Disk injury

[Elizabeth Terris]

Joe was deadlifting 285 pounds on 1/28/2008 when he felt a pop in his lumbar spine at about L4-L5. He felt immediate numbness/electrical sensation into his bilateral buttocks. He immediately stopped lifting. On 2/1/2008 he went to see a neuro -spine specialist who said that he was neurologically intact and that he likely ruptured L4-L5. Conservative treatment was recommended - antiinflammatories, antispasmodics and pain meds.

Two weeks later, Joe is no better. He cannot ride in or drive a car. He can tough it out for 10 minutes, then he gets out and walks and has pain for a few hours after any car ride.

The pain is now mostly on the right side. It is primarily in the leg and radiates down into the ankle. He says that it feels like someone hit him in the back of the legs with a 4x4.

He got some stretches from a PT but really wants to continue crossfitting in some capacity. He has been doing his prescribed stretches along with pull-ups, ring dips and push-ups.

Comments? Suggestions?

Thanks so much.

Elizabeth

[Howard Wilcox]

It sounds like an MRI or CTscan is in order.

Also, there's this book (w/f/s):
http://www.amazon.com/Treat-Your-Bac...2918827&sr=8-1


If is a disk issue, that might be something to check out. You can also google for Robin McKenzie and see the sequence of exercises/stretches to do and see what happens. If you live in an area with a Relax the Back store, they often sell that book.

Good luck,

howard

[Elizabeth Terris]

I also think an MRI is likely a good idea, however, my question is will it change the treatment plan? I don't think it will since surgical intervention is always the last resort. So won't the treatment be the same? Exercise, stretch, medications?

[Howard Wilcox]

Well, McKenzie primarily advocates extension if it is a disk issue...so it is important to know. He goes through an explanation of why "touching your toes" type stuff is bad (particularly in the beginning). Through the extension exercises, the pain often centralizes (he was the first to document this apparently). When I had a back issue, the lack of this centralizing phenomenon led me to believe it wasn't a disk issue (later confirmed with an MRI).

So, there will be stretching, but you don't want to do it in the wrong direction...


howard

[Lenora Galitz-Pfeffer]

I do the McKenzie exercizes for L-4 and L-5 from physical therapy. My physical therapist also applied other techniques to facilitate healing. She used galvanic ultra sound, electro-stimulation, massage, and some muscle energy work to move my pelvis correctly. Definately get as complete a diagnosis as you can. MRI usually gives plenty of info. You want to know exactly what is going on with the disk(s).

[Corey Duvall]

MRI is only needed if Joe has a problem holding his bowel/bladder. This would signify impingement on the cord and is a surgical consult. Other than that, and MRI would do nothing to change the protocol.

The following advice is hinged upon the diagnosis of an L4/L5 disc rupture. Provided this is correct, the my advice is below but should not be taken over the advice of paid professionals.

To know what to do next, you must understand how Joe hurt himself. The discs of the spine are meant to absorb compression along a neutral position (standing with good posture). Flexion of the spine (forward bending) decreases both the discs ability to absorb compression and the muscles ability to stabilize. Improper deadlifting flexes the spine, then loads the discs with a great deal of force and BANG, you damage the disc. Had Joe been properly deadlifting, he would have bent from the hips, the back would have remained in a rigid straight posture and the disc would have absorbed the compression successfully. As a result, this was not the case and now he has damage.

The damage means the inside of the disc has problem been squeezed out. This is considered a foreign substance to the body and it has sent the repair vehicles to fix it. This is known as inflammation. The inflammation also signals the nervous system that there is damage and this is recieved in the brain as pain; this is a protective mechanism to limit Joe from doing even greater damage. The fact that he has now reduced many of the symptoms to one side is a good thing. It means he is reducing the amount of inflammation and the tissues are healing.

What should he do now? The first thing he should do is buy "Starting Strength" by Mark Rippetoe and learn the proper lifting mechanics. Ironically, these mechanics are also the way we were meant to move in real life. If he wants to continue crossfitting, learning how to move properly is IMPERITIVE. During his down time, a little reading will do him some good. The mackenzie extension protocol would also be a good bet. Find a GOOD PT or chiro who utilizes it and see them. Take the pain medication as is necessary to sleep (sleep is NECESSARY for healing).

When Joe is pain free and ready to begin training again, he should get a training partner to learn the lifts with, utilize digital coaching on this site, and do things PROPERLY this time.

Good luck, Joe.

[Dan Hollingsworth]

Elizabeth,

As others here have stated, the MRI is only necessary if surgery is indicated. Sounds like Joe is getting along, albeit uncomfortably, but getting along, so he should not be considering surgery at this point. There plenty of good studies that show that those who have surgery are no more satisfied one year out than those who went with conservative treatment (PT, meds as needed).

Not sure who Joe is seeing for PT, but I know someone in the San Diego area who I think is very good. If you PM me I'll give you his contact info.

The McKenzie is one approach to treating Joe's issue. It's a good approach, but not a be all end all. It's key to see someone who is well versed in many approaches so they know where to turn when the current approach isn't working.

[Elizabeth Terris]

Originally Posted by Corey Duvall

The first thing he should do is buy "Starting Strength" by Mark Rippetoe and learn the proper lifting mechanics. Ironically, these mechanics are also the way we were meant to move in real life. If he wants to continue crossfitting, learning how to move properly is IMPERITIVE.

Ironically Joe has been reading Mark Rippetoe's "Starting Strength". The day he got injured there was a lot going on in the gym, a film crew was there and everyone was distracted. Joe wasn't going for a PR he was just trying to sneak in a couple of lifts when the film crew wasn't filming.

[Erin Davidson]

frightening thread...

[Elizabeth Terris]

Originally Posted by Dan Hollingsworth

Elizabeth,
As others here have stated, the MRI is only necessary if surgery is indicated.

Would an MRI assist a physical therapist treat the disk?
Does anyone have any thoughts on Epidural Steroid Injections to decrease inflammation?