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Advice on biking after protruded disc at L4/L5?
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Hi All

I am in the final two days of a hospital stay which started with me in the emergency ward at 3am 3 days ago in the fetal position convulsing and yelling in pain with tears flowing into a puddle on the floor. It was the worst pain I could possibly imagine. The CAT scan showed a protruding disc that was compressing the nerve. Unimaginable pain in the SI area and the worst sciatica symptoms of my life.
I am 95% sure of the chain of events which caused this. I had a bad downhill mountain bike accident about 18 years ago that caused the disc herniation, but it only caused minor issues at that time and when I got into weight training I did not experience any problems for many, many years. Throughout those years I was no longer biking (I am a triathlon voyeur and have not done a race since the early 90’s). When I got a new road bike during COVID, I immediately experienced this back pain but it was nowhere near this bad (about 2 years ago) and it subsided. Then I took another long break until a friend coaxed me into doing the community stage of the Tour de France in July and I knew I had to start on the bike again. Immediately I experienced the symptoms again and suddenly after a week of very gradually increasing the duration I experienced severe symptoms. I can honestly say that nothing compares to nerve pain and I can’t even imagine what burn victims go through.

After that long winded opening, my question is this…

Have you experienced this and is it best to not go back to biking or were you able to get on the bike again? If so, how did you build it up so you could tolerate biking? I would love to hear from anyone that has experienced this or professionals that have treated this.

Big thanks in advance :)

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Adrian in Vancouver
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Re: Advice on biking after protruded disc at L4/L5? [AJHull] [ In reply to ]
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Disclaimer: I am an MD and do a fair bit of work in interventional pain (ie disc prolapses etc). But also have unfortunate significant personal experience of this.

Firstly, sorry that you are going through what you are going through. An acute disc prolapse with nerve compression can be incredibly painful. I hope that things are settling down for you. Where are things at pain wise and what is the plan from the hospital team? If there is significant nerve compression then you may benefit from a steroid injection in that area. If you have weakness etc on that side you may need surgery sooner to decompress that area, or if the pain is slow to settle.

In terms of what caused things, we often like to think we know what the sequence of events is that might cause something like this to happen, but from experience in medicine that is often misplaced. Of all the main triathlon disciplines, cycling and swimming tend to be the least likely to cause a prolapse compared to the repetitive pounding that happens with running. It can be hard to narrow down an exact pre-disposing event, but it can happen simply from lifting things at home etc.

Some important things to consider re cycling is your bike fit and position on the bike. Have you had a bike fit done? If not, try and have one done by someone who experience in also dealing with back issues (eg where I live we have some great physios who also do bike fitting etc). A physio is an important part of your recovery from this anyway, in terms of some of the exercises they can supervise you doing to increase your core strength etc.

I would not be too disheartened just yet. My L5/S1 disc is shot and I have had 3 nasty prolapses from it over the last 2 years. Doing my utmost to avoid surgery but that means no running, but I am allowed to ride to my hearts content. You obviously need to get through this acute period first, and it sounds particularly bad if you needed to be in hospital as such for pain management.
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Re: Advice on biking after protruded disc at L4/L5? [AJHull] [ In reply to ]
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All my seats needed a severe downward slope to deal. After 10+ years my disc healing a bit I can sit on a regular flat saddle again
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Re: Advice on biking after protruded disc at L4/L5? [Amnesia] [ In reply to ]
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Thanks for your reply Amnesia. Replies to your questions…
“ Where are things at pain wise and what is the plan from the hospital team? ”
With the rest in the hospital bed and holding back from anything other than minor movements and to a large degree the pain meds, the pain went down to a 3/10 which is very manageable. It even went down to a 1/10 last evening. I cannot sleep on my back, even with a pillow under my knees because I then get the sciatica like symptoms - the intense shooting pains down my left leg. So I sleep in the fetal position on my right side. This morning my pain was at 8/10 and I believe that is because my left leg was a riding slightly over the right leg and this put a pull on SI joint. I forced myself to walk the hospital hallways and the pain went down to a 6/10. The plan from the physician in the ward I am in that is caring for me is to get the pain meds figured out. I believe they have that figured out now. The team has been outstanding in their care. I believe they, along with good teachers, are the saints of society.

I would rather go home but as much as the world waves a flag at how glorious socialized medicine is (I am in Canada), there are some serious flaws in the system that cannot be ignored. It is almost impossible to get a designated family doctor due to lack of supply and without a family doctor, one is forced to go through the hospital emergency. I experienced the hospital emergency 3 times in the past week and every time they make you wait 4-5 hours in the waiting area chair before checking you in and then another 3-6 hours before a doctor sees you. When one is experiencing nerve pain which is 9-10 out of 10, that simply is not doable. As a result of a lack of family physicians, more people are turning to hospital emergency for non-serious issues and this is crippling a health care system that is already significantly hampered.

I like you advice about getting a proper bike fit. I did my own bike fit based on lots of reading, but if it can be tweaked for the better, I am for it. Perhaps the saddle needs changing too, even though the saddle is one of the top in the reviews.

I am also going to ask about steroid injections tomorrow. I feel the doctors in Canada are in a compromised position because I feel financial pressures from the government which then put pressure on the governing bodies, result in delays in getting the ideal care and often that care never comes. For instance, the wait for an MRI can be over a year depending on the condition. I have a torn meniscus in my left knee and the wait was 14 months. I never got the MRI. Hopefully steroid injections will not fall into the same category where the doctors hold back due to financial constraints. I am guessing that is a minor cost in comparison to MRI so financial cost will not be an inhibitor.

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Adrian in Vancouver
Last edited by: AJHull: Mar 19, 23 10:47
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Re: Advice on biking after protruded disc at L4/L5? [AJHull] [ In reply to ]
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Aj without getting into the gory details, I had a bad bike crash (head/spine smashed into a house and left knee and psoas all ripped up....that was 2011. I actually got back to tri later in 2012 after an initial period during which I could not walk from leg spasms, which now I know were caused by scar tissue on the psoas tugging at the pine in L4/L5 region. In any case, intially did not have enough control over leg to walk/bike/run but gained it back. My run speed was instantly down by 10-15 percent depending on they day, which I later realized was due to lack of range in left psoas and associated left glute and hamstring.

In 2015, I was at an ART session, and it was literally the straw that broke the camels back. By the next day, could no longer walk/jog/bike without total loss of control of left leg. Being in Canada they did not treat me seriously about surgery, so I went on 4 cortisone shots from 2016 to late 2017. By 2018 I was doing light jogging holding the rails of the treadmill. And then in the spring of 2019, I got back to a single outdoor run of 30 min. Also in spring of 2018 I got back into biking, but I promptly got run over by a school bus on my right arm and right tibia and foot. Fortunately, that was right side of body, with nothing but broken parts and bruises that eventually fixed up. In any case during the entire time I was swimming around 100km per month and staying fit and once I was able to bike and jog again, in 2019 did several olympic tris and a half and same in 2021 after C19 lockdowns allowed for events in Ontario and Quebec. I was on track for a decent year (for me) last year, and reinjured the entire area working on fixing my woodway treadmill of all things (I was fixing slats , and hunched over for something like 3 hrs removing stripped screws and later in the day when to lift something benign and everything went to shit.

I got another cortisone shot at the end of last Aug, and as I had qualified for St. George 70.3 Worlds, I went and kinda went through the motions (bike was OK with low torque, and generally aero position with weight on elbows is better than road position with all weight on butt). After this most recent flair up, my swim times are down by literally 8 seconds per 100m in all strokes because I don't want to torque hard with twisting with my lats and psoas while countering the other way with legs and kicking hard.....so my "anchor" from my legs is floppy and I slip more with my catch. But its a question of working with what I got working now.

I wonder sometimes if I should just go to the US and pay for a laser surgery than this endless management around mobiliity and the occaisional cortisone shot...the latter can't be good long term. I think at this point I am up to 6-7 over an 8 year window. Each one had a small "bump" but none of them did magic

I have a set of crutches in my basement where I keep my bikes and rollers and I keep wanting to throw out the crutches, but I know I am one bad event from being back on them at at time. Just last week my landlord offered us to move my company from a ground floor suite that is accessible to the second floor one which is much nicer but no elevators and having spent almost a year not being able to walk and the disaster of having to get around with crutches on stairs, I have a more compassionate view of people with mobility challenges too. I forsee a time when I may be in that camp, but as long as I can get to a pool deck and slide into the water, life will be OK.

Hopefully your case is something you can overcome, and get back to a decent quality of life. The Cortisone shot does have a tiny risk, but likely it will help put the current fire out from which you can work your mobility etc.
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Re: Advice on biking after protruded disc at L4/L5? [synthetic] [ In reply to ]
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Thanks for your input synthetic

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Adrian in Vancouver
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Re: Advice on biking after protruded disc at L4/L5? [devashish_paul] [ In reply to ]
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Wow…you’ve gone through hell. You must really love biking and running to keep going back to it.

I stopped running quite a while ago because I believe the evidence shows it is not the best exercise for the aging body after 40’ish years old. I know people will argue with that, but I have yet to see a older runner that looks their age or younger. I think cycling and swimming, being low impact, are fantastic, along with kayaking. My plan is to do those three sports and keep my weight training going.

I am determined to do everything within my means to prevent a reoccurrence of this nightmare experience. I will be incorporating a lot of strengthening and stretching exercises that address imbalances.

I am a fairly lean 218 pound male. When I did triathlon at my best, I was 168 pounds, but that was way too light for me. Definitely running at 218 pounds is hell on the body.

I have learnt a lot from this guys YouTube channel :

Not sure why the link is not showing up. It is the Institute of Human Anatomy

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Adrian in Vancouver
Last edited by: AJHull: Mar 19, 23 15:12
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Re: Advice on biking after protruded disc at L4/L5? [AJHull] [ In reply to ]
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I know the problems with the Canadian healthcare system only too well unfortunately.
There is obviously an enormous pressure on resources.
With the way your pain is and the CT findings then I would really try and push for an inpatient epidural/nerve sleeve steroid injection. It is such a quick procedure and can really help settle things down for you.
What do they have you on for pain relief at the moment??
Remaining as mobile as possible is important, most protocols will have you up and doing things rather than resting in bed nowadays.
Fingers crossed for you, sorry you are going through that and within that healthcare system, it is not easy.
I am lucky here in Australia, and being a specialist myself. I have had times where I am literally on the floor at work and needing an MRI for an injury, phone up my local place, am on the scanner 15 mins later and then 30 mins later with a radiologist for one of our high level national sports teams taking me through my findings.
Keep us updated if you can/want to.
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Re: Advice on biking after protruded disc at L4/L5? [AJHull] [ In reply to ]
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I can definitely relate to your post sharing your extreme agony due to sciatica. Hoping that you are able to continue to find relief and heal.

I had a herniated L4/L5 disc almost 4.5 years ago and a piece of the herniation had broken off and was putting pressure on the nerve, creating severe sciatica, primarily at night. The only way I can describe the intense nerve pain was as if my entire leg, from my hip to my toes, was on fire from the inside - out. I recall asking my wife several times to “just cut my leg off” during those sweat filled bouts of agony. The only temporary relief (and by temporary, I mean it just took the edge off) I found was to completely wrap my leg from hip to toes with a few large gel ice packs / wraps.

I also had “drop foot” at the time, so I ended up undergoing a microdiscectomy close to 4.5 years ago now, and am thankfully still able to enjoy / pursue many extreme sports hobbies along with SBR.
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Re: Advice on biking after protruded disc at L4/L5? [AJHull] [ In reply to ]
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December 2020, I experienced the exact condition you described. It turned out that I had a herniated disc at L4 that was touching a nerve or nerves. There is a post I made in archive on my situation from this period.

I am sorry you are going through this pain you described! I have been injured more than I can count, most seriously when I was younger and motorcycle racing. However, the low back/hip pain that I felt in December 2020, was far greater than every experienced and unbearable.

It took a little bit to get into my personal care doctor given the hospitals were under a heavy workload for Covid-19. Once I got in for visit with the doctor, she said it is likely a herniated disc around L3 or L4. The doctor's triage plan for my back pain started with Step 1. Use anti-inflammatory drugs until pain subsides enough to start physical therapy.

I am thankful every day that I recovered after about 2 months working through Step 1 and did not have to deal with any invasive treatment.

The first few weeks in December 2020, I was in extreme pain during the time it took to see a doctor and get a diagnosis. Once I started Step 1 using the anti-inflammatory drugs, the pain did not go away immediately by any means but, progressively decreased over about 3 weeks. After the pain decreased down to a 1 or 2 out 10 scale. I started physical therapy. I was able to start swimming and riding my bike after about 2 1/2 months.

I have continued a core, glute, and hip flexor move routine I learned in physical therapy that takes 10 minutes every morning and 10 minutes in the evening. So far, I am pain free.

Interestingly, the doctor did not order an MRI for the initial diagnosis but had one done after and it revealed a herniated disc right were the doctor expected per the diagnosis.

I am not a doctor and have no medical experience so I cannot offer advice, just encouragement to research all options available to you since every situation can be different and work with your doctor.

Feel free to PM me if you have any questions about my experience.

Wishing you the best swift recovery!
Last edited by: JJD: Mar 19, 23 22:19
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Re: Advice on biking after protruded disc at L4/L5? [Amnesia] [ In reply to ]
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Thanks for all the support.

It has been a journey these past days. I had an MRI and the next day the surgeon left the decision to me on whether I try physiotherapy and other modalities to see if this gets better over time or whether I take the route of surgery. It was clear from his messaging and the information he provided that I should go the surgery route. I decided on surgery and I am glad I did because they next day the pain got worse even though the pain medication was increasing in frequency. My left leg was starting to go numb and I was back to periods of pain at 9/10.

I am going in for a laminotomy and a discectomy hopefully tomorrow.

Below is an image of my MRI:



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Adrian in Vancouver
Last edited by: AJHull: Mar 22, 23 21:55
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Re: Advice on biking after protruded disc at L4/L5? [AJHull] [ In reply to ]
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Best of luck and thanks for the update.
Ouch, that is a massive prolapse and you can see why you have some significant nerve compression.
There are some very very clear indications for surgery as opposed to a conservative route and you have them. I am glad there is a definitive process in place for you now. Chances are you will wake up with minimal pain because of the relief of the compression.
I wish you all the best and look forward to the updates afterwards.
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