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-   -   A Somewhat specific Herniated Disk Question (https://board.crossfit.com/showthread.php?t=15406)

Josh Briggs 02-02-2007 11:20 AM

I have a severely herniated L5/S1 disk, as well as mildly & moderately protruding L4/5 and L3/4 disks. Clinical findings correlate well with the MRI results, and I have had an epidural cortisone nerve root block at the S1 level, which has allowed me to return to a moderate level of activity (ie. swimming & walking).

I've got a referal to a neurosurgeon clinic in 2 weeks (a rather unique setting where one is initially seen and triaged by a physio), and everyone who has looked at me so far (2 physios, and 1 general surgeon who works with prolotherapy in backs) has had the reaction... "you need to see that neurosurgeon."

All of that, attempting to illustrate that I am neither faking, nor whining.

So far, in concurance with the physios advice, activity has been:

Swimming (.5 - 1 hr / day)
Walking (1 - 3 hrs / day)

Things I have been told to avoid are:

Anything that increases intra-abdominal pressure... so variations on planking, and general ab-stabilization work that I was doing to start with got taken out.

Anything with extra load... so that eliminates anything with a weight on my back.

I've generally been given the go-ahead for BW squat & 1 leg squat variations, which I have been doing with a ball against the wall, to prevent ANY forward flexion.

Streching I am working with cautiously, as I notice a large flexibility assymetry from L to R sides, primarily in Glute and Hamstring, and as the ability of my pelvis to rotate forward, and absorb motion / load (ie. hamstring flexibility) is a causative factor in my case, I dont' want to exacerbate this aspect of the problem by allowing the muscles to tighten further. I relize the nerve irritation danger of stretching in this area, though, so have been trying to be cautious about that.

So, any thoughts on anything else I can do to promote muscle firing, flexibility, and strenght on my L side, as well as ativities I can use to prevent other areas from atrophy'ing... WITHOUT compromising the nerve healing?

I've experimented a little with standing stationary biking (I can't sit), and pullups and dips, all with a concentration on keeping the core relaxed, but it's hard to say whether they have been helpful or harmful, given the delayed feed-back nature of the injury.

I know some have sung the praises of light swings, which I haven't tried... as they seemed a little aggressive at this point.

PS. As an aside, I would strongly recommend (at least for those in the Canadian medical system) anyone in a similar situation to buck up the $800 for the MRI... granted, most of the assymptomatic population has bulging disks too, but for those who know their bodies pretty well, and "know" that something is seriously amiss, and positive correlation between MRI results and symptoms makes things happen alot quicker, as it shows the medical profession that you aren't simply whining.

Elliot Royce 02-02-2007 11:40 AM

Josh:

sorry to hear about the disks. I have a pretty bad herniation at C5/6 and another one at C6/7. You are right to continue your activity as best as you can. I always point people to Dr. John Sarno's book, Healing Back Pain, which seems to have helped a lot of people including myself. He emphasizes the need for activity of the right kind. I'm not qualified enough to advise you on specific exercises.

However, I would say that my impression is that you are focusing too much on staying in shape, etc. rather than on trying to cure the problem without surgery. 4 hours a day of exercise seems a bit much. Have you tried ART, accupuncture, massage, and other modalities?

Over time I found that I could manage the level of pain by managing how much activity I did. At this point, you're in the acute phase so you can't calibrate. But I would try backing off a little on the extra work and focus on the swimming and walking for a few weeks.

You really don't want to have to have surgery if you can avoid it. So the key is getting this acute pain down as quickly as possible. I had two epidurals and they made it possible to deal with things.

Hope this helps. There are previous discussions if you search on treating back pain.

Josh Briggs 02-02-2007 12:00 PM

Thank you Elliot,

He. Ok, nice to hear some more reinforcement for taking it easy. On one level, I know this... it's just hard to do.

To clarify the other points:

I've read Sarno's book, as well as the Mackensie stuff, Egosue book, the Kalindra stuff on SI disfunction, and a bunch of medical journal reports on sugical techniques, successes, failures, causative factors... etc.

I've tried, ART, massage, rolfing, acupunture, chiro, crainial sacralsupplements, homeopathic remedies, energy healing, and physio exercises. All provide temporary relief but nothing lasting.

I've read everything I could find on the boards related to back pain (I actually have no pain in my back, it's all glute and lower), disks, herniations, and bulges.

Regarding surgery, while it seems that most people here are rather against it, my understanding of the discectomy is that it is actually extremely effective (88% return to pre-injury level of proformance in a study of disectomys done of 60 olympic and professional atheletes. Avg. re-hab time: 5months). The problem is in choosing the appropriate surgical candidates and in relizing that even with the surgery, the real healing and future prevention is done through the re-hab training.

What the surgery DOES seem to be able to do is prevent incessant re-injury in people with severely compromised spinal canal... as long as they put the time in after.

Elliot Royce 02-02-2007 12:40 PM

So you would get a discectomy rather than a fusion? That makes a big difference from what I understand. Nothing wrong with a surgery if the alternative is pain. I know how disabilitating that incessant pain can be - it drains you of enthusiasm and fun -- and would certainly have gone for an operation if the pain hadn't largely gone away over time.

The research I've seen relating to the success rate is for fusions and that shows no difference between those who did the operation and those who waited. Of course anything in aggregate is going to blur the individual outcomes. I wanted to have a discectomy but the surgeon said it would not cure the problem as the degree of herniation was too great.

It sounds like you've had this for a while. If there is still meaningful pain after the epidural and if it gets worse when that wears off, then all the exercise in the world is not going to help.

Did you do a nerve test to see how much interference your muscles are getting? My left side is still getting interference even if I don't experience much pain -- my doctor says that if I ever stop exercising, my left arm will atrophy. At present, the bicep is about 0.5" smaller than the right.


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