Its a single level............do the surgery,, do the recovery now, get back to training sooner. It's the cure to decompress the nerve. If the herniation is large enough that you can't walk without pain its not going away.

Yes its single level on the MRI seems isolated.

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2024: Bevoman, Galveston, Alcatraz, Marble Falls, Santa Cruz

I sympathize with you as I have been through all the pain I ever want to feel, mine started unfortunately from an IVC filter rupture in early 2012, the filter ruptured into the spine and went into the disk at L3 L4, no end of pain into the groin and hip area, had groin surgery to remove some nerves as everyone thought it was just the groin nerves at first, wasn't until later in 2012 I found out about the rupture, filter was removed but damage was done to the disk, over the years it progressively got worse then in 2015 it really hurt after a bike ride, had the MRI saw about a 9mm protrusion, had all the usual epidurals, ended up with 9 of them over the following years, none of them helped, some steroid nerve blocks and then in 2018 tried 3 lots of stem cells into the disk, NOTHING really worked, yes I tried acupuncture, various physical therapy's, even chiropractor nothing worked, I stopped running all together just biked, swam and walked along with the gym, way too many days in pain trying all sorts of treatments, saw so many doctors it was crazy.

This past February I had a discectomy removed some of the disk and cleaned up the scar tissue around the femoral nerve, thought I had really messed up when after the surgery I couldn't move my right leg due to the femoral nerve damage but slowly worked that better, today I still have nerve pain but not like I used to, back feels weaker, when I bike I am now slower than I used to be prior to the surgery lost some strength in my right leg, but overall the pain is no where like it was. I would do the surgery again over the years I went through hell with the pain and all the other "treatments" I tried and forgetting the thousands of dollars I paid out on all the other stuff to try to fix something that needed to be surgically removed from pressing on the nerves.

Don't wait too long like I did as I have permanent femoral nerve damage from the disk pressing on it for all those years and the damage the IVC filter prong did that went into the nerve. Hurting ones back is the worst and yes it is scary to think about the surgery on the back as we all hear horror stories about what can go wrong but I was at the end of my rope when I finally said enough and did it, I just wish I had done it years ago and maybe the nerve damage today wouldn't have been so bad.

Thank you for the response, man no easy answers.

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2024: Bevoman, Galveston, Alcatraz, Marble Falls, Santa Cruz

It isn't an easy decision I know. Just to let you know after the surgery recoup...

I started out first week trying to get movement back in my right leg, leg lifts etc. it was a bitch trying to move a leg that didn't want to move, dragging it when I walked, but gradually over the first 3 weeks or so I persisted every day working the leg finally it started to come around more, then started to walk down the block then further was up to a couple of miles by about 4 weeks, if you train it is part of your life to push so you have that in your favor. I then got on the exercise bike in the gym and went 10 min then 20 within the week and then it closed down because of the virus. I went to physical therapy for about 3 weeks before I lost that due it them closing. So I got my bike out on the wind trainer got up to about 20 min then decided to ride outdoors at about week 7. Went for a 5 mile ride, felt like 50 but stuck at it, sore in the low back leg felt stiff and weak, kept at it. Then started to do a lot of the leg exercises with some 10lb ankle weights just kept at it, but about 3 months I was cycling 20 miles, doing some hand weights at home, walking 6 miles most days. My longest bike right now is 28 miles, still have some pain at that distance so don't push it right now, no need.

I do miss swimming just wish I could see how the back was for that but won't chance it yet. I think you will be surprised how quickly you can return especially if you have that training mind set you know how to push your body and how your body feels doing it... Best of luck... Cheers LA Rob

My plan as of now was to go 6 months and try everything else before surgery, but also one reason I am posting just to see if that seems like a good plan or if its even worth the wait.

The thing that drives me crazy is I have full strength, before I just decided to shut it down I pushed the highest 20min power and 60min power I had ever pushed on the bike and a lot of the times when I was working out on it, the back would feel better for 3-6 hours after the workout then next morning it was back to same pain.

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2024: Bevoman, Galveston, Alcatraz, Marble Falls, Santa Cruz

The PT I have been going to keeps using that same phrase "decompress the nerve" he keeps thinking if we can just take some pressure off of it with PT it might get better..... but you are right have not been walking without pain for many many weeks now. When I was still running on it after about 8-12 min of some uncomfortable running it would stop hurting (granted it was still pretty hard to put on my shoes before hand) .... anyone experienced that?

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2024: Bevoman, Galveston, Alcatraz, Marble Falls, Santa Cruz

As has been said....do the surgery, relieve the compression, get back to normal sooner and get back to training sooner.
All therapies have a role under certain circumstances, it seems pretty clear from what you have written here that surgery has a greater role to play in an optimal recovery for you.
The longer you put things off the longer it will be til you are back training and racing, hence why you should just bite the bullet and get it all done.

I don't have anything really meaningful to add, but just make sure you are in a good headspace with everything. And it does sound like you are motivated in trying to correct this and that sometimes can be detrimental to very type-a triathletes. Not sure if it is the exact same, but what changes in 2011 did you make to allow you to get back at it. FWIW, given an MRI, many if not most athletes would likely show some issue with protrusion, herniation, stenosis. Some would believe that general stress causes some of the back issues out there. Wishing you the best with this.

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Bummer dude, sorry to hear.

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Dimond Bikes Superfan

Thanks dude appreciate the words. Yea mentally been kinda fucked the last few weeks, starting to understand why chronic pain pts are always in such a bad mood. Doing things like racing or Kona seem small when you are simply trying to just sleep in a bed or walk without pain.

I agree with you that most people around our age will have jacked up MRI no matter what just some of us are symptomatic while others of us are not.

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2024: Bevoman, Galveston, Alcatraz, Marble Falls, Santa Cruz

If anything these kinda of messages are at least motivating me to go start trying to find surgeons btw Austin and Houstan.

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2024: Bevoman, Galveston, Alcatraz, Marble Falls, Santa Cruz

My story on this is long-ish, but not as much in timeframe as others here have already posted.

I slipped on ice in Feb 2019. Thought I'd pulled the hamstring. Kept getting slowly worse until late Aug 2019 when it gave out and had the full issues down the whole leg. Chiro, PT, finally an MRI -- L5-S1 herniation. Then a 3-month battle getting scheduled for a cortisone injection, which turned out to be completely ineffective. That gets me to March 2020. Went to surgeon, they agree microdiscectomy is the next step. Scheduled for June 28. In the mean time I sneezed while sitting in a really bad chair, and herniated L3-L4 (confirmed by second MRI). I basically scramble to get that one covered in the same surgery.

I'm now 7 weeks post surgery. The L3-L4 seems to be sorted. The L5-S1 seems to have not taken, and all the same pain is still there. I'm on a methyl-prednisolone course and started taking CBD, and am doing continuous acetaminophen/ibuprofen, which is helping, but the same triggers for pain are still causing pain, and if I'm not on top of the pain med schedule it becomes a constant ache.

So I guess the short of it is that my surgery results are 50%. Don't know what the next steps are... Fusion? ALIT? Or just deal with it...

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Some are born to move the world to live their fantasies...

https://triomultisport.com/
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I first herniated my L4/L5 in college squatting. I am now 35. To summarize without a lengthy post, I have thankfully had success with both PT and cortisone shots.

The number 1 thing I keep hearing from doctors is wait as long as you can before having back surgery. If you have surgery once, you have a very high likely hood of having another back surgery down the road. There also isn't a 100% guarantee it works and those few stories where it is actually worse.

Just some quick feedback from my experiences.

Here's the really tough part about back issues - Everyone is on an individual island - what works for me, may or will not work for you. Same with choices such as surgery - works for some, does nothing for others, or worse case scenario makes them worse!

Note I don't race or train that seriously any more - but I do when I can a moderate amount of cycling in the 300 - 400km/week for the bigger weeks of the year.

Confirmed via MRI 10+ years ago that after 4 - 5 years of suffering with on and off inconsistent low back pain that I did have a Herniated disc L4-L5 and a bulge in the one above. To confirm what I said in the first paragraph, I recall talking to the radiologist, about my results, and he said he's seen people with my same pathology who are in 24/7 agony, and others with no symptoms or pain at all!!

I was told then, and repeatedly along the way, that because I'm reasonably functional, I'm not a candidate for surgery. So I have been treating it my own way. I'm never 100% pain free. It's either low grade, mid grade or super acute. In the past 10 years, I have had 3 - 4 super acute attacks, where the pain has been crippling, and I have literally had to spend a few days in bed. But it gradually get's better.

Strangely, for me, the more I ride, within reason, the better my back is*. The more physically active I am in a day, within reason, the better my back is. I have a little strength, stretching and core routine that I do, that I have developed through trial and error that works for me. Again, getting back to the first paragraph - some of the classic, must-do, exercises for low back pain, like planking, actually make my back worse!

*I put in a massive month of riding for me in July - a number of 100 km rides and including a Summer Goal of a 200km ride, and my back has been reasonably good.

Best wishes.

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Steve Fleck @stevefleck | Blog

Don’t do the surgery. You don’t have the right PT. Find a spine specialist.... McKenzie credentialed. This will reduce with the right mechanical movements, though they do also respond well to injections. Spine surgery is over prescribed without observation for risk. What exactly have you been doing in PT where it isn’t working for you?

Weeks 3-6 I tried the routine I had done in past years that had worked. When I realized that was not working I switched and started doing a routine PT had prescribed: birddog, side planks, bridges, modified bird dog, and some breathing work. Going to see a different PT group tomorrow and a PT/movement specialist Thursday.... trying to get as many brains as I can involved; also why I am posting here, just to get more brain power involved.... one thing I have learned its very hard to make good rational decisions when you spend most of the day in pain.

I really appreciate all the advice, stories, and positive energy everyone has shared on this thread.... at the very minimum it's putting my head in a better place.

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2024: Bevoman, Galveston, Alcatraz, Marble Falls, Santa Cruz

Thanks Eric, appreciate the thoughts. :-)

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2024: Bevoman, Galveston, Alcatraz, Marble Falls, Santa Cruz

Interestingly enough this was similar to how I was from 2011-2019. Something changed in Oct 2019 a month before IMFL. Got through IMFL had a solid race (for me); but did not spend the winter doing strength work like I have done past winters, I mostly just eat and drank wine, when Covid happened and I was not working near as much I just started biking hard everyday trying to get strava top 10's (in Austin this is not easy) combo that with long weekend rides and then work starting back the back finally went; lot of hindsight 20/20..... Stick to the core / strength routine you have! Wish I had done the same.

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2024: Bevoman, Galveston, Alcatraz, Marble Falls, Santa Cruz

It’s clear why you aren’t getting better, nothing about those PT exercises will actually help you. You really need to find a spine specialist who knows how to reduce a derangement. Given what you are saying, a PT who knows what they are doing should be able to give you an exercise that will reduce/centralize or abolish your pain. The more you do that one exercise the better you will get until your body proves that it’s ready for a different reductive exercise.

You know any in Austin Texas? :-)

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2024: Bevoman, Galveston, Alcatraz, Marble Falls, Santa Cruz

From what I recall St. David’s should have credentialed PTs. There’s a positive Side too, this type of treatment lends itself really well to telehealth also. Good luck.

Did anyone try changing their diet? Going with a lot of anti inflammatory foods or any supplements that might help?

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2024: Bevoman, Galveston, Alcatraz, Marble Falls, Santa Cruz

Honestly, with your symptoms and MRI findings these changes won't really help much more than the 30% placebo related benefits of any intervention.
Once again, the choice is yours, but don't be scared or put off by surgery. Yes there are pros and cons and some patients are absolutely terrible candidates for surgery, but the longer you leave your pain at difficult levels with all the various wind ups and nervous system changes that occur at a molecular level the more locked in these changes become and the harder they are to reverse. (That is some complex chronic pain medicine there which is something I am heavily involved in....)

Crap you are not painting a pretty picture.

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2024: Bevoman, Galveston, Alcatraz, Marble Falls, Santa Cruz

Scott Herbowy is a Mckenzie instructor in Austin. Amazing clinical skills. I would start there. I have taken a couple of his classes with him. You won't find better.

Am just re-reading your original post now....have you tried any epidural injections or nerve sleeve injections? We would often do that first if pain was the major symptom and not much weakness from the herniation. It is a pretty simple day procedure and safe.

I did 2 rounds of Medrol Dose packs: one round was one week after the the PRP since the PRP must have increased the pressure so much it made life really bad and pain 4x worse. (thats Was 4 weeks ago)

I have my first epidural scheduled for this Friday.

I sent me MRI to my friend thats way smarter then me and a neurosurgeon: he did say that stuff seems small enough and with no muscle weakness so keep doing PT a bit longer.

PT today said it takes around 12 months for all the collegen fibers of a disk to repair, that was new to me.

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2024: Bevoman, Galveston, Alcatraz, Marble Falls, Santa Cruz

Hopefully the epidural will do the trick.
I tore my ACL in 2006 playing flag football; jumped up while running, cleat stuck in the mud as I came down on one leg and hyperextended forward over the locked knee. It was pretty dramatic in that I dented the head of my femur. I had to rehab that first, then had surgery (cadaver) and rehab'd after. That injury was sudden and painful but sort of peaked. Same with the surgery; first 3 days were just awful but then life got quickly back to normal. I did phys therapy like a maniac.
In 2011, herniated a disc. Different kind of injury with the sciatica and the constant feeling like you would sneeze and send everything in to spasm. Totally a strange and stressful kind of injury; the unpredictable nature made life suck. Was taking pain killers that would magically allow me to dance around. Crazy shit.
In any case, I got the epidural and it worked. Lots of rehab; I would say the rehab for the ACL post surgery was shorter than the rehab for the back post epidural. But the rehab does really help you make sure your glutes are firing and you have balance on both sides.
I did Wildlfower Olympic after the back rehab in 2:29. The hopeful news is the next year, dropped it down to 2:23.
Point being, based on my experience, you can recover and get back.

So fingers crossed the epidural will work for you. And it's ok to take a break from running. In addition to PT 3x/week, I just swam (no kick turns) and gradually started riding (no aero bars). Eliptical trainers are good, too.

Hopefully this thread will help others that maybe going through similar stuff.

Today was first day I did not have shooting debilitating pain, still soreness achy but not to the point I was feeling like I had to throw myself on the floor to lay down to get relief.

After today I think am going to hold off on the Steroid injection tomorrow and see how the next week goes, I think that is the smart call? Maybe I will read more about them tonight and wait till morning to make a final decision.

Things I have changed this week compared to the last 8 weeks:

- Eliminated almost all inflammatory foods from my diet
- tippled my water intake to around 100oz a day
- Cut wine from my night time routine
- Found a new PT
- Started working with a pilates / movement specialist
- At work I dialed back my work schedule to see less patients
- Started sleeping on my stomach recommendation of PT since sleeping on stomach was not seeming to help things.
- Working on my mental mindset

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2024: Bevoman, Galveston, Alcatraz, Marble Falls, Santa Cruz

The time course for the disc to heal is pretty long, but that does not tend to correlate with the improvement in your pain symptoms.
The epidural is a good option, great that you have no weakness. Interestingly my pain specialist that I work alongside never does PRP for these, will get her thoughts on it and let you know.
Keep us updated if you can.

Yea I went into the PRP full realizing it was going to be 50/50 (at best). That Dr and I had talked about it when I had hurt the back in 2017 and at that time we decided not to do it then. He also has written an article on it's effectiveness in Journal of the American Osteopathic Association. "Platelet- Rich Plassma and epidural Platelet Lysate: Noval Treatment for Lumbar Disk Herniation" Dr Rawson. Would I have do it again if I know what the week after was going to be like, no way. At the time it seemed to me a none invasive way to start working on the problem. On the flip side it typically takes 2-8 weeks to start to see results.

My afternoon has been not so great, so still have a scheduled appt tomorrow for the epidural.

In the past my body has responded good to steroids: lingering shoulder pain (broken clavicle) injection 100% fixed it in 3 days.

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2024: Bevoman, Galveston, Alcatraz, Marble Falls, Santa Cruz

I will track down that article and have a good read. I will admit to getting a bit annoyed at times when a more "novel" treatment is given first over those treatments with established efficacy, like an epidural steroid. As a medical practitioner and the risks were similar, I would go with the treatment with proven efficacy first.....

I had talked with the Dr and my PT about this and we considered this the least invasive of the two options. Now this is def not my field so I go off what the drs around me are telling me, throwing in some PRP seemed at the time easy and not to invasive, once again I would never want to go through that week I went through after the PRP again and unless I take another MRI which I don't think I will won't know if it really worked or not.

Today did the epidural with contrast dye. I am a baby 100% but man thats not an easy thing to go through. I think it was more the dye going in but my right IT band (area) / hamstring, and calf went ice cold then burning followed by so much pressure it felt like something was going to pop out of the skin..... they dont tell you that in the youtube videos (once again I am a baby so it could just be my perception of it).

I had to drive around to some of my offices to deal with some broken AC units and some cases right after and felt ok, about 2.5 hours latter went to Cosco and was walking around feeling mild burning in hamstring and the right foot lateral to bottom but not all the way to center of bottom of foot was tingly and numb: very odd feeling.

Got home and kinda of said fuck it went and drove the 3rd around for 45 min just for some mental relief. I have this amazing back support thing in this car and carbon bucket seats feel amazing (once you are in... hard as hell to get in).

When I got home I went and walked dog for 6 min! First 6 min of zero pain I have had in cant even remember how long. So looking at that as a positive.

What I am not sure with the epidural what to expect next? Google is not turning up great results.

Is the pain relief from the injection does it typical stick or get better? Does it go back to where it was after a certain amount of days? Are there things that can be done to make it stick or improve?

I am scheduled with PT 2x on Monday, Chiro and Pilates/movement Wed, Friday back to PT. Limited actual clinical working on smiles / teeth all week so that should help.

As always thank you to everyone that has contributed words / advice / encouragement; its been one of my few outlets that past week.

Btw covid and this I find I am looking at life a little differently then I used to.

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2024: Bevoman, Galveston, Alcatraz, Marble Falls, Santa Cruz

So I work as an anesthesiologist along side a pain specialist and we do all ours under sedation as they can be pretty unpleasant, as you found out!
In terms of the pain relief from them....you may get some initial rapid analgesia from any local that might have been put in with the epidural. That will be short lived (hours normally). The steroid often takes a few days to kick in, then that can give you pain relief for quite a sustained period of time. Everyone is different, we are often doing them for pretty nasty disc lesions where the patient is trying to avoid surgery. We also do quite a few actual disc blocks (ie putting local and steroid into the disc itself). Fingers crossed this settles it all down for you.

Thank you sir :-)

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2024: Bevoman, Galveston, Alcatraz, Marble Falls, Santa Cruz

To the OP, I'm really sorry to hear about your struggles. Long-lasting injuries are the worst, and the back in particular seems to vary so much in how it presents and responds. Hang in there.

I've read this thread with interest because my wife has struggled with sometimes-debilitating back pain over the past couple of years. At my urging, she finally got an MRI and saw a spine specialist, but they seem to think it isn't a huge deal since she doesn't have pain radiating down either leg. Here are the highlights from the MRI. Can any of you who have gone through this or are medical professionals comment on how likely you think this will respond to PT only? The part that worries me is 8-9mm of herniation. Sounds like a lot, but I just don't have any points of comparison.

IMPRESSION:

1. L4-5 and L5-S1 levels show mild to moderate disc degeneration with endplate irregularity adjacent marrow degenerative changes.
2. At L4-5 there is an eight - 9 mm broad-based posterocentral disc herniation with mass effect on left L5 sleeve origin. Facetal arthrosis present with mild central canal stenosis.
3. L5-S1 shows a 4 for mm broad-based posterocentral disc herniation into ventral epidural fat. Facet arthrosis without central canal or foraminal stenosis.

Twenty years ago I was having severe back pain. Hurt to walk. Hurt to sit. No way to find comfort or ease the pain. I hurt my back initially lifting weights in my teens. Saw a surgeon in 2000 who told me surgery was going to eventually be required and that my running days were over. But he wanted me to try PT first. So I lost some extra weight, did the PT and never went back to the surgeon again.

Since then I have ran thousands of miles, finished multiple marathons and triathlon races of all distances including the full distance.
Occasionally my back flares up but for the most part all is good.

Similar thread here: https://forum.slowtwitch.com/...perience_P7251735-2/

And I wrote there:
"Back issues are no joke and it's amazing how they manifest themselves. I tore my ACL and had it replaced in 2006 then herniated a disc in 2010.
The disc issue was far worse (constant fear of complete lock up) and took longer to rehab. Some observations/advice:
- Find the best PT around and look specifically for back injury specialty as well as someone who gets the whole picture on multisport. Go to PT religiously. It's not just about the McKenzie stretches, it is also about strengthening your glutes, your feet/ankle mobility, Achilles, calves, etc. Typically injuries like this originate from lower down and manifest at the back. Likely you have an imbalance and your glutes aren't firing properly.
- Recovery will take a long time
- Be careful on the bike, esp the TT position
- Be careful swimming with flip turns as that can cause jarring
- I *think* anti-inflammatory meds are ok but stay off the uber pain killers unless you want to get addicted and constipated
- Focus on posture
- Get a new bed! Tempurpedic type on the firmer side
- Massage ball (like a softer lacrosse ball) on the pressure points: piriformis, psoas. Basically where your inner leg terminates on the front, your ass cheeks, the whole ridge around your hip, lower back, etc. All of those areas are likely pulling on your lower back which is creating the imbalance.
- Don't use stability control shoes. Use neutral ones and zero drop shoes and try to walk around barefoot. Your foot is the first step (pun intended) in absorbing the impact to your body."

How old is your mattress?

Good idea on the continued foam rolling and ball work: i have kinda stopped doing those things.

Yea i have 2 tempurpedics but I have been reduced to the floor the last 3 weeks.

Yea flip turns not done one since 2018! Lol


Update on the epidural: day 2 post injection is def worse then the day before the injection with still some tinging in the foot and overall shooting / stabbing pain.

Working on saying a lot of this is still in my mind.

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2024: Bevoman, Galveston, Alcatraz, Marble Falls, Santa Cruz

Don't get too dis-heartened just yet. The steroid takes a few days to kick in so won't be doing much just yet and you can often get a little flare up before it starts to settle down. Just take things one day at a time and keep moving and exercising where safe to do so. How are you managing your pain (medication wise)?

Thanks for that, did not know that. Was pretty disheartening to have a day of no pain then followed by a day of significantly more pain.

Motrin 200-400mg or nothing. Not taken anything for pain for 4 days. I figured if I take pain meds then I don’t really know if it’s getting better or not and I don’t want to mask it and do to much on it.

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2024: Bevoman, Galveston, Alcatraz, Marble Falls, Santa Cruz

Don't get too caught up in trying to avoid the pain relief at the moment. Often there is an additive or synergistic relationship and you won't really end up masking the results of the epidural so just use what you need to use to get you through the day (talking mainly non opioid medications here....use anything opioid based sparingly because of other issues).

100%

Not even touched anything besides Ibuprofen or Tylenol (well guess wine kinda counts).

I did just walk 1 mile pain free today: thats a first in can't even remember how long ago! This was after last night feeling a ton of pain for a solid hour. Its a roll-coaster with the lower back.

I have found a couple of things at PT which help: Straight pressure (second person has to deliver pressure) on L5 while doing a push up / up dog movement and doing the same up dog movement on my own but with shifting my hips to the left first.

I can sit in a chair again pain free if I put a big towel right behind my back as well.

Still focusing on hydration and not staying in any one position that long.

Was able to speak with Nick who had sent me a DM a few days ago on here.... was just good to hear someones voice going through same thing.

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2024: Bevoman, Galveston, Alcatraz, Marble Falls, Santa Cruz

I think your best bet on recovery is identifying the pain generator. It's not easy.

I am a neurologist, neuromuscular specialist. I treat and diagnose back pain/radiculopathy all the time. I also have 2 herniated disks in my back (L4-5 and L5-S1), approx same onset as yours (2011).

The herniated disk is the easy thing to see on the scan. It may not be the source of your pain.

Epidural steroid will work for neuropathic pain. This is pain caused by the irritated/inflammed nerve root near the disk. This kind of pain can be sharp, but is often achy, throbbing, gnawing, and is CONSTANT. All the time. Doesn't matter what activity you do. Does not get better from lying down. The pain is often in the leg, not in the back. Sometimes it's in the buttock.

Pain that is mostly in/around the back is usually musculoskeletal pain. This worsens with activity. Depending on what it is that's generating the pain (ligaments, tendons, muscles, fascia, joints), it can be sharp, aching or throbbing. It will worsen with the activity and improve with rest.

Keep working with your pain doc and your PT to try to identify the pain generator. If its MSK, pain doc should be able to knock it out with an anesthetic and this is a good diagnostic trial. They can inject steriods same time, and see if pain is gone for a few months. If its nerve pain and the epidural doesn't help, there are good medications that can help.

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Two wheels good. Four wheels bad.

Thank you for insight; yes at first we thought it could be something in the hip, and still working on those muscles with PT. Feel like its more L5/s1 but yea who knows!

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2024: Bevoman, Galveston, Alcatraz, Marble Falls, Santa Cruz

So ten week update (losing track but I think its 10 weeks):

Last 24 hours have been really amazing: pain still present but no spikes that make me break out in cold sweat on my neck and have been able to walk for 30 min with nothing really sharp or super achy happening.

Changes:

Monday: PT x 2
Tue: Pilates: only doing 3 things
Wed:
1st: Chiro (first visit to Chiro alone, prev PT had done some adj but not this many: worked on Thoracic section a lot more).
2nd: Acupuncture / dry needling: man had flashbacks to my PRP and Epidural got through and it was far from fun, if I had never had had the Prp and epidural it would have made this much easier. Oddly felt much better right after, sore but better.
3rd: Pilates again.
- sore that night at sites of acupuncture.

Up until today had not done any work on teeth just exams which minimizes the bend and twist: I have some amazing co workers and other drs I work with that have picked up the slack and I am very appreciative.

Today: really no bad pain.

Still working the mental aspect of this all telling myself it will be ok and its not so bad and I will get through this.

Now I am not sure if the steroid from last Friday is kicking in and this bit of relief is short lived, maybe the Prp is working, is it the increases PT visits, of did the Chiro or acupuncture just do some magic?????

Going to enjoy these moments of no pain and hope they last.

First first time in a long time have thoughts of riding a bike and maybe still be able to race Kona in 13 months.

(I have listed both my TT bikes for sale and if I can get back to riding ever will be on a bike I can adj stack height very easy depending on how my back it feeling that day)

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2024: Bevoman, Galveston, Alcatraz, Marble Falls, Santa Cruz

Update?
Assuming since it has been a few days that things are doing much more bueno.

So sorry you are going through this:( I have herniations in L4 and L5 from a bad fall when I was in HS. I have seen the same chiropractor for the past 20 years, have an excellent PT, and am very disciplined with my stretching and strengthening. I also have bad days/weeks but have learned what I can and can't do during a flare up. I have decided that surgery has too many risks and have been able to keep it pretty much at bay. I have run Boston 20x and have done 16 IMs including Kona...so....don't give up hope! Get a good team around you who can help keep you strong and flexible, and who can help you troubleshoot when things get tough. Also, you will get really good at distinguishing pain from an injury, as opposed to pain/discomfort caused by your herniation. In general, I will train/race if it's nerve pain that doesn't impair my form, but will lay off if I suspect pain from injury. Good luck and let me know if you would like to connect!

the novacaine (or whatever)they use pre epidural steroid injection gives me quick relief for over 24hrs, then wears off as the actual steroid works it's way into the area and does it's thing. that can take up to a week for me, longer for others as i hear it.
good luck man!

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http://www.PatGriskusTri.com USAT Certified Race Director
2024 Races: USAT State of CT Age Group Championship/State of CT HS Champs/ CT Club Championship - Sat June 15th (Oly/Du/Sprint) Hopkins Vineyard Tri at Lake Waramaug Saturday July 13th http://www.HopkinsVineyardTri.com

11 week update:

- Pain is way down, can walk most of the day without anything sharp or shooting, unless say I sneeze or cough or getting in or out of car. Oh yea getting on socks still kinda sucks.
- There seems to be a light at end of the tunnel.
- I have formed a little team of: PT (I am seeing 3), Chiro, acupuncture, and pilates instructor. I have re arranged my work schedule to get in for 4 sessions a week. Making getting better a priority over work (thats very hard to do for me).
- Pt's are all aware of each other and each are working slightly different things.
- Chiro once a week to keep things loose but not have them to lose, adj to the thoracic area have helped.
- Acupuncture I was skeptical of but much more a believer of now.
- Pilates: working on walking better, activation of muscle I was not using well, posture, hips..... I should have been doing this years ago.

I cant point to one thing that is working sig better then another but it all together seems to be working.

I am currently walking 2 miles a day, long ways from running a marathon or doing a 6 hour ride but its def progress.

Some of them are telling me its ok to get back on the trainer and some are saying no not quite yet, its hard since I really still want to do something more then walk. But fuck its a different world then 4-6 weeks ago! Thanks for listening and mesg me back members of ST.

I am having some real hope now that I can go race in Hawaii in 2021. TT bikes are up for sale so would need to buy a new one but thats a good problem.

Brendan

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2024: Bevoman, Galveston, Alcatraz, Marble Falls, Santa Cruz

Question for those that have/had herniated disc: Does it always involve low back pain along with shooting pain down one leg? Are there any tell tell signs when it's a herniated disc vs just a pinched nerve?

I had a bike crash last Sunday and hit a tree at 30kph with my left side; impact was mostly on my left thigh but I also hit the tree hard with my left shoulder. At first I was only feeling the pain on the thigh and the shoulder Sunday through Tuesday, but on Tuesday night, while putting on my sleep shorts, I felt intense pain on my low back that literally put me on the ground. Interestingly, I was barely feeling any pain on my shoulder. I spent all Wednesday barely able to move and getting out of bed was excruciating.
I've been taking Naproxen and Cyclobenzaprine as prescribed and now I am able to move mostly pain free as long as I don't bend my spine. I don't have any shooting pain down any of my legs but I do feel a pinch above my left butt along with shooting pain on my low back with the bending movements.
I have an appointment with a spine specialist on Tuesday but I am nervous that I will get a herniated disc diagnosis.

The simple answer to your question is no.
Many people have herniated discs with no symptoms whatsoever.....
Whilst there are some things which will potentially indicate a pinched nerve versus a prolapsed disc, you will likely end up being imaged anyway which will likely be able to get you closer to knowing what is causing your pain.

A tissue-based diagnosis is irrelevant. Nearly 1 of 2 people have disc injuries regardless of pain status. Literally 95% of LBP can be managed conservatively. You are clearly improving and being active is the best thing for you. Clearly, you should avoid bending and sitting as those provoke your pain. Keep doing what you’re doing, it’s working.

Steve - yours sounds very similar to mine. FYI - I was told probably 20 years ago that I have a likely L4-5 herniation. I get the same "super attack" about every 2 years or so. It would have to be WAY worse before I would consider surgery.

To the OP - I have had the worst flare-up of my situation during this crazy covid time. It was REALLY bad in April and has gotten only slightly better. I believe a lot of it is psychological even though I am a pretty positive person. I chock a lot of it up to more stress with business, family, friends, and just life. The other thing my wife and I were discussing - I hurt everywhere right now - is that over the past 40 years I have frequently tapered, raced, and recovered. Now I have just done regular training straight through . . . I think that may be part of this terrible flare-up.

Best wishes,

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David
* Ironman for Life! (Blog) * IM Everyday Hero Video * Daggett Shuler Law *
Disclaimer: I have personal and professional relationships with many athletes, vendors, and organizations in the triathlon world.

Are you doing planks / working on your abs?

After inflammation goes down in the back, I find strong core is super helpful to getting the last bit of lingering pain to go away

Are you doing planks / working on your abs?


Part of what I have learned dealing with a wonky lower back going on 15 years, is I've had to develop a strength and core routine that works for ME! The classic plank, advocated by so many, really irritates my lower back. So I have a simple routine that works for me, and stick to that . . other people might be different.

This does point out the incredible individuality of back problems.

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Steve Fleck @stevefleck | Blog

Will update this.......

Now its Nov 23:

Original injury in June and pushed way past its limit into July.


After Speaking with people who reached out to me on ST and talking with my friend who is a Neurosurgeon (and a baller tri guy), really decided to not go surgical route seems like it could maybe fix the issue I had but would lead to other issues.

It's a bumpy road for sure with some up and down days (or weeks).

Whats worked: finding a core routing that works for me and doing it 6-7 days a week (doing 2.5-3 hours of core and weights a week for past 8-10 weeks), swimming has helped as well.

What still does not work: my daily job has been the worst thing for my back and I have had to limit what I do at work and work around it. Next year will bring another doctor in so I can move to just admin work on Tue and Friday.

What I have gotten back to doing since my initial post:
- Running: up to a 6.5 mile long run and 12-15 miles a week over the last 4 weeks.
- Biking: 5-8 hours a week: still all on trainer; every Sat or Sunday I do a 3 hours ride at 1/2IM watts. Hope to move outside by Dec.
- Swimming: no real limitations: other then no flip turns and I am careful about how hard I push off the wall.
- Weights / Core: 2.5-3 hours a week and careful with what I do. Yes I am doing squats.
- Before every run or bike I do something to active muscle.
- I am still sleeping on the floor but plan on buying a new bed this week and moving back to the bed at that point.


I had constant pain for months, periods I could hardly walk...... Now I am re focusing on return to racing in April and Kona in Oct and I think both those happen as long as I make smart choices and listen to what my back is telling me.


Hopefully that helps: but every situation with lower backs is so individual.
Its just a a awful injury that completely debilitating and life changing.

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2024: Bevoman, Galveston, Alcatraz, Marble Falls, Santa Cruz

Did you try the light dolphin kicking sets in the pool on front, on back, on each side, with and without fins yet or does that hurt?

Also in terms of biking, are you talking TT bike, or road bike. Its really funny, because I have had friends with these issues who are worse in a TT position. Others like me are better in a TT position with more weight on shoulders and less on butt. I would expect that riding outside is better due to variation and not that static position on the trainer. Not sure how much swimming you are doing, but if you can, I would replace some of the trainer time with swim since your feet and lumbar spine are not locked into fixed positions....more give in case there are small aggrevations. Half IM watts for half IM duration sounds like you are almost on the path that you can do Kona watts for Kona duration and you have 10 months to go. So maybe less bike is fine for now.

Walking is always good for range of motion and gradual torsion (depending on nature of your problem).

Did you try super light rowing machine for range of motion and core yet, or is that too hard?

Dolphin been scarred to try, maybe will try today. Fins general put to much more pressure on the L5 for some reason; just started using them again around 4-5 weeks ago.

TT vs road bike with my lower back has been interesting. Generally outside TT seems to for. whatever reason be a little easier on the back and road bike on trainer is easier. No clue why.

I walk more then I ever have no: figure thats a great way to just get some blood flowing. From what I have gained in knowledge the disc does not have a very good blood flow so the more you move the better the blood flow is and the faster it can heal.

Been scarred to try the rowing machine: you said just try to go light, so maybe will try that today too.

I use my 3 hours Zwift race on the weekend as more just a release to go out and feel like a athlete again and push some power...... also dont want to be embarrassed when I make it back out on the roads with my normal riding crew.

Edit:
- Really big overnight change for me was drinking water! Sounds crazy I know; but my pilates instructor asked me one day how much I was drinking a day (not including workouts) and I was around 15-30oz. I raised that to 80-100oz and general lower back aches almost disappeared overnight.

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2024: Bevoman, Galveston, Alcatraz, Marble Falls, Santa Cruz

haha. I know know the psychology of wanting to push to feel like an athlete again. Also agree about not doing anything that hurts. Let me know how the rowing machine feels at really light effort to expand range of motion at low load. I view it as a really super light deadlift followed by a short "upward row". Its all leg driven if you do it properly.

Also does it hurt to squat like a baseball catcher and stand up from there?

No not at all anymore. I am also doing front and back squats now. well maybe at the very bottom the back starts talking to me.

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2024: Bevoman, Galveston, Alcatraz, Marble Falls, Santa Cruz

What's all this talk about drinking water? You mean I cannot survive only on coffee all day? I could get banned from future riding in Italy for surviving on water rather than espressos and wine only.

I drink more coffee and wine then I do water! ..... well now I track my water all day :-(

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2024: Bevoman, Galveston, Alcatraz, Marble Falls, Santa Cruz

OK sounds like you're safe in case Team Ineos needs a backup for the Giro next year after your recovery is done (fingers crossed). The organizers won't ban you for wussifying your liquid sources. They probably will ban water bottles from the Giro anyway so that guys like Geriant Thomas dont get knocked out of the race from errant bottles. Just proper espresso stops at the top of Stelvio.

LMAO

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2024: Bevoman, Galveston, Alcatraz, Marble Falls, Santa Cruz