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View Full Version : Bulging Discs at L4/L5 and L5/S1


Ben Wenger
08-31-2010, 08:34 AM
For the past two months I've had pain and extreme tightness in my low back and right leg. The pain is worst upon first sitting and first standing. The tightness is pretty much constant. My issues seem to have started a couple of weeks after pulling a PR deadlift. My form got a bit sloppy, but I didn't think it was anything all that terrible. Lo and behold, a couple of weeks later I started having issues.

At first it was just a little bit of tightness in my right low back, glute, piriformis, hamstring, and IT band. Now, about two months later, the pain and tightness is pretty much constant and upon standing, after sitting for any period of time, I have a shooting pain down my right leg that takes my breath away and I can't initially walk or put any weight on the leg. After about 15 seconds the pain subsides a bit and I can begin to take a few baby steps and then move as normal.

I've seen my family doctor, chiropractor, and a physical therapist. After no one seemed to be able to figure out what the injury was I decided it was time for an MRI. The MRI showed that I have two bulging discs, one at L4/L5 and the other at L5/S1. The bulges are pressing on my nerves and seem to be causing all of the pain and tightness. I'm currently scheduled for an epidural steroid injection at each site. I'm told the injections will help decrease the inflammation and kind of flush out the area, hopefully resulting in pain relief.

Throughout this injury I have avoided taking ibuprofen and any type of anti-inflammatory (based on previously reading Kelly Starrett's blog post "Get Off The Ibuprofen Peoples!"). I've iced and upped my dosage of fish oil.

The PT and chiro have instructed me to avoid any type of exercise that puts strain on the low back or loads the spine. They have said to not run or row and no olympic lifts, deadlifts, or squats. I'm thinking that I'll lay off of all that for a few months and try and let the discs heal, but I need to do something. I'm thinking of swimming or cycling and limiting my lifting to bench, pullups, pushups, dips, and anything else I can think of that limits low back strain and loading of the spine. Any suggestions as to what I can do and what to avoid?

Anyone have experience with this type of injury? Thoughts on rehab? I've seen some recommendation for Robin McKenzie's work in this area. Anyone have experience with that?

Thanks

Justin Z. Smith
08-31-2010, 10:55 AM
The PT and chiro have instructed me to avoid any type of exercise that puts strain on the low back or loads the spine. They have said to not run or row and no olympic lifts, deadlifts, or squats. I'm thinking that I'll lay off of all that for a few months and try and let the discs heal, but I need to do something.


You should read a book titled 'How to Eliminate Training Angst', learn to play chess, bake goodies, paint pictures, follow doctors' advice.

Justin

Brian Strump
08-31-2010, 11:31 AM
The actually MRI findings would be most helpful. More people than not will have bulging discs on MRI. We've got plenty as patients and members that are doing deadlifts, squats, etc.
I wouldn't recommend them to you just yet, but the actually findings would be helpful.
Post them if you can, and you could get some more informative replies.
As for the cortisone, it's a crapshoot, may help, may not.
But I will tell you whats the easiest ways NOT to strengthen your lower back------> avoiding squats and deadlifts.

Ken Cook
08-31-2010, 01:36 PM
Ben,

Well I wish I knew what I know now back when I had my L5, S1 disc problems back in 1998. 2 surgeries later and I am doing pretty good but wish I had looked for other alternitives to surgery since I sill have the nerve pain in my leg from time to time.

The injections have worked for me, hopefully they work for you also. Hope you start feeling better soon. I would avoid surgery at all costs it caused me more problems than it helped with for about 7 years.

Carey Wheeler
08-31-2010, 03:58 PM
Tough break! I, like 90% of the population, have had back trouble but fortunately no disc prolapses.

The mechanism of this injury is typically years of postural lumbar flexion (while sitting, lifting etc) with weakening of the outer fibres of the annulus fibrosis (AF) (the tough part of the disc around the nucleus pulposus (NP)) due to occasional injury (i.e do you have a history of actute, recurrent back pain?).

What is theorised to happen over this time is that the weakening of the AF allows the NP to be forced backward towards the spinal cord. The activating event, the incident where the disc actually prolapses, usually involves lifting with a flexed lumbar spine and possibly some rotation. In a true 1rm deadlift there is almost always plenty of lumbar flexion and, more often than not, some twisting as the weight is inched up past the knees. This twisting can be caused by a low dominant shoulder (i.e right handed people usually have a lower right shoulder) or slight pelvic, quad/ham, and back strength imbalances.

If you have found that leaning forward and standing up etc are your most painful activities (classic disc prolapse symptoms) it is because as you lean forward and load the front of those bulged discs, they are pushing the prolapsed region onto your spinal cord.

The focus of your rehab during this acute stage should be to encourage lumbar extension and open up the front of the disc. This theoretically will create a vacuum pressure within the disc and should act to draw the NP back into the centre of the disc (if flexion has forced it backward, extension should draw it inward).

Test: Standing, attempt to touch your toes. Pain? How much? how far down your leg does it go?
If you lay on your stomach and just rest there for a minute or so you will hopefully only be experiencing minimal to no symptoms. The next step is to then prop yourself up onto your elbows, take a breath and then return to the flat position 10 times.
Retest: Stand, attempt to touch your toes. Does your pain change? Is your pain the same, better, or worse? Does it not travel as far down your leg? If worse, stop immediately. If the same or better, try propping yourself right up onto your hands into a full back bend, take a breath and return to the prone position. Repeat 9 more times. If this is painful, return to just the elbow position for now.
Retest again: Same, better or worse?

If better, repeat this every 2 hours (without the test,retest) and monitor how your symptoms change (hopefully improve). Avoid lumbar flexion at all costs! This is the standard protocol for the management of a lumbar disc prolapse.

NB: to help you avoid lumbar flexion when standing up, first position your feet in a split stance (like a small split jerk), lean forward as you would for a deadlift (maintaining lumbar extension/neutral spine), place your hands on your knees and then stand without slumping. I assume putting shoes and socks on is a horrible experience for you? To help with this plan ahead. Put your shoes and socks next to you on a stool, then lift the foot you're dressing onto the other knee (glute stretch position) and dress yourself with a straight back.

Hope this helps!!!! Remember, if the extension exercises are painful and increase your symptoms stop immediately. I, myslef am a physical therapist and definitely recommend seeing a McKenzie practitioner, but this should tide you over till you get there.

Good luck!

Ben Wenger
08-31-2010, 05:22 PM
Thanks for the replies so far. I ordered McKenzie's "7 Steps to a Pain-Free Life" today.
Test: Standing, attempt to touch your toes. Pain? How much? how far down your leg does it go?
If you lay on your stomach and just rest there for a minute or so you will hopefully only be experiencing minimal to no symptoms. The next step is to then prop yourself up onto your elbows, take a breath and then return to the flat position 10 times.
Retest: Stand, attempt to touch your toes. Does your pain change? Is your pain the same, better, or worse? Does it not travel as far down your leg? If worse, stop immediately. If the same or better, try propping yourself right up onto your hands into a full back bend, take a breath and return to the prone position. Repeat 9 more times. If this is painful, return to just the elbow position for now.
Retest again: Same, better or worse?
When completing the above I was first able to reach about my mid-shin when attempting to touch my toes. The pain I was experiencing was extreme tightness in my right bicep femoris. After the 10 elbow press-ups, I was able to reach my toes, with equal tightness in the bicep femoris. After the 10 full press-ups I was again able to touch my toes with equal tightness in the same area. Casey, I know you suggested repeating the elbow press-ups and full press-ups every two hours, but if I'm able to do the press-ups more frequently (say every hour or even half hour), would that be more beneficial?

Also I went through the CD with my MRI results. The attached Word doc is the best shot I could find on my scan.

Some further info about me: my job basically involves sitting behind a desk all day. This is what seems to be causing me the greatest amount of pain. My job involves conducting interviews which typically last about 30-45 minutes, during which I remain seated. After each interview I usually have about 5-10 minutes where I can get up a stretch a bit. Any suggestions on what I can do at work to try and keep lose? (can't really be laying on the floor doing press-ups)

Thanks again.

Brian Strump
08-31-2010, 07:28 PM
Not best quality, and can't measure those, but they certainly look like more than "disc bulges", especially at L4-5 and L5-S1. Axial views would help to make better determination, but those bottom two discs look like rather large herniations, not bulges.
The McKenze protocol may help, but I would try for some professional help(DC/PT) as well. The cortisone will probably helps, but if you want to avoid surgery, it'll be best to start rehabbing now. I'd recommend following up with the DC/PT in addition to the cortisone now, and use the book you ordered as a reference. With a good practitioner, you should heal much more effectively than by yourself with a book.

Rich Wilson
09-01-2010, 06:40 AM
I am so sorry you are having so much trouble.

I have a similar, yet much more minor problem. My L5 disc bulges a bit as a result of a poorly performed squat 2 years ago at a Globo-gym. I just started CrossFit because I have a few friends who had minor back pain that went away with the strength training.

Experts watching this thread, as a newbie, what is the best way to avoid this injury if there is already a minor history of pain in the back that sometimes goes into the legs? Just lighten up on the weight? Take it easier than those around me in the CrossFit gym?

Carey Wheeler
09-02-2010, 03:33 PM
I know you suggested repeating the elbow press-ups and full press-ups every two hours, but if I'm able to do the press-ups more frequently (say every hour or even half hour), would that be more beneficial?

Often, with things like this, more isn't always better. Too many extension movements beyond neutral can potentially aggravate some of the inflammation that is present and even cause some facet irritation.

While on inflammation, cortisone and anti-inflammatory meds not only inhibit the production of inflammatory mediators, they also inhibit the production of anti-inflammatory mediators which facilitate the healing process. The enzyme pathway that is used for the production of these mediators is the same and that is what is inhibited. Unless you are horribly uncomfortable and non-functional I would try and avoid them.

Some further info about me: my job basically involves sitting behind a desk all day. This is what seems to be causing me the greatest amount of pain. My job involves conducting interviews which typically last about 30-45 minutes, during which I remain seated. After each interview I usually have about 5-10 minutes where I can get up a stretch a bit. Any suggestions on what I can do at work to try and keep lose?

This is really difficult with desk/office based work but you really need to avoid lumbar flattening/flexion and especially flattening/flexion with rotation at all costs. When seated you need to roll your pelvis forward and lift your sternum to get you spine back into neutral.

A neutral spine will cause neutral NP deformity where as a flexed Lx spine will keep pushing the NP's towards your L4/5 and L5/S1 spinal nerves. If you are neutral more than you are flexed then when you do your extension drills you are really doing some good work to reverse the compression of your nerves.

Given that you saw positive changes pre and post we can reason that these movements are beneficial for you. But, you still need to get in and see a licensed practitioner...I would put money of the fact that you have some pelvic misalignment and a host of other issues that will be perpetuating your condition.

Just be aware that if any therapy you get involves putting you into lumbar flexion with rotation (the typical side lying lumbar stretch/mobilisation/manipulation) you should run for the hills!!

Thanks for posting the MRI pic by the way!