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Old 12-21-2013, 03:59 PM   #1
Alden Hingle
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Sciatica and Degenerative Disk Disease

I apologize in advance for the long post but I hope to get an opinion about appropriate future activities from the medical professionals on the list.

About four months ago, I hurt my lower back during a high rep kettlebell workout. Very painful so I scheduled an appointment with an ortho and took a couple of weeks off. By the time of my appointment, my back no longer hurt and the doctor's guidance was "probably a torn annulus; resume normal activities as tolerated." Basically, if it doesn't hurt, it is ok.

Within about a month, I started having sciatica. The sciatica is worse on the left side but presents on both sides. The tingling goes all the way to the bottom of my foot on left side; right side is not as frequent nor as intense.

I went to see a different ortho since he has a great reputation and specializes in minimally invasive techniques. Figured if I end up needing surgery, I wanted the best and the quickest recovery. He ordered x-rays and an MRI.

The X-rays and MRI indicated degenerative disk disease at L4 and L5 and in the T6-T12 region, anterior-posterior stenosis in the L4-L5 region and bulging disks at L4 and L5; I also have "anterior wedging suggesting a old compression fracture at T12-L1." I am not having any issues from the DJD in the T6-T12 area or the anterior wedging at T12-L1. Those were discovered in an x-ray in 1988. The only issue I am having is the sciatica.

Based on the x-rays and MRI, the ortho said, "Your back is not in great shape. You should avoid squats and other exercises that put an axial load on your spine. You don't want to put any more wear and tear on those disks." He recommended that I cease doing squats, overhead presses, running, deadlifts, etc. The ortho referred me to a pain management clinic for injections to calm down the nerves. Those are scheduled for Monday. He indicated if the injections don't work, the next option is surgery to clean up the stenosis and to trim the bulging disk. He also gave me a consult for physical therapy.

The PT had similar recommendations as the doctor. He recommended no squats and no standing overhead presses. He thought deadlifts were ok as long as I went for higher reps and avoided heavy singles. He also suggested that I should stop trying to act like I am still 30.

Bottom line is I'd love to keep doing the strength training workouts and oly lifts but don't want to increase the chances of needing surgery or making my back worse. I've been doing core strength work (KB swings and Turkish get-ups); emphasizing the organized spine and good form. Given what the x-rays and MRI reflect, are my days of doing the four big lifts over? Are there exercises I just should not do any more? Are there exercises I should ensure that I do to protect the disks and delay or reduce further deterioration?

Thank you for your time.
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Old 12-26-2013, 10:56 AM   #2
Alden Hingle
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Re: Sciatica and Degenerative Disk Disease

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Originally Posted by Alden Hingle View Post
I apologize in advance for the long post but I hope to get an opinion about appropriate future activities from the medical professionals on the list.

About four months ago, I hurt my lower back during a high rep kettlebell workout. Very painful so I scheduled an appointment with an ortho and took a couple of weeks off. By the time of my appointment, my back no longer hurt and the doctor's guidance was "probably a torn annulus; resume normal activities as tolerated." Basically, if it doesn't hurt, it is ok.

Within about a month, I started having sciatica. The sciatica is worse on the left side but presents on both sides. The tingling goes all the way to the bottom of my foot on left side; right side is not as frequent nor as intense.

I went to see a different ortho since he has a great reputation and specializes in minimally invasive techniques. Figured if I end up needing surgery, I wanted the best and the quickest recovery. He ordered x-rays and an MRI.

The X-rays and MRI indicated degenerative disk disease at L4 and L5 and in the T6-T12 region, anterior-posterior stenosis in the L4-L5 region and bulging disks at L4 and L5; I also have "anterior wedging suggesting a old compression fracture at T12-L1." I am not having any issues from the DJD in the T6-T12 area or the anterior wedging at T12-L1. Those were discovered in an x-ray in 1988. The only issue I am having is the sciatica.

Based on the x-rays and MRI, the ortho said, "Your back is not in great shape. You should avoid squats and other exercises that put an axial load on your spine. You don't want to put any more wear and tear on those disks." He recommended that I cease doing squats, overhead presses, running, deadlifts, etc. The ortho referred me to a pain management clinic for injections to calm down the nerves. Those are scheduled for Monday. He indicated if the injections don't work, the next option is surgery to clean up the stenosis and to trim the bulging disk. He also gave me a consult for physical therapy.

The PT had similar recommendations as the doctor. He recommended no squats and no standing overhead presses. He thought deadlifts were ok as long as I went for higher reps and avoided heavy singles. He also suggested that I should stop trying to act like I am still 30.

Bottom line is I'd love to keep doing the strength training workouts and oly lifts but don't want to increase the chances of needing surgery or making my back worse. I've been doing core strength work (KB swings and Turkish get-ups); emphasizing the organized spine and good form. Given what the x-rays and MRI reflect, are my days of doing the four big lifts over? Are there exercises I just should not do any more? Are there exercises I should ensure that I do to protect the disks and delay or reduce further deterioration?

Thank you for your time.
Any feedback from the physical therapists or Orthopaedists on the forum?

Thanks
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Old 12-26-2013, 12:49 PM   #3
Sean McLeod
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Re: Sciatica and Degenerative Disk Disease

im no help to you but im in the same boat as you. i have the pain all the way down my right leg. the pain is unbearable in my calf. numbness in my foot. its been this way for about 2 weeks, the pain has gone down some though. i also was told i have degenerative disk. i can be fine for months then all of a sudden my sciatica will flare up bad, i guess its just something we will have to live with?
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Old 01-01-2014, 01:50 PM   #4
Ari Sherwood
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Re: Sciatica and Degenerative Disk Disease

How did the injections go? Injections have good success rate for radicular/leg pain/sciatica, not so much for back pain only. They certainly may buy you some time and let you get back in the gym, but given the current state of your discs, the reality is that you probably shouldn't continue to go heavy on squat, overhead press, etc. a lot and expect to maintain the disc height. Maybe 1X/week, but probably better to go higher rep and lower weight, maybe EMOM style.

Look into substituting more single leg work (lunges, pistols, split squats, etc.) with DB's and KB's in order to reduce the spinal loading. You can still maintain and develop good leg strength but take some of the axial loading levels down. KB's will also improve overall core strength and spinal stabilization.

Don't forget the mobility, especially thoracic, hip flexors, quads and glutes.

I've been going through my own journey with this stuff the last 6 months - DDD, L5-S1 spondy, radiculopathy. I have been scaling back on WOD's and loads, as well as limiting extension/hyperextension movements, and it all seems to help somewhat. Also just got an epidural yesterday and it seems to have helped calm the nerve down a lot.
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Old 01-02-2014, 07:28 PM   #5
Alden Hingle
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Re: Sciatica and Degenerative Disk Disease

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Originally Posted by Ari Sherwood View Post
How did the injections go? Injections have good success rate for radicular/leg pain/sciatica, not so much for back pain only. They certainly may buy you some time and let you get back in the gym, but given the current state of your discs, the reality is that you probably shouldn't continue to go heavy on squat, overhead press, etc. a lot and expect to maintain the disc height. Maybe 1X/week, but probably better to go higher rep and lower weight, maybe EMOM style.

Look into substituting more single leg work (lunges, pistols, split squats, etc.) with DB's and KB's in order to reduce the spinal loading. You can still maintain and develop good leg strength but take some of the axial loading levels down. KB's will also improve overall core strength and spinal stabilization.

Don't forget the mobility, especially thoracic, hip flexors, quads and glutes.

I've been going through my own journey with this stuff the last 6 months - DDD, L5-S1 spondy, radiculopathy. I have been scaling back on WOD's and loads, as well as limiting extension/hyperextension movements, and it all seems to help somewhat. Also just got an epidural yesterday and it seems to have helped calm the nerve down a lot.
Ari - All good advice. I already have decided that I will lighten up the loads and go for higher reps. No more heavy singles or even triples. I tried some split squats a couple weeks ago but am not sure I am doing them correctly. Can't seem to get my posterior chain engaged the same way as it is with a regular squat.

I was really excited because the injections initially helped a lot. The cramp in my hip was gone and the tingling in my calf and foot were significantly reduced. Unfortunately, the epidural seems to have "worn off" in the last day or so (9-10 days after the epidural) and now the sciatica is about the same as it was before. I am really disappointed because I followed the doctor's orders explicitly; no workouts/ no bending, lifting or twisting/ no hiking/ no stretching/ nothing but walking...

Here's wishing you have more lasting results from the injection!
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Old 01-03-2014, 08:48 AM   #6
Ari Sherwood
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Re: Sciatica and Degenerative Disk Disease

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Originally Posted by Alden Hingle View Post
Ari - All good advice. I already have decided that I will lighten up the loads and go for higher reps. No more heavy singles or even triples. I tried some split squats a couple weeks ago but am not sure I am doing them correctly. Can't seem to get my posterior chain engaged the same way as it is with a regular squat.

I was really excited because the injections initially helped a lot. The cramp in my hip was gone and the tingling in my calf and foot were significantly reduced. Unfortunately, the epidural seems to have "worn off" in the last day or so (9-10 days after the epidural) and now the sciatica is about the same as it was before. I am really disappointed because I followed the doctor's orders explicitly; no workouts/ no bending, lifting or twisting/ no hiking/ no stretching/ nothing but walking...

Here's wishing you have more lasting results from the injection!
Oh, bummer. I was hoping to hear more encouraging news on your injection. I have had significant relief over the last few days, but I can feel a bit of the tingling coming back. Keeping my fingers crossed, and sorry you're going through this too.
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Old 01-03-2014, 02:43 PM   #7
Michael V. Erickson
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Re: Sciatica and Degenerative Disk Disease

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Originally Posted by Ari Sherwood View Post
Oh, bummer. I was hoping to hear more encouraging news on your injection. I have had significant relief over the last few days, but I can feel a bit of the tingling coming back. Keeping my fingers crossed, and sorry you're going through this too.
I got the injections four and a half years ago after months of radiating pain due to a disk bulge at L3-4. A day or so after the injection I got busy with Bill Starr's "Rehabilitating the Lower Back" protocol and I've been pretty much okay since. I'm now doing Pavel's S&S kettlebell GPP protocol with no pain. If I do nothing and sit around I get radiating pain, I do the exercises and I'm good. I like Bill Starr's high rep extremely light good mornings and halting dl's, gets the blood circulating and loosens up the area where the nerves get impinged I'm imagining. Sort of like neural flossing. Works for me. I also like the McGill back stuff, and the MacKenzie press-ups but I think Bill Starr's article did the trick for me. I'm 65, not lifting anything heavy. Swings mostly with 16Kg and 20Kg kettlebells, occasionally swing the Hungarian core blaster I made for 5 or 6 reps (about 70 lbs). The most I deadlift is 200 lbs. It's comfortable but that's where I hurt myself so I'm not excited about going down that road again.
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Old 01-04-2014, 03:18 PM   #8
Ari Sherwood
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Re: Sciatica and Degenerative Disk Disease

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Originally Posted by Michael V. Erickson View Post
I got the injections four and a half years ago after months of radiating pain due to a disk bulge at L3-4. A day or so after the injection I got busy with Bill Starr's "Rehabilitating the Lower Back" protocol and I've been pretty much okay since. I'm now doing Pavel's S&S kettlebell GPP protocol with no pain. If I do nothing and sit around I get radiating pain, I do the exercises and I'm good. I like Bill Starr's high rep extremely light good mornings and halting dl's, gets the blood circulating and loosens up the area where the nerves get impinged I'm imagining. Sort of like neural flossing. Works for me. I also like the McGill back stuff, and the MacKenzie press-ups but I think Bill Starr's article did the trick for me. I'm 65, not lifting anything heavy. Swings mostly with 16Kg and 20Kg kettlebells, occasionally swing the Hungarian core blaster I made for 5 or 6 reps (about 70 lbs). The most I deadlift is 200 lbs. It's comfortable but that's where I hurt myself so I'm not excited about going down that road again.
Thanks Michael. I appreciate the suggestions. I love the McGill stuff, and have actually spoken to him a couple of times. In my case, due to the L5-S1 spondy + DDD, extension/hyperextension movements (as in the Mackenzie press-ups, KB swings to some extent, oly lifts, etc.) are no dice for me. Extension closes down the foraminal space and impinges the nerve root and brings on the sciatic pain. But I definitely can see the benefit of the Bill Starr rehab protocol and have done it in the past before the spondy started acting up. I will look into the Pavel S&S routine to see if it's something I could tolerate.
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Old 01-05-2014, 05:53 PM   #9
Alden Hingle
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Re: Sciatica and Degenerative Disk Disease

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In my case, due to the L5-S1 spondy + DDD, extension/hyperextension movements (as in the Mackenzie press-ups, KB swings to some extent, oly lifts, etc.) are no dice for me. Extension closes down the foraminal space and impinges the nerve root and brings on the sciatic pain.
Same for me. The Mackenzie press-ups were great at making the buzzing in my foot and calf worse. When the buzzing is bad and I am trying to get to sleep, I sleep with a pillow under my stomach. The flexion gives the nerve a little more room and eases the sciatica.
KB swings don't seem to be a problem as long as I focus hard on keeping an organized spine, hinging at the hips and keeping the flexion and extension to a minimum.
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Old 01-06-2014, 09:07 AM   #10
Ari Sherwood
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Re: Sciatica and Degenerative Disk Disease

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Same for me. The Mackenzie press-ups were great at making the buzzing in my foot and calf worse. When the buzzing is bad and I am trying to get to sleep, I sleep with a pillow under my stomach. The flexion gives the nerve a little more room and eases the sciatica.
KB swings don't seem to be a problem as long as I focus hard on keeping an organized spine, hinging at the hips and keeping the flexion and extension to a minimum.
Yeah, I tried doing press-ups for a few weeks before getting my diagnosis and I was wondering why I wasn't getting any better!

Check out this article on KB swings: http://ragewellness.com/2013/12/shou...-conditioning/ {WFS}

It seems there is some shear and compression force generated on swings, especially at L4 on L5 (posterior shear). McGill actually studied KB swings in 2012 and raised some doubt as to whether they are a good idea for an unfortunate minority of us.
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