method which directions did the PT have you lean to, and did the pain centralize? That is usually considered progress, even if the pain in the back gets worse at first for the initial treatments. What you are trying to do is shift the fluid in the disc away from the buldge by closing down the space with the bones. It usually can take some time for it to have long term positive out comes with reguards to back pain. The cetralization should begin to occur within one treatment. Age will also be a factor here. As we age we lose fluid in our discs makeing this treatment less effective. That said, I have seen this treatment work well with 50 year olds.

Traction works under the same theory (fluid shift), albeit, a different method. If you are not on it long enoungh you wont get the results that you want. If your on it too long it'll make you feel alot worse.

I would give these two options your most attention. Your posture throughout the day can also have a huge impact on the outcome. I read several studies last year on the long term (~5yr) surgical outcomes being no better, and maybe slightly worse than a conservative treatments like McKenzie, traction. It sounds like your doc has already said that you are not really a surgical candidate though.

The clinical prediction rule for spinal manipulation is that usually it is only effective for pain that is short term (<16days), with no distal symptoms (leg pain), internal rotation of the hip, >1 hypomobile segment, and not afraid to work or exercise. This is describing a mechanical type pain which is not your symptoms, so im not surprised that this didn't help significantly.

If the disc is inpinging upon the nerves there is a chance that it is setting off the myotomes (muscle nerves) and causing them to fire and contract. If this is the case ART is only treating the symptoms, not the cause and will be unsuccessful as well.

I would also be aware that an aero position on the bike many times can make it worse, but not always. If it does agrivate it you might consider spending some time on a mountain bike/roadbike with an upright position. Changing your day to posture can be huge as well. If you spend the majority of time seated or leaning that can make it worse as well.

I would say go back and spend some time with the PT and let them help you.

Hope that helps
Seth

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Seth Wilkie DPT, ACSM-HFS

Thanks alot for your response. With the Mackenzie Method the PT had me doing extension press ups 6-8x a day and actually taped my lower back so I could not really slump or lose the curve in my lower back. One problem was the tape ate up my skin so I had to stop after a 4-5 days. Doing the press ups constantly also made my lower back sore so I was afradi I might be causing more problems than I was solving. In terms of centralizing, over the last 40 days I have noticed the symptoms centralizing in the area on the left side of S1/L5 (noticed a week or so before trying the Mackenzie Method actually) - previously the symptoms jumped all over (hamstring, glutes, piriformis, etc) so that it was hard to tell where the problem was stemming from. Now that I have cut back on training and the secondary symptoms have receded I can more clearly sense the tightness around the SI joint - sometimes the ligaments over the joint feel sore to the touch, other times not.

In terms of surgery, the doctor is actually suggesting the idea while I want to try everything possible before resorting to that last resort. In terms of the bike, I haven't ridden in aero position since July - all road or mountain bike and neither is very aggressive position - another reason all this is so frustrating.

I am only 40, what is the usual time you'd expect to see results doing the Mackenzie Method with someone my age? I am thinking it might make sense to try it again (also looking at flexion distraction and spinal decompression therapies) but want to know how long I should stick with it based on the research before concluding its a dead end.

Thanks again,
Jack

Others mentioned McKenzie, which helped me. So did a device at the PT - forget the name but it pulled on me to alleviate the pressure on the disc. This all took ~ 6 months.

Ultimately I had two injections to relieve the pain, that was 5 yrs ago and no issues since then. I do my core/back/ etc exercises regularly. My Doc said "there's no such thing as one back surgery".

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don't just do something..... sit there

Jack, I seem to be in the same boat. I've been dealing with a pain in the hammy, glute and calve for years. It would move around, respond to ART and massage for a while but always present. I'd stretch the hammy's like hell thinking that was the issue but no relief. Finaaly got an MRI and have 2 large bulges, one pressing on the sciatic nerve. These threads would have lead me to that realiztion long ago had I followed them sooner. Anways I've been doing McKenzies for a month or more, other stretches and strenghthening too. Glute pain is gone but still feel pain in the hammy. I take an ice pack to work and put it in my shirt backnow and again and am constantly correcting my posture to avoid the slump. Tomorrow will be my first epidural injection in hopes of getting the swelling down. I'm up for anything that will speed this thing along and allow me to get back to training. Now is the season to heal!

M

Same here, but I ended up getting 3 injections which did not help at all. Did PT, ART, chiro, massage, etc.

Every year as the season progressed my hamstring and glute pain got worse until it felt like my hamstring was just going to rip off at the upper attachment point. It was like a knife stabbing me in the butt, along with numbness and tingling at various points along my left leg and a dull pain in the belly of my hamstring. Bad on bike, worse on run especially uphill or with intensity. Finally gave up in March '07.

MRI showed severe DDD at S1/L5 and a bad disc at L4/5. Symptoms were not exactly in line with the pictures. PT's agreed that core strength was not a problem. Aggressive stretching just made the pain worse.

Went to Doc V at Boulder Neurosurgical (a fast IM triathlete himself) and he did a two level microdiscectomy in Aug '08. Came back slow and steady. Swimming at 3 weeks, bike at 6 and running at 12.

My daily pain (sitting, driving, etc) is much, much better. The stabbing, intense pain is gone, but I still have numbness, tingling and a general sense of my left leg being not right. Now it seems worse on the bike than the run. I have done 3 Olympics and a 1/2 IM since the surgery. Swim and bike times are not far off from pre-surg, but run is about 30-40 sec/mile off of where it was.

I can no longer take the daily beating of hard training. Can handle a tough day or two, but will then need a very easy or rest day. Worst thing is that I have lost confidence in my ability to push and suffer.......I now question what I am damaging and if it's worth it.

Definitely consider the surgical option. I suffered with pain for several years needlessly. I wish I had done things sooner. I am told that a fusion surgery is inevitable, but a friend (and ST poster) had one the month before my surgery and is on track for a PR at IM AZ next month. I will gladly hook you up with Doc V, just ask.

This injury may have accelerated the end of my competitive career, but my overall quality of life is much improved and I can still swim, bike and run at a more moderate level......can't complain too much about that.

G

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It's a little like wrestling a gorilla.........you don't stop when you're tired.........you stop when the gorilla is tired.

Jack,
Sorry that it has taken me so long to get back to you. I have been swamped doing a clinical rotation.

You probably have plenty of fluid left in your discs for McKenzie to work at your age. When I say centralize the symptoms i mean while doing the press ups. Like I said earlier sometimes you will actually see an increase in focal back pain but your distal leg pains reduce. If you are having skin breakdown with the taping let your PT know, they may have some other alternatives. The other guy was descibing lumbar traction that helped him. Similar principle of shifting the fluid distibution within the disc.

I agree with what some of the others have said about "core" work helping. I would make this my mission in life and be extreemly consistant with the press ups and the body posture throughout the day. ROM of the hamstrings should be symetrical, but if they are really tight you might consider lengthening them with some long duration low load stretching. You are looking to elongate the fascia/connective tissue, not just the muscle fibers (hence the time ~5-20min). Let your PT make sure you are doing this right. It may not even be a problem. ROM testing and x-rays would tell the PT if this is appropriate. There is a lot of research related to having tigher hamstrings enabling you to be a faster runner, so discuss this with your PT.

You also metioned that you are getting pain in the SI region. This could be related to the back or it could be coming from your foot. The Piriformis is pretty much the only muscle that crosses this joint and it is the strongest supinator of the arch. It can cause a tilting of the sacrum and cause it to get stuck. My experience has been that stretching it usually only pisses it off if it is the root of the problem. There is no way to tell with out doing a thorough evaluation, so I can't help you with this, but Your local PT can.

Accupuncture can also help with pain w/o alot of the side effects of the drugs, but does nothing for the underlying problem. There really is not anything that surgury doesn't have the potential to make worse.

Take home message go back and spend some time with your PT.

I hope this helps
Seth

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Seth Wilkie DPT, ACSM-HFS

McKenzie method got me from a pretty painful state with L5/S1 bulging disc to now about 90-100%. Doing the "press ups" as you call them took several weeks to notice a difference. My low back ached like yours and I wondered if it was doing me any good. In time it went away and my disc problems did too.

I'm a big believer in McKenzie.

Sounds like the bulging disc and its effects can be the beginning of the end :-( I have no signs of DDD and have not once suffered the level of diabilitating pain as some on these threads have expressed. Enough to have given up running and racing for the time being, no aerobike rides and ez swimming only. I'm 49 and am hopeful that I have discovered it soon enough so that between the PT and Epidurals it can be controlled, reduced and maybe go away all together.

Once healed I'd be happy to do core strenghteneing and stretching daily, indefinately. Some have found relief enough to get back into IM. If that is the case then there seems to be hope.

I have seen a lot of good advice in response to your thread and hopefully I can offer just a bit more.

From what I can gather, you are referring to a contained herniation not a slipped disc. If you have enough disc space you can consider a Percutaneous Discectomy. This procedure has evolved dramatically over the years and especially in the last 5 years. Essentially, a Pain Management or Ortho Physician can insert a device through a needle, not much larger than an epidural needle, into the disc and remove a small amount of the disc material thus relieving some of the pressure causing the herniation. I have seen this procedure done about 30 times and have been impressed with the results. This is an outpatient procedure that should have you walking out within a couple of hours. The procedure itself should take about 20 - 45 Minutes. L5-S1 is a challenging approach but well within reach of a competent physician.

There are a number of procedures / devices designed to deal with contained herniations of the disc. I have seen instances where almost all of them have worked to some extent but the most consistant in my experience is Percutaneous Discectomy. PM Me and I can point you towards some interesting information on the procedure, devices and possibly some good physicians doing this in your area.

Bulging disks, L4-L5. L5-S1. Diagnosed via multiple MRIs over the last 12 years.

Sometimes it's better, sometimes it's worse.

Work on your core. Take NSAIDs. Deal with the pain for a bit, but it will
get better.

My recollection is that studies show that the difference between surgery and PT
over a 2 year period is statistically insignificant.

Don't stop exercising.

IMO. IANAD.

-Jot

The latest - I met with the Bronovo Hospital neurologist earlier today. He interviewed me about my symptoms, did a physical exam and then reviewed my current MRI as well as my old MRI from 2001. His opinion was very clearly that the slightly bulging disc at S1/L5 is not the source of my problems. In explaining it to me, he showed me how the slightly bluging disc on the new MRI looks exactly the same/no worse than it did in 2001 (same exact small bulge - looks no different). He also showed me a bisected view of the nerve (new MRI) which showed it was not being impinged by the disc (white stuff still surrounding the nerve -its not being compressed). He also said at least 2-4/10 people my age would have the very same bulge and that my symptoms did not really correlate exactly to what an S1/L5 bulge would cause. He also did not see any issue with any other parts of my spine (L4/L5) or pelvis that would cause the problems I am having. In fact, despite 6 ironmans in 6 years and lots of running and riding he said my back looks no worse for the wear from 2001.

He did say, however, that something else may be slightly irritating the nerve (either in the lower back or piriformis or SI joint), but if so it was not the sort of the thing an MRI would show. Because he does not think disc compression is the issue, he did not think spinal depcompression therapy would help me. As for how to relieve tension in the surrounding muscles, he felt that was not his area of expertise as he did not have alot of experience working with athletes. In sum, he felt confident that the S1/L5 bulge was not the problem (nor was anything else on the MRI) but he did not have any other diagnosis of what may be causing my problem.

Overall, I guess good news as the disc + possible surgery was about the the worst possible outcome. Given the above, however, I have little no clue on next steps. One possibility I am now considering is whether all this is being caused simply by supertight hip flexors. On the internet a couple days ago I found a stretch that really stretches my hip flexors (basic lunge stretch but place back foot up on chair turning ankle inward then when you do stretch reach with opposite hand up and somewhat over behind you + if you can take other hand a reach back to touch foot on chair). Before doing this I would not have said my hip flexors were particularly tight (no soreness) but they feel soo much looser after holding this stretch for 30 seconds on each side - much more of a stretch than basic lunge stretch. Anyway, I am wondering if tight hip flexors alone could have been pulling my pelvis out of whack and causing the sciatica - could it be that simple? If so, can this just be relieved by consistent stretching? I have had the psoas ART massaged a couple times through the abdomen and it didn't seem to do much, but this stretch seems to really loosen it up some - I am going to see another couple PTs/osteotherapists next week but I am hoping this might be the light at the end of the tunnel. Again, anyone who has had any experience with something similar and found this to be the solution (or not), I'd love to hear from you.

No answers, but continue to deal with the issue in the same area. I got my back shot around 2 months ago and things got better. Then 2 days ago
I was moving ladders and doing some painting. I messed something up again and can now barely walk again because the pain is so bad.
This is no fun having a back injury.

Dave

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Dave Campbell | Facebook | @DaveECampbell | h2ofun@h2ofun.net

Boom Nutrition code 19F4Y3 $5 off 24 pack box | Bionic Runner | PowerCranks | Velotron | Spruzzamist

Lions don't lose sleep worrying about the sheep

What he said. :-(

Every good day is a gift.

G

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It's a little like wrestling a gorilla.........you don't stop when you're tired.........you stop when the gorilla is tired.