I think the answer to that question depends on exactly what's causing the pain, but when I went through this a couple years ago I was told that the spine and back prefer to be active and that I was better off continuing to do activities I could tolerate. I had a bulging L5/S1 and went through a series of three injections over maybe two months. The first two didn't do much but the third was like someone flipped a switch - pain gone and hasn't been back since. Good luck!

Hey man thanks for the response, really appreciate this.

I have had cortisone injections in lower back L4/L5 on two separate occasions. Both times my pain went from a 8 to a 0 in a couple of days. I was able to resume all SBR activities a few days after each shot without issue. Of course, I continued to work on things to help resolve the issues like posterior chain work, flexibility, etc. The shot really is a short term band aid but I would say I probably got 4-6 weeks of relief on both, enough time to get over the hump. I have had no long term effects from the shots and my back is feeling good. Obviously, I would use the injections sparingly but they worked well for me. Good luck.

Cortisone injections aren’t really indicated for lbp of a chronic nature. If it’s being “offered”, my guess is your physician doesn’t expect much for results.

Your PT is sub par. You can stretch muscles and strengthen whatever, but it is unlikely to help. Find a better PT.

The natural course of LBP is self limiting in nature as long as you don’t actively worsen it. As stated, you need to be active. The few things that research into LBP is conclusive on is activity is good and if you’ve had back pain in the past you’re likely to experience it again. We should be treating back pain like the common cold, nearly everyone gets it and if we manage it effectively things will be fine.

I’ve had 5 epidurals in 12 years and many rounds of prednisolone in between epidurals. L5/S1 herniation. Even had a microdiscectomy on it. For at least 10 years, the epidurals were by far the best thing. Like absolute magic. The last one didn’t help and I have since developed SI joint disorder (probably related, or at least a symptom of the same problem). I got a trigger point shot in my Piriformis and it helped a ton, too.

I’ve recently got serious about working with my PT to get at the real root of the problem and it’s helping- but in general, I had really good experiences with the epidurals.

Here's what I am experiencing now as a dad.
I have a daughter (only 18 yrs old) who was doing about 600 hrs/yr bike training and racing, she experienced something pretty similar to you (seen all sorts of specialists for the last 2 years). She had two cortisone injections (from a known physiatrist). After 6 weeks the pain was still there in her SI region. She then went back to the physiatrist for an "on bike" test, under local anesthesia, to locate the exact region of the pain.
But it didn't do anything concrete because it didn't address the problem.
We then went to a reputable physio-ostheopath that worked with many top athletes. She found many anomalities in her SI joint. She (the ostheo) adjusted her SI joint, and reffered her to a sports therapist, also very reputable. She works with many national team members in different sports. After a 2 hours evaluation, where she determined how my daughter "moved" every body part in relation to the "whole", she ended up with a training routine to help her learn new and correct moving patterns.

So, in short, from what I understood of the cortisone effects, I think it's better to start biking again after a 4 weeks period, when the body starts producing it's own hormones again to replace the injected cortisone.
BUt like you wrote, if your moving pattern is a little off by a "locked" SI joint, or something else. Chances are you're going to go back to stressing an area, and back to chronic pain.

Louis :-)

Louis, excellent post.

I am actually thinking of switching to a highly recommended professional in Montreal who also uses physio, chiro and osteo techniques in the treatment of his patients.

I hope your daughter can beat this thing. Sounds very similar to what I am going through.

Other people have already beat me to it. I had lower back pain for close to a year with no resolution in sight. I changed to a McKenzie method physical therapist. After the first visit she identified an SI joint issue and I started wearing an SI support belt. After a few months of hip strength, stretch and therapy the pain was gone. I’m back to biking and running. Every so often it acts up again and I get the pain under control by targeting si work again. Everyone is different and yours may be in your back but don’t be afraid to see if your hips are causing the pain. You may be looking in the wrong area for the actual cause.

It actually starts in the SI region and then a few days later the L4 area starts to hurt pretty good. I thought about one of those belts.

I'd look at other PT options you can find as others mentioned. I've found swimming helps a lot with different back pain. Also some of the E-stem units are really good, and portable as well and have been a big help for me. Are you still trying to ride in the same position you were when younger? You may have to adapt to a less aggressive position if riding is aggravating.

I suffered from LB chronic pain for many years and tried ozone, epidural shots, physios, osteopathy...I strongly advice to take a look at Loreley Moseley's approach for pain. I ignore if there is any physical evidence for your pain but I just can tell you too give it a chance if your back is not seriously injured (and even so).
Meditation is also helpful to manage the stress related.

Good luck

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Spaniard. Sorry for my english for the sensitive ones :P

I am medical and have more than average experience in what you are talking about.
There is limited advice I can give you online as there is likely a lot more to your history etc in addition to what actual injections your pain physician is planning. However, in terms of your question, you should be fine to do as you have suggested. The steroids themselves will often take a few days to kick in. We would normally say to patients that they can resume exercise within a few days within reason.
Often these injections can be done as more of a diagnostic procedure rather than purely therapeutic, what I mean by that is they can do a series of injections in different areas to see potentially what is causing the pain and then look at longer term solutions targeted to a specific area. For instance, if your SIJ injections give you some temporary relief then you could look at a rhizotomy procedure which may give you 6-12 months of relief in that area.

Herniated L3 and L4 complete rupture of L5/S1 legs basically numb. Thank you military. These shots are the things that keep me moving, i refuse surgery, because i've yet to meet anyone whos been successful. Its a band aid I know it. But im happy right now, and it keeps me enjoying life. I go for another round this upcoming monday