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L5 Herniation Diary: PT / PRP / Cortesone / Injections / Surgery? / Advice
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I have a very stubborn L5 herniation.

First injured in 2011, since then had some flare ups and a routine I would follow to get it better normally few days to few weeks.

Like an idiot in June started seeing some issues (shooting pain while bike and soreness while running for the first 8-10min) just ignored it all till I realized I could hardly walk without pain.

July finally got a MRI: L5 herniation confirmed; all my signs and symptoms go along with this finding as well: stabbing pain to dull acc in right hip, radiating pain down lateral side of right leg, some tingling in the right calf and on rare occasion some weird tingling in the foot.

Good news no loss of muscle strength and no numbness.

Bad new: cant walk most days more then 5-20 min without pain so bad I have to lay down.

It been 8 weeks since I shut down all workouts and focused primarily on recovery. I am going to PT about 2-4 x a week, I sleep on the floor, 2 rounds of oral steroids, did a PRP injection 3 weeks ago, and scheduled for a steroid injection on Friday. I have also changed my normal work load at work to allow me to lay on the floor as much as possible during the day (doing dental work all day is def not helping either).

I cant really tell if I am very slowly getting better or not.

I have Kona in the calendar for 2021 but all I really want to do is be able to function like a normal person without pain.

I am considering surgery if I cant make a sig bump in recovery by sept / oct.

I have read the other threads and surgery seems to be a mixed bag but having never gone through this before I don't really know what realistic to expect and not?

advice / help from the ST community.

Thanks, Brendan

https://www.instagram.com/toothengineer/

2020: Covid and herniated disk
2021: Kona, R2R2R
2022: Denali
Last edited by: Toothengineer: Aug 21, 20 23:46
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Re: L5 Herniation Surgery vs Continue PT / healing [Toothengineer] [ In reply to ]
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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.
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Re: L5 Herniation Surgery vs Continue PT / healing [Rideon77] [ In reply to ]
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Yes its single level on the MRI seems isolated.

https://www.instagram.com/toothengineer/

2020: Covid and herniated disk
2021: Kona, R2R2R
2022: Denali
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Re: L5 Herniation Surgery vs Continue PT / healing [Toothengineer] [ In reply to ]
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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.
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Re: L5 Herniation Surgery vs Continue PT / healing [hercules] [ In reply to ]
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Thank you for the response, man no easy answers.

https://www.instagram.com/toothengineer/

2020: Covid and herniated disk
2021: Kona, R2R2R
2022: Denali
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Re: L5 Herniation Surgery vs Continue PT / healing [Toothengineer] [ In reply to ]
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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
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Re: L5 Herniation Surgery vs Continue PT / healing [hercules] [ In reply to ]
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hercules wrote:
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.

https://www.instagram.com/toothengineer/

2020: Covid and herniated disk
2021: Kona, R2R2R
2022: Denali
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Re: L5 Herniation Surgery vs Continue PT / healing [Rideon77] [ In reply to ]
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Rideon77 wrote:
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.

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?

https://www.instagram.com/toothengineer/

2020: Covid and herniated disk
2021: Kona, R2R2R
2022: Denali
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Re: L5 Herniation Surgery vs Continue PT / healing [Toothengineer] [ In reply to ]
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Toothengineer wrote:
Rideon77 wrote:
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.


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?

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.
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Re: L5 Herniation Surgery vs Continue PT / healing [Toothengineer] [ In reply to ]
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Toothengineer wrote:
I have a very stubborn L5 herniation.

First injured in 2011, since then had some flare ups and a routine I would follow to get it better normally few days to few weeks.

Like an idiot in June started seeing some issues (shooting pain while bike and soreness while running for the first 8-10min) just ignored it all till I realized I could hardly walk without pain.

July finally got a MRI: L5 herniation confirmed; all my signs and symptoms go along with this finding as well: stabbing pain to dull acc in right hip, radiating pain down lateral side of right leg, some tingling in the right calf and on rare occasion some weird tingling in the foot.

Good news no loss of muscle strength and no numbness.

Bad new: cant walk most days more then 5-20 min without pain so bad I have to lay down.

It been 8 weeks since I shut down all workouts and focused primarily on recovery. I am going to PT about 2-4 x a week, I sleep on the floor, 2 rounds of oral steroids, did a PRP injection 3 weeks ago, and scheduled for a steroid injection on Friday. I have also changed my normal work load at work to allow me to lay on the floor as much as possible during the day (doing dental work all day is def not helping either).

I cant really tell if I am very slowly getting better or not.

I have Kona in the calendar for 2021 but all I really want to do is be able to function like a normal person without pain.

I am considering surgery if I cant make a sig bump in recovery by sept / oct.

I have read the other threads and surgery seems to be a mixed bag but having never gone through this before I don't really know what realistic to expect and not?

advice / help from the ST community.

Thanks, Brendan

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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Re: L5 Herniation Surgery vs Continue PT / healing [Toothengineer] [ In reply to ]
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Bummer dude, sorry to hear.

Dimond Bikes
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Re: L5 Herniation Surgery vs Continue PT / healing [Thomas Gerlach] [ In reply to ]
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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.

https://www.instagram.com/toothengineer/

2020: Covid and herniated disk
2021: Kona, R2R2R
2022: Denali
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Re: L5 Herniation Surgery vs Continue PT / healing [Amnesia] [ In reply to ]
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If anything these kinda of messages are at least motivating me to go start trying to find surgeons btw Austin and Houstan.

https://www.instagram.com/toothengineer/

2020: Covid and herniated disk
2021: Kona, R2R2R
2022: Denali
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Re: L5 Herniation Surgery vs Continue PT / healing [Toothengineer] [ In reply to ]
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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...

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Re: L5 Herniation Surgery vs Continue PT / healing [brider] [ In reply to ]
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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.
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Re: L5 Herniation Surgery vs Continue PT / healing [Toothengineer] [ In reply to ]
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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.


Steve Fleck @stevefleck | Blog
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Re: L5 Herniation Surgery vs Continue PT / healing [Toothengineer] [ In reply to ]
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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?
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Re: L5 Herniation Surgery vs Continue PT / healing [AndrewL] [ In reply to ]
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AndrewL wrote:
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.

https://www.instagram.com/toothengineer/

2020: Covid and herniated disk
2021: Kona, R2R2R
2022: Denali
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Re: L5 Herniation Surgery vs Continue PT / healing [ericlambi] [ In reply to ]
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ericlambi wrote:
Bummer dude, sorry to hear.

Thanks Eric, appreciate the thoughts. :-)

https://www.instagram.com/toothengineer/

2020: Covid and herniated disk
2021: Kona, R2R2R
2022: Denali
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Re: L5 Herniation Surgery vs Continue PT / healing [Fleck] [ In reply to ]
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Fleck wrote:
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.

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.

https://www.instagram.com/toothengineer/

2020: Covid and herniated disk
2021: Kona, R2R2R
2022: Denali
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Re: L5 Herniation Surgery vs Continue PT / healing [Toothengineer] [ In reply to ]
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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.
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Re: L5 Herniation Surgery vs Continue PT / healing [AndrewL] [ In reply to ]
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AndrewL wrote:
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? :-)

https://www.instagram.com/toothengineer/

2020: Covid and herniated disk
2021: Kona, R2R2R
2022: Denali
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Re: L5 Herniation Surgery vs Continue PT / healing [Toothengineer] [ In reply to ]
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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.
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Re: L5 Herniation Surgery vs Continue PT / healing [Toothengineer] [ In reply to ]
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Did anyone try changing their diet? Going with a lot of anti inflammatory foods or any supplements that might help?

https://www.instagram.com/toothengineer/

2020: Covid and herniated disk
2021: Kona, R2R2R
2022: Denali
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Re: L5 Herniation Surgery vs Continue PT / healing [Toothengineer] [ In reply to ]
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Toothengineer wrote:
Did anyone try changing their diet? Going with a lot of anti inflammatory foods or any supplements that might help?

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....)
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