Herniated Disc

Triathlon Forum
1

Years ago (maybe 8 or 10) I injured my lower back at work. The PA at the company clinic diagnosed it as a pulled muscle and sent me away with with some sort of anti inflammatory to recover. A year or so later, same injury, same PA, same treatment. In the following years I’ve had the same injury once or twice each year and treated myself with OTC drugs and rest. Each time I’d recover in about a week. Last Friday I had another episode and followed my typical treatment. Just when I started getting better, I had the worst pain I’ve ever had on Monday. Bad enough to know it had to be more than just a pulled muscle. So I finally went to the doc after all these years. After maybe five minutes on the table, he diagnosed me with a herniated disc. Says I’ve got the classic symptoms. I had an MRI Thursday and will know the results Monday. All involved (Orthopedic Dr., Chiropractor, Physical Therapist) are very optimistic that my treatment will not involve surgery. And they’re supportive of my active lifestyle and want me to continue when I recover. But I’ll probably be dealing with the prevention and treatment of this condition for the rest of my life.

So, are any of you guys and gals training with this injury? What do you do to protect yourself? Any advice would be appreciated.

2

Ouch!

I’ve had this condition 4/5 times in the past. My doc initially told me I had to stay in bed for a couple of weeks. After seeing a physio - I was told that staying in bed was the worst thing I could do. Disc manipulation and movement is the key to recovery for this ‘type’ of injury.

The ‘gel’ contained within the disc seeps out and can touch the nerves in the spinal cord, typical symptoms can be sciatica - where you get shooting pains down the back of your legs.

I was told NOT to sit, do plenty of walking in short spruts, take showers and not baths…and avoid sitting as much as possible. I also rolled up a towel into a ‘tube’ shape and used it as a support in bed to try and keep the spine in a neutral position. I also used a bag of frozen veg wrapped in a thin towel as ice treatment every 3/4 hours to aid recovery.

I had deep disc massage approx 4/5 times and after a couple of weeks things were pretty much back to normal.

I have had recurrences since but the early warning signs are lower back ache, when I get this I become very wary of my stature and make sure I do not sit for prolonged times.

3

I had the same problem except mine became so severe that surgery was necessary (Cue Simpson’s Comic Book store owner voice:…worse…pain…ever). I didn’t have any lasting effects from the surgery but I did herniate a different disk about 4 years later. This time it wasn’t as bad and I didn’t need surgery. I try to be very careful with my back now and avoid heavy lifting, etc.

It won’t keep you from being active though, (I’ve done two IMs since and am doing IMCDA in June) so don’t let it discourage you too badly.

4

The best preventive treatment for HD is complete recovery/minimal activity with specific therapy/activity that will prevent the herniation.

Trying to be active while doing therapy for a HD is always counterproductive.

How long therapy may take is very relative… it can be months to years. Basically, the idea of training and expecting to solve a HD problem is a bad one… the best and faster route toward recovery involves solving the HD problem first. Then, start training to re-gain any lost fitness. Trying to maintain fitness and solving a HD is very problematic and can result in HD therapy being ineffective (if not a waste of time).

The idea of training with an injury (specially with regard to the spine/back) is oxymoronic. This process does NOT improve fitness, but typically results in loss of fitness because of constant injury aggravation. To think otherwise is only wishful thinking and signs of compulsive behaviour that results in a more serious setback from injury.

I think the biggest challenge will come from disciplined treatment WITH the disciplined ability to not re-injure the HD with training. At this point, complete rest and therapy are the routes to better fitness… not, working out while have an HD.

Good Luck… Joe “been there, done that and still doing that” Moya

5

I am a triathlete because of a herniated disc, I started swimming because running and biking caused the pain to become unbearable, I had to do something so I hit the pool. About 4 years ago I had what the doctor said was a severly herniated disc, he said I would have to have surgery, I really didn’t want anybody cutting on me so I started looking into the surgery and found that almost 50% of the time the surgery makes you worse, also if the disc is removed and the vert fused, the disc on either side have to take the extra force that the missing disc previously took, there is a big chance that you will suffer a second or third herniated disc.

I could not sleep for more than 2 hours at a time, I would spend the night walking laps around the house until the pain subsided enough to go back to sleep for another 2 hours, this went on for almost 3 months, I could not sit for any length of time, the pain would just kill me, but I am living proof that you can rehab a bad disc.

There are lots of different levels of herniated disc, I believe that I read 45% of adult males have some sort of degenerative back problem.

If your disc is ruptured and there is a piece in the canal pushing on the nerve, you will need surgery to remove the piece.

For two years I could not bike or run, I tried every 6 months to get on the bike, but always suffered the next day, I honestly thought that I would never be able to do any biking, forget about Ironman, this was one of the life long goals I had and it looked like that one was never going to happen, I am happy to tell you that next month I will be competing in the Florida Half and next year I will be doing an IM somewhere, I have not had any pain at all in over a year.

I did two races last year one sprint and one oly and I took second in my age in both, I have also run 2 marathons in the 3:20 area in the last year, you can continue to race and train, but you will have to heal your disc first, I can promise you that you will not enjoy the pain I had to endure, don’t allow the disc to herniate any more than it already is.

The key is strengthen your abbs ( the lower back is supported by the abbs )and swim, flip turns seem to have been the thing that helped most, you compress and release the disc over and over and it seems to help, I always felt better after a swim. I am not a Doctor, I am just telling you what I went through and how I fixed it. If you are carrying some extra weight, lose it, your back does not need the stress.

Ring.

6

—>> Recovering from a herniated disk since mid- January. 3 or 4 previous instances over past 5 yrs of back pain, muscle strain etc., I guess indications my back was poorly taken care of.

I had horrible sciatic pain (lying on the floor crying and unable to move without awful pain) from the bulge in the disk pressing on my nerve root, finally had 2 lumbar / steroid injections to reduce swelling and pain. Now feels decent, not great but I can go to Phys Therapy and do a bit of slow riding and some swimming. Have not run a step since January 19, might try a brisk walk on treadmill this week. No racing for me for at least 4-5 months- I was completely inactive for all of Feb and half or March.

I also have treatment with a <DRX 9000> machine at the PT - it’s a device that pulls gently on my spine to open spaces between vertabrae and let my disk back where it belongs. Seemsto help.

I do an hour of core stuff 3-4 times a week, hoping to go to half hour 3-4 times and a bit more training by end of May.

MRI will tell you how bad your is - just recover and keep your lower and back strong and flexible. I have consumed a few hundred ibuprofen since JAn also, don’t like that but it sure relieves the pain.

7

Thanks for the feedback.

It’s encouraging to see that some of you have had worse sounding conditions than mine and have been able to recover and continued to compete.

I hope the MRI will reveal that I’ll be able to continue training soon. I’ve only been away from training for a little over a week and I’m going a little stir crazy.

8

If you have a disc problem, the first thing you have to realize is that this is NOT like any other soft tisse injury ie a little R & R and physio and you are good to go in 2 - 3 weeks. You may have a permanant condition/problem that will be with you for the rest of your life. That’s the bad news. The good news is that you can get “better”, but it’s going to take time AND you may have to shelve permanantly or at least for an extended period of time some activities that cause you pain/problems.

It’s a very complicated area of the body. What works/helps some causes more pain for others. Some have the same type of disc herniation and suffer no pain what so ever and so on. You need to find a rehab program that works for you, focus on it, look long term( read: a year minimum) and then get to work on it.

Best wishes.

Fleck

9

“… I’ll be able to continue training soon. I’ve only been away from training for a little over a week and I’m going a little stir crazy.”

I predict this will be your biggest hurdle to overcome… and, the HD is but a corollary problem to your inability to rest, recover and concentrate your efforts toward solving your potentially serious and permanent disk injury issue.

Matching expectations to reality are very difficult concepts to apply when it comes to injury and recovery. Optimism is good provided it is tempered by the facts.

FWIW Joe Moya

10

The best preventive treatment for HD is complete recovery/minimal activity with specific therapy/activity that will prevent the herniation.

Trying to be active while doing therapy for a HD is always counterproductive. I have to respectfully disagree with this statement. COMPLETE rest is not the recommended treatment for herniated disks. Patients should always be encouraged to remain as active as possible but within specific guidelines. If it is confirmed that you have a herniated disk, you will want to avoid high-impact activities, such as running and also activities that put your lumbar spine into a flexed position, ie cycling especially in the aero position. But to say that you should do no exercise at all, I think is too extreme of an attitude. I do agree with Joe M that if you do have a herniated disk the activity you engage in shouldn’t be considered “training”, but simply exercise. Studies have shown that the most effective treatment for long term success with back pain (that’s all types of back pain) is regular exercise. This has been shown to be more beneficial than spinal manipulation, physical therapy modalities such as ultrasound, electrical stimulation and traction as well as medication and surgery. You’re going to have to be smart about this, listen to your doctors and therapists. Just keep in mind that there is a light at the end of the tunnel, but unfortunately noone can tell you how long that tunnel is.
Best of luck.

11

LT. Dan - Good points… but, we are on the same page…

I just didn’t do a good job of explaining complete/minimal activity… this doesn’t mean no activity. And, yes… the activity as to be not counter-productive.

Unfortunately, some athletes misconstrue what “activity” means.

My opinion is that it is better to err on the side of less activity rather than test the limits of activity.

I think the issue revolves around “specific guideline”… I prefer guidlines that are more based on inactivity rather than activity. When I post suggestions on the internet, I always try to err on the side of “safest” and “surest” direction.

You actually didn’t disagree with me… I just didn’t explain myself fully… and, that is because I don’t have the particulars.

Joe Moya

12

Johnsonpt1,

I have had several peole with herniated discs in my deepwater running classes. They are sent here by their PTs. It is a non-impact way to train, strengthen abs and increase range of motion in the lower back.

Check with your doctor about rehabing in the water. If it is a go I can give you some workouts to do on your own.

DougStern

13

I’d love to see the workouts for pool running, I am just about to try it this week.

Very worried (esp since indoor pool) it will be more boring than peeling potatoes.

14

I take care of tons of spine/disc patients, and do a fair amount of spine surgery for disc herniation. Watch out: there’s a lot of information - and misinformation - out there.

First, discectomy is typically recommended only for those with leg pain/ sciatica. We have virtually no evidence that discectomy will help to relieve back pain.

Second, you can treat disc herniation nonoperatively and it will improve. The piece of herniated disc is attacked by macrophages/immune system and “eaten up” over time. The piece of disc in the spinal canal can literally disappear. Corollary: there is a subset of people who never get all better, and they usually need an operation eventually.

Third, if you take a group with acute discs herniations and operate on half, while not operating on the other half, their clinical results at five years and at ten years are essentially identical.

Next: be as active as you can be without making yourself worse. And focus on core strength to 1.) relieve the pain you have, and 2.) prevent recurrence.

And lastly, the best analogy of “nucleus pulposis to annulus fibrosis” is “toothpaste to tube.” No amount of manipulating the tube is going to suck or pull the toothpaste back in. It doesn’t work that way. Don’t waste your time pursuing this, no matter how many primary care docs, therapists or chiropractors tell you to.

Good luck - hope this helps. Send me a message if you have questions. And remember: free medical advice is worth exactly what you paid for it.

15

SP,

I love peeling potatoes.

Get some other people interested in water workouts and do it to music if you are able to.

We run with very long levers meaning you do NOT deliberately bend your knees when you run in the water.

Do a series of intervals of 45 sec. on and 15 sec. off. The speed with which you move determines the workout.

Check my website at www.dougstern.com for form instructions and sample worlouts.

Stay focused on the task at hand and start to feel how it works.

DougStern

16

Thanks for the feedback.

It’s encouraging to see that some of you have had worse sounding conditions than mine and have been able to recover and continued to compete.

I hope the MRI will reveal that I’ll be able to continue training soon. I’ve only been away from training for a little over a week and I’m going a little stir crazy.

I injured my low back lifting weights (deadlifts) a few years back.

  1. Don’t put too much faith in the MRI. It’s impossible to tell whether a bulging disk was there BEFORE your injury, and possibly not the cause of your current pain.

  2. Be patient. It took at least 4 months for me to walk around 100% normally. And then I’ve had 4 episodes of sudden stabbing pain (triggered once when just walking!) that was nearly as crippling. Each took about a week to feel better enough to want to walk (riding was OK by day 3 or so). Note that I differ from those above, and found sitting to be infinitely better than standing. Standing is the painful stuff for me.

17

Received the MRI results back this morning. The results confirmed I have a slight herniated disc.

The treatment plan is physical therapy/DRX9000 therapy and electro therapy 3 times per week for 6-7 weeks and continue chiropratic adjustments weekly. They’ll be giving me additional exercises to do on my own also…core stuff I’m sure. They also suggested I start with a glucosamine sulfate supplement.

One crucial point I failed to mention earlier is that the orthopedic doc is a triathlete. I didn’t know this until I was in his office and started talking to him. It was a huge relief for me to have someone who knew where I was coming from.

As far as activities, they said I could start swimming and biking right away, but no running for at least six weeks. Other than a race I HAD coming up in a couple of weeks, I don’t have any more races scheduled until August.

I may just have to write the rest of this year off as really easy base training as far as running, when I’m able to get back to it. Swimming is my weakest area, so this will give me a reason to spend more time in the pool. And I could could always use more time on the bike. Optimism is the key…right!!!

18

Interesting, I have never heard of the DRX9000, looks very similar to the VAX-D units that I have heard of only through patients and the internet. Both of these look similar to traction, although they will say they are not the same. At any rate, best of luck with your injury.

As Aztec stated, don’t get too caught up in you MRI and the herniated disk. It may or may not be the cause of your pain. Continue to listen to your doc, therapist and chiropractor. Man, you must have good insurance.

I’ll go back to what I said earlier, if your doc does think it is your disk that is causing your pain, I would not spend a lot of time in the aerobars. Sit up enjoy the scenery and the big base you are building.

19

DRX is analagous to those other “modern” traction machines like VAX-D. Allegedly it applies the “pull” to a specific place in the spine (in my case the L4-L5) bu raising or lowering the attachment point. They claim it’s different than “old style” traction which just pulled.

I have peeled many many potatoes (in an earlier career I was a banquet chef in a huge hotel). but will try the pool workouts.

SP

20

And lastly, the best analogy of “nucleus pulposis to annulus fibrosis” is “toothpaste to tube.”

Actually, I prefer to use the jelly doughnut analogy where annulus fibrosis is crust and nucleus pulposis is the jelly filling. But then most of my patients seem to be more familiar with jelly doughnuts than they are with toothpaste.

As another spine surgeon, I second what el guapo writes. Good luck. I have several patients who have returned to triathlons and running after both conservative treatment and surgery. The key is not to get discouraged or rush things too fast.