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Tip to manage and looking for spine friendly workouts for L5-S1 Disc her iation
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Ive had back pain on/off for the past year. This year, I've had four sciatic episodes (sharp shooting pain from butt to mid thigh, sit to stand is excruciating) lasting 1-2 weeks. In between the episodes, the back pain tempers down to a tightness/achiness that is manageable with PT and dialing back activity.

However, it keeps coming back and i cant seem to progress. In December, I got an MRI and based on that I stopped running and cycling and upped my PT exercises. I started to feel better, but two weeks ago I had another flare up. This time was more intense and lasted longer. I got an epidural shot for it, which helped a bit. Right now, I have intermittent dull butt ache and a sore low back. Sometimes my hamstring has a tightness running down it. The sharp, shooting pain has subsided. There are no neurological symptoms.

This is the MRI:

L5-S1: Large disc protrusion (2.0 x 0.6 x 1.0 cm) dissecting below the disc level, eccentric to the left where it contacts descending left S1 nerve root in the lateral recess and approaches the right-sided S1 nerve. No foraminal stenosis.



For now, plan is to avoid flexion, continue body weight and PT (low weight, high frequency, lots of core/glutes). I was told to stay active with movements that don't cause pain. I was told by the doctor to consider surgery if symptoms worsen or persist after another round of PT.


Anyone have any tips on how to stay active with this injury? I've been swimming workouts, but avoiding flip turns. No pain during swimming. Any tips for how to best deal with this also welcomed :)


Also, Im only 30 years old. Have been running for the past 6 years (3 marathons, several halfs), swam in high school (but not very competitively. Strokes are decent). Decent cyclist, but used to do more spin classes than actual long rides (based in NYC). Only got to do one sprint triathlon but would like to get back into things, particularly running! Would also like to get back to skiing/snowboarding.....getting a little more hopeless on that though
Last edited by: runner15: Feb 28, 20 12:51
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Re: Spine friendly workouts for L5-S1 Disc herniation [runner15] [ In reply to ]
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Hello runner15 and All,

I had a herniated disk from lifting weights ..... identified with X-Rays (and a good deal of pain) many years ago.

My doctor recommended NO ACTIVITY for 6 to 8 weeks after it occured ... as he said it would heal with scar tissue and plague me forever after if I exercised during the healing.

I spent 6 weeks on the beach reading in the sand.

It healed well and I was fine afterward. I will never know if he was right and exercise would have caused a problem.

But it turned out well for my case.

Our hospital here in Escondido CA advertised for some time that they were a center for a spine treatment inserting small metal spacers to assist herniated disks.

I have friends that have had surgical treatment and fusing vertebrae with little success but that was 20 years ago .... hopefully procedures have improved.

Cheers, Neal

+1 mph Faster
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Re: Spine friendly workouts for L5-S1 Disc herniation [nealhe] [ In reply to ]
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Interesting. Everything I've read has said 1-2 days of bedrest max and low impact activity after. Perhaps the management of this has changed in the past 20 years?

The tough part is that this has been so ongoing. I returned to activities relativey soon in the past (I had gone to the docto and PT and both gave me the ok). This is also before the MRI was done and the diagnosis was given.

Seems like theres a tough balance to strike between too much and not enough activity.

Surgery (microdiscectomy for the l5s1 disc) was thrown out as a possibility, but I'm still hopeful to avoid this. Since this latest flare up, I have done nothing but swim and elliptical and the PT exercises, although I do wonder if swim "workouts" cross the line into too strenuous. I was in pretty good shape pre injury.

Definitely could use tips for management of this. Really sucks.
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Re: Spine friendly workouts for L5-S1 Disc herniation [runner15] [ In reply to ]
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I ruptured two discus in 2017, L4 and L5. It was basically a full year before I was completely cleared. For the first 3 months, I was not cleared to do anything more than walk. After that, I started with PT and began running and injured myself again. We started back over at square one with no significant activity beyond walking for 3 months. I then started cycling again, and I was completely cleared about 5 months out from the second injury. Today, I can do everything I could before I hurt myself but run.

When I was allowed to start physical activity again, I was told I could do anything that did not hurt, except run. I think if you can swim comfortably, then go for it.

Matt
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Re: Spine friendly workouts for L5-S1 Disc herniation [runner15] [ In reply to ]
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if it doesn't hurt, do it..

The herniated disk may or may not be the cause of the pain. I have the herniated L5-S1 disk, as does most of the population over 40.

Fifteen years ago when I had my first bout of back pain, PT gave me a large range of exercises, and recommended both Pilates and yoga as maintenance in the long term. I had about four months off running, with weekly PT sessions and massage. I now have only mild pain, very little as long as I keep up with the core exercises and stretching.


Sciatica showed up a few years later, another set of PT exercises help to keep it manageable. This flared up last year. In desperation tried the Sacro Wedgy which has actually worked, not clear if it was that or the daily foam rolling though.
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Re: Spine friendly workouts for L5-S1 Disc herniation [Matt_Stimpson] [ In reply to ]
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Thanks for the response.

Oh man, bummer on the no running. Im sorry to hear that you can't run.

I'm hoping I am able to run again. Im 30 so the prospect of never running again would be very difficult.

Surgeon told me that not being able to run is evidence of impacting quality of life and would be a reason to undergo the procedure and said I should be able to return.

Really would prefer to get there the conservative way if I can....

I was also told that cycling is more problematic since its in a flexed position vs running which is in a neurtral position. I'm not in a hurry to do either to be honest.
Last edited by: runner15: Feb 28, 20 10:45
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Re: Spine friendly workouts for L5-S1 Disc herniation [doug in co] [ In reply to ]
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I've heard a lot about yoga and pilates being beneficial. At what point did you start doing them? Right now, I was told to avoid flexion so sounds like thats out for a bit.
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Re: Spine friendly workouts for L5-S1 Disc herniation [runner15] [ In reply to ]
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I had L4/L5 and L5/S1. I went through all the shooting pain and stuff and then one day it just stopped. I did the cortisone shot and the rack and I assume that helped fix it. Now I just avoid carrying heavy things, keep my weight normal, do core workouts, and if I do squats and deadlifts I only do what weight my back can bear, not what my muscles can bear.

I also assume I have good road and tri bike positions, with my hips and lower back in a sort of neutral position that doesn't aggravate anything. I'm a biomechanically efficient runner.

good luck!

E

Eric Reid
AeroFit | Instagram Portfolio Coaching and Bike Fitting
Chapel Hill, NC
Aerodynamic Optimized Bike Fitting, Retul Pre-Purchase Bike Fitting, USAT Level 1 Triathlon Coaching, Nutrition
Ask me: Scody Optimized Speed Suits | CeramicSpeed Oversized Pulley Systems | HUUB Skinsuits and Wetsuits | Bombshell Aerodynamic BMX Wheels
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Re: Spine friendly workouts for L5-S1 Disc herniation [runner15] [ In reply to ]
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runner15 wrote:
Thanks for the response.

Oh man, bummer on the no running. Im sorry to hear that you can't run.

I'm hoping I am able to run again. Im 30 so the prospect of never running again would be very difficult.

Surgeon told me that not being able to run is evidence of impacting quality of life and would be a reason to undergo the procedure and said I should be able to return.

Really would prefer to get there the conservative way if I can....

I was also told that cycling is more problematic since its in a flexed position vs running which is in a neurtral position. I'm not in a hurry to do either to be honest.

Thanks but I have made peace with it. I am a good bit older than you (43), and I was very upset about not being able to run at the time. I was told early on in the first visit I needed to stop running due to degenerative disc disease (which admittedly a lot of us who are just a bit older probably have), and my physician felt like my running days were behind me. I called shenanigans until I injured myself running. I really did not want to stop, but there is no way I can be hurt like that again. The thing I try to remember is that once a disc is ruptured, that is it. There is no putting the lid back on. If more "goo" gets pushed out, you are back to square one.

As for riding, a lot of people are surprised that I am able to ride comfortably with no problems, but it has been my saving grace. I bought a new road bike, joined club, and I'm a full-time roadie now.

We were really close to surgery. If the last steroid injection had not worked, surgery would have been the next step. But conservative treatment ruled out in the end. It just took a long time.

Matt
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Re: Spine friendly workouts for L5-S1 Disc herniation [ericMPro] [ In reply to ]
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ericMPro wrote:
I did the cortisone shot and the rack and I assume that helped fix it.

This is a timely thread for me. I have had an MRI and have a follow up next week.
What is "the rack" Are you referring to an inversion table?
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Re: Spine friendly workouts for L5-S1 Disc herniation [runner15] [ In reply to ]
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You might google a trainer named Ben Bruno.

It's more strength based, but he has some sort of chronic back injury and has published a lot on various websites about training with back issues. Most of it is various ways to strengthen the lower body while avoiding either spinal loading or flexion -- things like belt squats, single legs, etc.

I dislocated some ribs in my back 7 or 8 years ago, and couldn't put a barbell on my back for nearly a year. His stuff was very helpful. Obviously different from endurance sports, but if it's a matter of doing something to stay fit, it might help.
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Re: Spine friendly workouts for L5-S1 Disc herniation [Geronimo] [ In reply to ]
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Interesting thanks!

I've gotten the gamut of advice with strength training ranging from its necessary to strengthen the back and core vs. Prioritizing Mobility and alignment and no weights.

No clear linear path on treating this damned thing.
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Re: Spine friendly workouts for L5-S1 Disc herniation [runner15] [ In reply to ]
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Hello runner15 and All,

Have you tried some back braces?

They immobilize the back and that is helpful.

I forgot to mention that I do not do leg lifts and sit ups as a precaution ... but doing gut exercises on the machine where you bend over as you do it works OK.

I think the sit ups put a lot of compression on the spine.

Strengthing the core is key to helping stabalize the spine.

Good luck .

Cheers, Neal

+1 mph Faster
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Re: Spine friendly workouts for L5-S1 Disc herniation [runner15] [ In reply to ]
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runner15 wrote:
I've heard a lot about yoga and pilates being beneficial. At what point did you start doing them? Right now, I was told to avoid flexion so sounds like thats out for a bit.

ya, don't do them now.
Typical progress if you attend PT regularly will get you mostly pain-free in a couple of months.
By then it should be fine - ask PT or doc before starting new things though..
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Re: Spine friendly workouts for L5-S1 Disc herniation [doug in co] [ In reply to ]
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Gotcha. Thanks.

On board with the daily foam rolling(and or lacrosse balling). Saw the sacro wedge, almost got it but obtained a standing desk which helps with the sitting at work problem.
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Re: Tip to manage and looking for spine friendly workouts for L5-S1 Disc her iation [runner15] [ In reply to ]
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Pilates reformer with a good instructor. This is literally what the reformer was invented to correct.



DFL > DNF > DNS
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Re: Tip to manage and looking for spine friendly workouts for L5-S1 Disc her iation [runner15] [ In reply to ]
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runner15 wrote:
Ive had back pain on/off for the past year. This year, I've had four sciatic episodes (sharp shooting pain from butt to mid thigh, sit to stand is excruciating) lasting 1-2 weeks. In between the episodes, the back pain tempers down to a tightness/achiness that is manageable with PT and dialing back activity.

However, it keeps coming back and i cant seem to progress. In December, I got an MRI and based on that I stopped running and cycling and upped my PT exercises. I started to feel better, but two weeks ago I had another flare up. This time was more intense and lasted longer. I got an epidural shot for it, which helped a bit. Right now, I have intermittent dull butt ache and a sore low back. Sometimes my hamstring has a tightness running down it. The sharp, shooting pain has subsided. There are no neurological symptoms.

This is the MRI:

L5-S1: Large disc protrusion (2.0 x 0.6 x 1.0 cm) dissecting below the disc level, eccentric to the left where it contacts descending left S1 nerve root in the lateral recess and approaches the right-sided S1 nerve. No foraminal stenosis.



For now, plan is to avoid flexion, continue body weight and PT (low weight, high frequency, lots of core/glutes). I was told to stay active with movements that don't cause pain. I was told by the doctor to consider surgery if symptoms worsen or persist after another round of PT.


Anyone have any tips on how to stay active with this injury? I've been swimming workouts, but avoiding flip turns. No pain during swimming. Any tips for how to best deal with this also welcomed :)


Also, Im only 30 years old. Have been running for the past 6 years (3 marathons, several halfs), swam in high school (but not very competitively. Strokes are decent). Decent cyclist, but used to do more spin classes than actual long rides (based in NYC). Only got to do one sprint triathlon but would like to get back into things, particularly running! Would also like to get back to skiing/snowboarding.....getting a little more hopeless on that though

Surgery.
If you had bitten the bullet at the time you would be miles ahead of where you are now.
That is a massive prolapse.
Good luck, but you have the long road or the short road choice to make very soon....
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Re: Tip to manage and looking for spine friendly workouts for L5-S1 Disc her iation [Amnesia] [ In reply to ]
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Given the persistent nature of this, my gut feeling is to choose the surgery route if the sciatic pain returns.

Why do you say I need to make a choice very soon?
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Re: Spine friendly workouts for L5-S1 Disc herniation [TriSolo] [ In reply to ]
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TriSolo wrote:
ericMPro wrote:
I did the cortisone shot and the rack and I assume that helped fix it.

This is a timely thread for me. I have had an MRI and have a follow up next week.
What is "the rack" Are you referring to an inversion table?

No you lie on your back and they put a belt around your hips and another around your torso and pull medieval style

Eric Reid
AeroFit | Instagram Portfolio Coaching and Bike Fitting
Chapel Hill, NC
Aerodynamic Optimized Bike Fitting, Retul Pre-Purchase Bike Fitting, USAT Level 1 Triathlon Coaching, Nutrition
Ask me: Scody Optimized Speed Suits | CeramicSpeed Oversized Pulley Systems | HUUB Skinsuits and Wetsuits | Bombshell Aerodynamic BMX Wheels
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Re: Tip to manage and looking for spine friendly workouts for L5-S1 Disc her iation [runner15] [ In reply to ]
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runner15 wrote:
Given the persistent nature of this, my gut feeling is to choose the surgery route if the sciatic pain returns.

Why do you say I need to make a choice very soon?

Because your symptoms are significant.
The long road means months and months of various therapies with no certainty of results.
The short road means biting the bullet and considering surgery ASAP....it can often be a better call to make than waiting months for conservative treatment only to find you are in the same spot, whereas if you had surgery back then, you would probably be fully recovered by that point.
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Re: Spine friendly workouts for L5-S1 Disc herniation [doug in co] [ In reply to ]
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doug in co wrote:
if it doesn't hurt, do it..

The herniated disk may or may not be the cause of the pain. I have the herniated L5-S1 disk, as does most of the population over 40.

Fifteen years ago when I had my first bout of back pain, PT gave me a large range of exercises, and recommended both Pilates and yoga as maintenance in the long term. I had about four months off running, with weekly PT sessions and massage. I now have only mild pain, very little as long as I keep up with the core exercises and stretching.


Sciatica showed up a few years later, another set of PT exercises help to keep it manageable. This flared up last year. In desperation tried the Sacro Wedgy which has actually worked, not clear if it was that or the daily foam rolling though.


Along the lines of what Doug is saying I would just do as much as you can. Generally from what I have seen with others, running is good. If you are a former high school swimmer, I'd just swim a lot. Depending on the issue, biking may be the problematic one.

I've battling an L4/L5 + L5/S1 for 5 years after they were injured between a crash and a chiropractic session in 2015. I finally was able to start running last winter and the moment I started running again, things dramatically got better. Swimming kept me sane.
Last edited by: devashish_paul: Mar 1, 20 8:42
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Re: Tip to manage and looking for spine friendly workouts for L5-S1 Disc her iation [runner15] [ In reply to ]
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I had probably 18 months until I finally cracked the solution to get mine under control.

In addition to what others have said
- Adjustable Standing/Sitting Desk for work - absolutely essential.
- Isolated strengthening of the lumbar extensors really helped me (using medX lumbar machines).
- McKenzie type stretches
- Later into my rehab dry needling was useful.
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Re: Tip to manage and looking for spine friendly workouts for L5-S1 Disc her iation [runner15] [ In reply to ]
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I would also suggest checking out Foundation Training and reverse hyper extensions. I had a micro discectomy on the l5-s1 in 2008 as a 28 year old and it was the best thing I ever did, but I also realize I may be one of the lucky ones.

Good luck sir, and remember to stay mentally strong as well as working the physical.
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Re: Tip to manage and looking for spine friendly workouts for L5-S1 Disc her iation [runner15] [ In reply to ]
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Might look up Stuart McGill, PhD out of Canada. He has a number of YouTube videos and a book titled the Back Mechanic. Lots of good information.
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Re: Tip to manage and looking for spine friendly workouts for L5-S1 Disc her iation [runner15] [ In reply to ]
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so you've been dealing with it for a year and minor improvement, but you're still having symptoms. the issue is there in NO workouts you can do while recovering because FLEXION is involved and it puts your disc in the bad place.

i don't know why people shy away from the microdiscetomy. i had one at 45 on L5-S1 and within 2 years I was setting 70.3 and IM PRs. training pain free was a life-changer and the best thing I could have every done. i was back on the bike 12 weeks later (nothing but walking for 10 weeks, then gradually yogging / spinning after).

you wait too long and you could risk permanent nerve damage in your feet and calves.
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