I’ve been dealing with “arthritic changes” coupled with disk degeneration in the L4/L5/S1 region, for well over two years now. MRI confirmed the absence of stenosis, and all recommendations point to physical therapy and pain management. The pain mostly subsides with anti-inflammatories and heat, and generally improves as the day wears on (I presume, due to the supporting musculature loosening up during the course of the day), though the central point of injury remains acute and, at times, debilitating.
On good days, I only feel pain when overextending my spine (arching the back, missing a step on the stairs and fully extending the leg/pelvis joint, etc), but it’s like a lightning bolt shooting through my spine when it occurs, and it invariably lands me on the floor. Running has ceased altogether, as it requires both jarring impact, axial loading, and mild spinal extension. In the course of two years, I’ve gone from ultramarathon distance running to hobbling after 1/4 mile. Cycling poses no problems whatsoever, but running is my true love.
I’ve been referred to yet another PT program, and to a pain management specialist. I’m hoping the specialist finds some success in one method or another. I’ve read of epidural steroid injections and heard anecdotal stories of other sorts of site injections providing lasting relief. Any additional anecdotes or leads (I’m willing to travel) on specialists who’ve proven successful in this area would be greatly appreciated.
Sphere - sorry to hear about your pain. Back pain is ubiquitous as you know and that greater than two thirds of us will experience is at some point in our life. Also, not that it’ll make you feel any better but your distribution is also about right. Can we have a bit more information such as your age, smoking history, any pain running down your leg, medical care so far, numbness in your legs or feet, etc. Hope we don’t have to turn into a pure cyclist.
35 y/o male, nonsmoker, no leg radiation/tingling/numbness whatsoever. All centrally located, radiates laterally on occasion (feels more like muscle pain when it does, though). The persistent, disabling pain is central, and acute when extending (even slightly) my spine. Arching backward gets uncomfortable, running is impossible unless leaning forward, holding onto a baby jogger to take the load off.
From what I’ve read, I’m not a candidate for steroid injections. There’s no stenosis (MRI confirmed) or radiation to the lower limbs, and nothing structurally visible beyond bulging and collapsing disks in the areas mentioned (bulging first detected 15 years ago via MRI. Apparently, it’s worsening).
The pain in this general area (muscular, I’m sure) used to come and go several times per year, but since laying flooring in my home 2 years ago, it’s been persistent and worsening, and the centrally located pain that hits like a lightning bolt is entirely new.
I’ve had mild success with PT and core training, though mostly with the radiating pain. The central issue remains. The electrical muscle stimulation seemed to help a great deal in “unlocking” the steel trap of muscle/tendon/ligament around the area, but it never resolved the primary issue that leads to it. Chiropractic care was neither helpful nor harmful; he seemed to think that the superior aspect of my sacrum was shifted posteriorly, accounting for the acute pain on extension. He based this on physical exam, not film. I’m not sold on the idea, though it sounds somewhat plausible, given the mechanics and structures involved.
I had a bulging disk 5 years ago which left me almost unable to walk. It was due to playing rugby though not any kind of illness. My pain was central but also down my left leg and so acute that I would also end up on the floor and then usually in hospital asking for some kind of pain help. I saw a spinal specialist and he said I could have an injection to stop the pain, this however would not fix the problem and could in fact make it worse as the bulge would still be there. I decided to go for my other option which was surgery. He went into my spine and carved away part of the disk so that it was just far enough away from nerves to stop the pain but not enough to weaken the disk even more. 1 week in hospital and I was out. I wouldnt say its 100% perfect but if I keep fit and keep moving its fine. I am in some pain most of the time but its so little that I dont notice it any more and am able to run, swim and cycle to heats content…or as far as my legs will take me:)
I often hear people trying to avoid surgery and I was advised by many people not to do it as it was not reversable - however I knew that what I had wasnt just going to go away and I knew that I didnt want to go on with that kind of pain.
I guess it depends on what shows up on the MRI - is the bulge pushing against your spine or other nerves? what exactly is causing the pain?
Having had several issues with L4/5 - many years ago I was recommended a book called Pain Free by Peter Egoscue— this was a real life saver to me and all my clients now buy this book and do the exercises.
One of by buddy’s could not lift his briefcase and 6 weeks post starting the exercises he was able to run again.
Obviously no promises but the exercises have worked for many.
The only surgical option (though it’s not recommended) is fusion. There’s no apparent nerve root impingement on the film, only bulging and collapsing disk. Although, I wonder how accurately the MRI reflects the structural relationship during load-bearing movements, given that it’s recorded while lying supine. Pain is never caused from lying supine or standing upright, only during axial loading or extension. It almost seems useless to shoot the film in that position.
The only surgical option (though it’s not recommended) is fusion.
Really? No diskectomy? Laminectomy? No artificial disks?
The last time I looked research showed that the 2 year outcome was the same
with surgery, PT and doing nothing.
For me it doesn’t hurt to run, but running makes it worse (if that makes sense). I’m
trying to bike more and swim more and wait it out. I did PT for a while, and their
DRX machine seemed to help, but I don’t think the PT work (core, etc) did much.
I would have your iliopsoas checked for shortening/tightening. Many times due to the many hrs sitting at work and many miles cycling the hip flexors are the problem with chronic, debilitating back pain in the asbsence of discal or facet issues.
I would have a good Chiro or PT or massage therapist do some deep tissue work and see.
Well, this is certainly a pickle isn’t it? It sounds like you and your medical team have done your homework and feel that the degenerative levels are the pain generators. Careful here, though. If you were to pick up a copy of Campbell’s Operative Orthopedics, you’d find a spine MRI study of assymptomatic volunteers. Upwards of 35% had MRI abnormalities…but no pain! Just something to keep in your back pocket.
Where to go from here is a tough call. Some want to race no matter what but I think if it were me, it’d take a long time before I had a back operation. I’d really be concerned about the long term. That said, pain management guys have lots of tricks and if you were lucky, maybe one would marry your sister. Give it a go.
My wife had a very bad bulging/herniated disk & sciatica a few years back. Tried the epidural steroids several times, did nothing for her.
Did regular chiro, PT, stretching, other stuff - nothing really worked.
Was seriously considering surgery, as she was in constant pain, and was just miserable all the time.
Suggested she go see my ART guy, as I’d had good luck having some other odds and ends sorted out w/ ART treatments.
She did, and literally after the first treatment, she went from hardly being able to bend at the waist, to touching her toes pain-free. She continued treatments for about 6 weeks or so, I believe 2x a week, and has been (mostly) pain free and living a normal life ever since.
Disclaimer - even the Doc has stated it doesn’t work for everybody all the time. Some issues are different/more serious/whatever, and ART won’t work. A friend of mine had a badly herniated disk, so I sent him to the same ART guy, who told him there was nothing he could do for him in his instance.
That guy ended up having surgery, and after a long rehab is now back to crushing dreams in run and multisport events again.
I’m not a doc, but I have had considerable experience with herniated discs. About 8 years ago I had a lamenectomy, to remove disc material from 2 bulging discs in my lower back. Operation was a total success. Up until that point I had gone through a progression of treatments+injections+ exercises, and finally, the final stage of pain killers. At the end I was chewing oxycontin caps to get relief. My tolerance to meds was through the roof. The good news is the surgery worked. Here is what worked for me:
1)There is a first aid position, (in yoga I think it’s called the cobra.) It looks counterintuitive, but a N.Zealand doc. discovered its effectiveness by happenstance. It works, and I still use it to loosen up occasionally. It’s in a book called (I think) “Heal your own back”.
The source of your pain is disc material “impinging” on your sciatic nerve. Nerve damage is bad, and irreversable. The nerve is inflamed, and that pain/inflamation can manifest itself in all sorts of odd ways. I could run, but cycling was out. The reverse of your condition. The best way to fight inflamation is w/ice, not heat.
2a) Swimming seems to be truly theraputic. When you are really hurting, I would try some laps.
After a good long rest, I would try trail running instead of road running. Trail running is 3D movement, and dirt and grass are much more forgiving than concrete and asphalt.
People will tell you to strengthen your core…I would only do core work if it was strictly balanced between straight abs, obliques and lower back. Alot of low back pain in this country is due to an* imbalance* between abs and low back strength, not core weakness.
If you EVER get numbness radiating down the outside of your quad, or hamstring, do not pass GO, head directly to a good back surgeon. That numbness is the first sign of your sciatic nerve degenerating.
I have more tips and tricks, I just don’t want to be tedious. Post back if you want more. Good luck!
Biking is bad for your back , don’t be fooled.
Open water stretch swimming is the best , especially in cool water.Absolutely the best.
Put a hand rail on each side of your steps in the house and use them to pull stretched out.
No heavy wieghts.
Massage the area in a way that will actually release excess material.
very similar pain as yours, i am 62, had disk protrusion in l4l5 area si issue too. avoided running for nearly 2 years, never thought i would rid myself of this nagging pain. what seems to be working for me now and allowing gradual return to running (swim and bike were ok for most part) is egoscue method for body realignment; dry needling to break up all the trigger points in low back areas (extending laterally across the iliac crest).
first mri in 2006 showed considerable protrusion ( electric shock occurred quite frequently); went back for another in april because i still had pain axially in back area and even thought i was developing drop foot, which i thought meant the disk was being further herniated. to my surprise the mri showed the protrusion almost eliminated no stenosis, same osteophyte formations as 4 years ago. conclusion, doctor said it was much better, so he suggested dry needling for my back and knee tendinitis (had this for over 2 years as well).
bottom line the needling started in mid april and i cannot believe how much better my back and knees feel (tps in quads and calf). this coupled with daily egoscue routine since last march 1 and i am happy to report i am running again (up to 1.5 miles at 9 minute pace) and so far so good. the back is still pullling a tad but much better. In addition i do inversion daily (5-8 minutes) using teeters table.
i too love the run and while it may be too soon to tell, i think i may be back to doing triathlons in not too distant future (just can’t come to grips with aquabike).
simple test is to roll on lax ball or tennis ball and see if that helps muscles around spine (multifidis, ql, etc)…just don’t roll ball directly under spine.
I had a badly herniated disc about 5 years ago. Physio and some treatment helped me to get “better”, but I always had nagging problems and chronic pain. The problems would flare up when I was most active. Between the painkillers, antiinflamatories, nerve blockers and physio it was “manageable” but it still caused all sorts of problems in my life. When ramping up volume for my first IM in Lake Placid in '08 things became worse than ever. My left leg was pretty much paralyzed at one point, I was in loads of pain and had to take lots of time off work. Needless to say IMLP didn’t happen and I watched from the sidelines high on oxycotin and in a wheelchair.
BUT, some good did come out of it. A family member had me referred to a new doctor. He is an athlete and understands the importance of someone being able to lead the lifestyle they want, and in my case it included being quite active. He took a whole new approach with me opposed to my old doctor who simply overprescribed oxycotin and actually got me addicted.
This new doctor referred me to a back surgeon and before long I was on the operating table where I had L5/S1 fused. I was obviously nervous about the surgery, but it was the best thing I have ever done for myself. Recovery took a while - about 3 months before I could start easy training. I only had about 5 solid months of training to prepare, but just 9 months after my surgery I did IMLP 2009.
It is incredible to live pain free. People who have never had severe back pain just don’t get it. The best part for me is that I can now do the necessary work to keep my back and core healthy, whereas before my doctor said I just didn’t have the strength and ability to do the work because I was in so much pain.
I don’t know if surgery is for you or not, but I thought I’d share my story incase it help.
Very helpful, as were everyone’s personal stories. Between the MRI and the absence of radiating symptoms below the waist, I’m encouraged by the prospect of this being a negotiable problem without surgery, given the right combination of pain relief, PT, and balanced strength conditioning. I’m meeting with a pain management specialist and a new PT guy next week; I’ll be sure to update as conditions change.
Great to hear, Jason! I have been through much the same progression (including a microdiscectomy that afforded me relief for almost 2 years) and am scheduled for an S1/L5 fusion in two weeks. I actually found 3 spine doctors who agree that this is the right thing to do!
“…the importance of someone being able to lead the lifestyle they want, and in my case it included being quite active…”
**
This has been the biggest stumbling block, most docs seem to think that “well, you are over 50 and it’s probably just time to cut back” is an acceptable answer. This is my quality of life we are talking about! If, after the fusion, I am unable to resume doing what I love to do, well, then I will know that I did everything I could. But to simply give up without making every effort just is not the way I want to live.
Good luck with your surgery. How are they fusing your spine? They used coral for me… they grind up coral and pack it between the vertebrae, whcih then acts as a scaffold that the bone can grow on and eventually fuse. It is apparently a newer technique. The recovery is a little longer because you need to be very careful for a couple of months as the bone grows, but my surgeon thought that was the best approach and I’m happy with the outcome.
I also know someone who just had titanium rods insterted to do their fusion and he’s recovering very well. I suppose everyone’s situation is different.
My biggest piece of advice is to listen to the doctor an PT regarding your recovey. At times I felt like I could do more than they recommended, but by sticking to their plan I recovered relatively quickly with no problems or setbacks. If they say walk 20 minutes, do it but no more. I know that some of us have the kind of personalities where we feel we can push harder and though a little “discomfort”, but that’ll just create more problems for you. Be patient, take the time to recover properly, do the work to recover which can be hard at times, and then get ready to have (hopefully) a pain free back with unlimited activity. That was my case. I hope you have the same.
Oh, and if you have any questions or concerns about the surgery and want my perspective, feel free to PM.
The extension exercises(cobra position) someone was referring to earlier are part of McKenzie classification of LBP. Find a PT certified in MDT. MRI findings may or may not be present with pain.