Bulging disc and sciatica

[Ered_Lithui]

Reading through the threads, back problems seem to be sadly common here.

The back story (no pun intended): I woke up one morning in mid-March with numbness in my left leg. After six weeks of constant weakness and mild pain, plus lower back pain, a lumbar MRI showed a lateral disc bulge at L5-S1 crushing the nerve root.

I'm finally starting physical therapy for overall lower back pain, but the neurosurgeon I saw thinks that a microdiscectomy is probably the only solution left for the leg pain. To his credit, at our first meeting three months ago he was inclined to wait it out and try less invasive treatments (oral and epidural steroids, which failed). It's been five months with virtually no exercise; even standing up and bending over cause shooting pains.

Even if the sciatica is resolved, my back is a mess, with multiple levels of degeneration, disc bulges and stenosis. I'm only 25; no one has a clue what happened here. I've been told I probably shouldn't run, which is a real disappointment, and that everything else will be gradual and tentative. Lower back pain anecdotes abound, of course, and most of them seem to end with "I just have to live with the pain and limit my activity." Every time I hear this sort of resignation, my heart sinks a little.

Where are the people who've been through this, still have horrible backs and yet remain super-active? This board seems like the right place to find them. I'm hoping some of you can help me out, either with suggestions for what to do next or just encouragement. I know life goes on... but it doesn't always feel like it will these days.

Okay, done whining. Help me, TE; you're my only hope.

[KnottedYet]

"McKenzie" (mechanical diagnosis and therapy) certified or diplomate physical therapist.

They will be able to tell you within 3 visits if physical therapy will help your particular issues. They will not just throw random exercises at you.

http://www.mckenziemdt.org/

[jessmarimba]

I have no words of wisdom or help for you...but this board has been nothing but encouraging for me (check out the Aaargh broken back thread). There are a few responses of people who have returned to activity from awful injuries and it helped me a lot. I'm one month into a 6-month hiatus from exercise due to a broken back, and while they have implied that biking and running will be "frowned upon" I don't think I can quit that easily. At least not without something equally fun to replace it! So I'll definitely be supporting you and hoping to learn from you as you sort this all out. And while I support the position of surgery as a last-ditch effort...it's not the end of everything.

Please keep us updated!

[malkin]

*waving hand in air*

1. Listen to Knot, she knows everything.

2. I had an L5 S1 herniation. I don't know any technical terms for the severity of how these things go, but after poo-pooing my complaints for months, when my ex- took a look at my images, he said, " OH MY GOD.."

I saw a doc who thought I might be a good candidate for non-surgical treatment. He encouraged me to work hard in PT by saying, "There are men with knives pounding at the door trying to get to you!"

PT was awful. The whole thing was awful. I had just turned 40 and felt like the warranty had just run out. It took a long, long time. Six months, then twelve months went by, and I'd pick up a milk jug (or a 6 pack) and set myself back, and I couldn't steer a grocery cart without hurting myself, and lots of stuff like that. but the days went by one at a time, and now it is over 10 years and it's good. And I didn't have surgery.

I believe nerve pain to be especially stressful emotionally. Don't be surprised if you feel crazy.

[Ered_Lithui]

Thank you so much for your responses! Jess -- I can't imagine going through a broken back! (And being told not to bike! Fortunately the doc says biking will be fine for me once the leg pain's gone.) I know I'm lucky in the scheme of things.

And thank you, Knot! I just checked, and the PT who read my MRI (and thinks PT could fix the leg pain) is listed on the McKenzie web site -- unfortunately, she lives 100 miles away, and the one I've been referred to is a DPT but isn't McKenzie-certified. I don't know if my insurance would cover visits to a non-referred PT close by. At the very least, I'll see what my PT recommends and try to check with the other one to see if it sounds reasonable.

Malkin, I'm so glad to hear you're doing well now.

2. when my ex- took a look at my images, he said, " OH MY GOD.."

Hah! Yep. I had started to wonder if I was imagining things, and then the MRI came back. I felt vindicated, which helped...a bit.

I had just turned 40 and felt like the warranty had just run out.

And this really resonates with me. I'm really curious -- were you able to ride in the interim? What's killing me right now is that I can't swim, play tennis, bike, or run -- even *walking* up or down slight inclines hurts -- and the lack of exercise has me pretty depressed. It's hard to hear my boyfriend mention his latest casual 80-miler knowing that it's more mileage than I've gotten in six months.

(And also because I'm lusting after a new road bike. You know.)

[KnottedYet]

I just checked, and the PT who read my MRI (and thinks PT could fix the leg pain) is listed on the McKenzie web site -- unfortunately, she lives 100 miles away, and the one I've been referred to is a DPT but isn't McKenzie-certified.

Can you call the McKenzie PT who read your MRI and thinks PT is viable, and ask her if she can recommend someone near you? McKenzie Certs and DIPs are *months* of further study after graduating PT school.

Someone who hasn't done the advanced study isn't going to have a clue. Having them treat you and asking the McKenzie PT to check their work isn't feasible for a couple reasons: For one, the general PT doesn't know MDT in the first place. For two, asking a non-treating PT to check the work of the treating PT is ethically and legally a complete and total no-no!

[berkeley]

Herniated disc here. We should start a club.

In addition to McKenzie, also check out the work of Stuart McGill.

http://www.backfitpro.com/

In the end, you have to find something that works for you - everyone is so entirely different when it comes to this. I know people who have done the discectomy will great results, I know some who ended up back in surgery again a few years later.

I've been religiously doing the McKenzie exercises without only short term relief (but at least some relief) but so far no change day in and day out. I just had a cortisone epidural - I'm one of the lucky ones that gets some real relief from that, so I'm hoping it works this time around again.

It does curtail biking at least in the short term - the flexion on the spine is really not what you need right now.

I'm at my year anniversary in dealing with this, so I know how frustrating it is. And whoever said you'll start to feel crazy is totally right. Chronic pain is mentally defeating.

[KnottedYet]

Herniated disc here. We should start a club.

It does curtail biking at least in the short term - the flexion on the spine is really not what you need right now.

Flexion is only bad if someone has a posterior disc bulge, and only 60% of back pain is caused by posterior disc bulges.

There is no such thing as "McKenzie exercises" because there is no one single "McKenzie" approach to joint derangement.

One person's corrective motion is another person's re-derangement motion.

Berkeley - if you've been doing something for months with no lasting results, then it is the wrong thing. Whoever gave you those "McKenzie exercises" either didn't know what they were doing, or hasn't heard from you how they are working and been able to modify them to get you the correct motion to push your unique and particular bulge back into place. (I'm assuming you are doing the motion 10 times every 2 hours, avoiding your deranging direction, correcting your posture, engaging your core at all times, and have not progressed)

People aren't cookie-cutter xerox copies of each other, and neither are painful backs, and neither are corrective motions.

[Ered_Lithui]

For two, asking a non-treating PT to check the work of the treating PT is ethically and legally a complete and total no-no!

Duly noted! I'll see if she can recommend someone here.

And Berkeley--a year! Augh! I'm so sorry.

[berkeley]

Flexion is only bad if someone has a posterior disc bulge, and only 60% of back pain is caused by posterior disc bulges.

There is no such thing as "McKenzie exercises" because there is no one single "McKenzie" approach to joint derangement.

One person's corrective motion is another person's re-derangement motion.

Berkeley - if you've been doing something for months with no lasting results, then it is the wrong thing. Whoever gave you those "McKenzie exercises" either didn't know what they were doing, or hasn't heard from you how they are working and been able to modify them to get you the correct motion to push your unique and particular bulge back into place. (I'm assuming you are doing the motion 10 times every 2 hours, avoiding your deranging direction, correcting your posture, engaging your core at all times, and have not progressed)

People aren't cookie-cutter xerox copies of each other, and neither are painful backs, and neither are corrective motions.

I absolutely agree - which is why I said following the McKenzie method has not helped me - it is quite possible that it won't work for all who experience back pain. And the people I've seen have been instrumental in getting me from being completely unable to do anything to at least functional - so I do trust that they know what the're doing. I loved my PT - it's a teaching facility at the local university and I've seen them several times for other issues.

If she has nerve root impingement, I still don't think riding a bike is a good idea. She did say it was lateral and impinging a nerve root to me would mean biking riding would be difficult until she can get it worked out. Not to mention, flexion itself can be very hard on the back - bulging disc or not. Just my two cents there. YMMV.

I have a ruptured/herniated disc - there is no "pushing it back in". Perhaps this is true in the case where the disc is "just" bulging. Following good body mechanics will make it not continue to ooze the good stuff out of the disc, and critical in order to stop the degeneration.

As an aside, probably the most frustrating thing for me in dealing with this has been when people think it's just a matter of doing X and then everything will be all better - if only it was that easy. Eight months of physical therapy, seeing multiple people in the practice (one who is McKenzie certified), and every other alternative method short of surgery.... I'm much better, but not anywhere near 100%. It is a hard thing to deal with, mentally.

I do appreciate the insight everyone has given me over the year, but just because yoga/inversion table/acupunture/this exercise/that exercise/surgery helped someone, doesn't mean that it will help everyone. It's a very difficult thing in all of this - knowing what advice to follow, what to do, who to listen to, etc..... even beyond the should I have surgery or not? big question, there are a lot of little questions that bog you down.

[KnottedYet]

A herniation (which is a bulge) can be pushed back into place.

A rupture (torn annulus) cannot. A rupture with fragmentation is a surgical candidate. A rupture with leakage is painful as all heck because the disc goo is caustic. Those leaking discs are obvious to the clinician, and they also respond mechanically. If you move one way, it leaks more. If you move another way, the tear is pinched shut and the leak stops.

Folks with tears don't have much fun because they have to spend about 3 days pretty much in one position (the one that pinches the tear shut). It's not a matter of just repeating a motion over and over agan, it's more like holding a cut shut and waiting for it to clot. They have to take 3 days off work and have help at home for 3 days.

Flexion is not inherently bad. McKenzie MDT uses flexion all the time. Some bulges require some flexion to go back into place. (anteriors and often laterals) Some posterior bulges with lateral components get WORSE with any extension. There are no blanket rules because every herniation is unique and the forces every person's body experience are unique.

After the derangement is resolved for a week, the back needs to return to full range of motion in both flexion and extension every day or the repair will never remodel into something tough and elastic, and will likely bust loose again. Flexion is important, and not inherently evil.

Berkeley, I'm sorry you've had such a rough time. Is it possible for you to go back to PT and see only one therapist for continuity of care? I would (of course) recommend you see the cert. MDT. Did the cert. get to see you often enough that they could tell if you had a responding direction? Did you try the 3 days in the responding position? Of course, if it's already been 8 months you've only got about 4 more before it spontaneously resolves anyway. (ruptures have a natural history of about a year)

Ered - I'm sorry to have hijacked your thread. When I was talking about flexion not necessarily being a bad thing I was NOT suggesting you leap onto your bike and go for a ride, I was only talking about the direction of spinal motion and its effect on disc pressures. I was also not suggesting you bend over and do potato-pickers...

[malkin]

... were you able to ride in the interim?...

I wasn't cycling at the time, but I could barely sit, so cycling wouldn't likely have been comfortable.

In PT they had me walk on a treadmill, in a harness to partially unweight me. The harness was designed for a person about 3 times my weight, so they had to pad me up with pillows for it to get a hold of me.

I also walked in the pool, which was funny because the ancient arthritis patients could zoom along and I couldn't figure out even how to do it. After pool walking, they'd have me hang out in the deep end of the pool with weights on my ankles and a life jacket for flotation. That felt great--except for when there was too much weight or not enough flotation and I'd sink.

I can laugh about this now. Even at the time, sinking in the PT pool was kind of funny.

Hang in there.

[jessmarimba]

I've heard so much great stuff about pool walking that I'm asking today if I can try.

Ered - I know how you feel about so much time not exercising. It's absolutely frustrating! I just bought a wii to keep myself busy - I'll play ya in wii tennis (or something I'm equally bad at) if you want company

[badger]

Yikes, sorry to hear of your problems at such a young age!!

sorry to hijack, but Knot, would you say that McKenzie would help someone like me with a twist in C1 by 7 degrees? I get a slew of problems due to it, namely migraines, and things are made worse by the fact I have mild scoliosis that makes my right hip higher than my left. I've done PT before and nothing's really come of it so I've resorted to chiropractic, which has helped, but I'm afraid I'm dependent on adjustments and want to be a bit more proactive in helping myself rather than going to him when my headaches get bad. Lately I'm getting numbness down my hip/thigh as well...

There are a couple of McKenzie certified clinics near me. I don't want to waste their time or mine if it's something they're not specified to do. Thanks in advance!!

[KnottedYet]

Yikes, sorry to hear of your problems at such a young age!!

sorry to hijack, but Knot, would you say that McKenzie would help someone like me with a twist in C1 by 7 degrees? I get a slew of problems due to it, namely migraines, and things are made worse by the fact I have mild scoliosis that makes my right hip higher than my left. I've done PT before and nothing's really come of it so I've resorted to chiropractic, which has helped, but I'm afraid I'm dependent on adjustments and want to be a bit more proactive in helping myself rather than going to him when my headaches get bad. Lately I'm getting numbness down my hip/thigh as well...

There are a couple of McKenzie certified clinics near me. I don't want to waste their time or mine if it's something they're not specified to do. Thanks in advance!!

MDT is all about getting your own movements to correct your body. (doing your own chiropractic, as it were) The body has a wealth of corrective motions and is constantly correcting itself without you being aware of it. MDT gets you to do some focused repetitive concious movements to correct a particularly sticky bit. They are the same motions your body would normally use anyway, just with more oomph.

An MDT therapist will know within 3 visits if self-management is going to work or not, so don't fear you will waste anyone's time. (and yes, you can be taught to correct your own rotations)