Losing fight with a car

Triathlon Forum
1

So, I’ve been working through this for a few months and figured I might as well ask ST to share some of its collective knowledge on the subject.

Background:
About three months ago, I was hit by a car while cycling. Fortunately, I was going uphill and the driver accelerated through a stop sign into me (I did not have a stop sign), so speeds we low. I went up onto the hood of the car, and when the driver stopped, I was thrown onto the ground. I have since had my bike’s fork and my helmet replaced and the driver’s insurance company has claimed fault for the accident. I’m 25 years old.

Unfortunately, I’ve been dealing with back issues for most of those three months.

Treatment:
Following the accident, I had an x-ray to rule out rib fractures. None were found.
Back pain (lower right side, between L3 and S1) continued and I began seeing a physical therapist about 2 weeks later. I went to therapy 1-2 times per week for about 8 weeks. Initial responses were good, and the muscles in the affected area began to loosen up and feel better, except for one area which, whenever the therapist did trigger point techniques, would send me through the roof with pain. I still have this reaction to that spot but improvement of the area as a whole seems to have stagnated over the past several weeks.

A couple of weeks ago I saw an orthapaedist on the recommendation of the therapist (largely to rule out fracture of a transverse process). I had an MRI which, apparently, didn’t show much (besides no obvious fractures) and the orthapaedist said the likely culprit is a L4/L5, L5/S1 facet joint sprain. He put me on an anti-inflammatory and said if it doesn’t do anything in 2-4 weeks, that it probably wasn’t going to help. So far, I don’t really notice a difference with the medicine (it’s been about 2.5 weeks). Orthapaedist says the next step is steriod injection, but that I may continue my current training load, which I reduced from about 10-15 hours per week to 5-8 hours per week following the accident. I can make do, but the situation is far from ideal.

The physical therapist believes I may have an adherent nerve root at L3 due to some of my symptoms (area of pain, point sensitivity, occasional tingling in right side of quadricep when pressure is put on the spot, level of discomfort while exercising).

Personally, I would like to avoid a steriod injection unless absolutely necessary, especially since I get the feeling that the orthopaedist mostly wants to use it primarily for either confirming or ruling-out the sprain. The physical therapy route for either injury is different and more time consuming and since I don’t really know the cause, I’m pretty confused on what to do.

So my question(s) is (are): have any of you had similar injuries or symptoms? Was there anything in particular that keyed you one way or another? What were your treatment options and how did you proceed?

Any help is much appreciated!

2

If you are not sure about the diagnosis or if you feel unsatisfied, seek a second opinion from another specialist. I was not always heavily set on seeking second opinions, but last year I was in a bad bike accident as well. I’ll give you just one example from my multiple injuries. Broken shoulder, diagnosed in one emergency room. I was subsequently sent to another trauma unit and a second set of doctors told me that I would definitely require surgery to fix. I was uncomfortable with the explanation of why I needed the surgery and didn’t understand the nature of the break. I subsequently went to a shoulder orthopedic specialist who took x rays at different angles and even though he had never seen a fracture like mine in nearly 15 years as a specialist, he said it would likely heal stronger and quicker without surgery than if I had surgery. In the end, I opted to not have surgery and feel much better about the choice. You have options. Although my injury was a bone injury and yours sounds like maybe nerve(s) related, you should get all of the information you need to be fully informed and comfortable. Also, it will take time, so be patient. I think we, as athletes expect to heal up nearly immediately and get back to normal training and life, but a little patience now can forgo a lot of frustration down the road. Good luck.

3

document everything. maybe keep a log/journal.

4

Personally, I would like to avoid a steriod injection unless absolutely necessary, especially since I get the feeling that the orthopaedist mostly wants to use it primarily for either confirming or ruling-out the sprain. The physical therapy route for either injury is different and more time consuming and since I don’t really know the cause, I’m pretty confused on what to do.

But the injection might tell you WHAT it is, and then the PT would be more helpful. I don’t understand your objection to the injection.

Whatever happens, I hope you’re pain free soon.

5

I’ve done a little bit of research and the consensus seems to be that the steroid injections have a tendency to decrease the useful life of connective tissue and damages muscle. (There is probably more to this than I know but I’m not sure the cost/benefit is in the injection’s favor). They also have to give the injection under x-ray since the joints are deep and very small. Personally I’d prefer to avoid having needles anywhere near my spinal cord unless I’m sure it’ll help.

6

Personally, I would like to avoid a steriod injection unless absolutely necessary, especially since I get the feeling that the orthopaedist mostly wants to use it primarily for either confirming or ruling-out the sprain. The physical therapy route for either injury is different and more time consuming and since I don’t really know the cause, I’m pretty confused on what to do.

But the injection might tell you WHAT it is, and then the PT would be more helpful. I don’t understand your objection to the injection.

Whatever happens, I hope you’re pain free soon.

I had a steroid injection in my shoulder that was primarily a diagnosis tool. By having that, it helped determine what should be done next. I was very happy with my treatment and prognosis. I elected to not have surgery. I will get it done, but not yet. I have reduced what I do with my shoulder and that has helped a LOT and my latest prognosis has gone from operation in 2-5 years to 5-10 years. I wanna do a couple more IM before I take the year off for surgery and recovery. MY swimming has suffered but I can still smash out a 1:04 time for 3800m so not toooo bad.

For sure, get a second opinion, but then do listen to the experts. If possible, try to get a specialist who’s active/sporting/triathlete ifyou can. It won’t guarantee a good result but it might help.

Good luck

7

I’ve done a little bit of research and the consensus seems to be that the steroid injections have a tendency to decrease the useful life of connective tissue and damages muscle. (There is probably more to this than I know but I’m not sure the cost/benefit is in the injection’s favor). They also have to give the injection under x-ray since the joints are deep and very small. Personally I’d prefer to avoid having needles anywhere near my spinal cord unless I’m sure it’ll help.

You might look into this a little more. It’s true that steroid injections can ‘weaken tendons’ (that’s what I’ve been told) but that’s why doctors will only do, say, 3 in one particular spot (also what I’ve been told). It’s certainly a risk-benefit analysis.

I’ve had two cortisone injections in my right anterior hip for psoas tendonitis. The MRI to dx that was done with dye, which meant an x ray was used to inject the dye so they (a) got it in the right place and (b) didn’t nick my femoral artery :wink: The cortisone shots were done under ultrasound.

I’m not trying to convince you of anything, just trying to provide more information. I truly hope you figure out what’s going on. It’s no fun to be in pain and not be able to train as you’d like.

8

document everything. maybe keep a log/journal.

+1 Include pain, lost training/racing, missed work, etc.

Sadly, you may need this once the driver’s insurance company stops playing nice.

9

Thank you all for the insight and advice. I’ll definitely have my fingers crossed over the next few weeks.